Introduction: Depression is an important health problem in adolescence, and is associated with a significant functional deficit, reduced quality of life, and suicidal behaviour. Despite this, several studies have suggested a possible under-diagnosis of depression at these ages, whereby a considerable number of sufferers may not be diagnosed, and not receive any kind of professional help as a result. At present there is a certain degree of consensus at international level about the need to carry out depression screening tests with adolescents in primary healthcare, as recommended in the updated version of the Clinical Practice Guide on major depression in infancy and adolescence, from the guideline programme of the National Health Service. However, the difficulty of implementing this recommendation lies in the fact that it is necessary to coordinate this screening process in order to implement it in an effective way. The TIDY programme (Therapeutic Identification of Depression in Young People) was designed in the UK as a therapeutic identification procedure that combines screening for depression in adolescence with a short psychological intervention in primary care. The TIDY, associated with the training of primary healthcare doctors and nurses, has proven to be both viable and accepted in the UK. In Spain, a small pilot study has been carried out in Galicia, and there is clinical interest in exploring mechanisms that contribute to the early detection of depression in the field of primary healthcare.

Aims: the general aim of this report is to evaluate the viability and applicability of the TIDY Programme in the National Health System. The specific objectives are: 1) to review the scientific evidence on the effectiveness, safety, and viability of the TIDY programme, or alternative programmes for the therapeutic identification of depression in primary care; 2) to discover the main hurdles/enablers for implementing the programme from the perspective of the main stakeholders involved, 3) to explore the viability of implementing the programme in the national health system from an organisational perspective, and 4) to analyse the ethical-legal and social implications, as well as those associated with the perspective of patients on the implementation of the programm.

Methods: a mixed methodological strategy was used, combining a systematic review of the literature and a qualitative study. In the case of the systematic review, a bibliographic search was carried out in October 2017 of the following databases: CRD Databases, Cochrane Library (Wiley), Medline (PubMed), Embase (Ovid SP), ISI Web of Science, Scopus (SciVerse), PsycINFO (Ovid SP), ClinicalTrials.gov and ICTRP. Two independent reviewers selected the articles based on previously established inclusion/exclusion criteria, and evaluated the risk of bias in the studies. This information was compiled in the evidence tables, and a narrative summary was made of the information.  In order to identify the perspectives (hurdles, enablers, and perception of viability) of the main stakeholders involved, a qualitative study was carried out, combining semi-structured interviews and focus groups with investigators, clinics, managers, adolescents, and their families. A thematic analysis was made of the information, using the Atlas.ti software as a suppor

Results, discussion and conclusion: See pdf below