Nearly eight per cent of Canadian adolescents – about 150,000 — will have major depressive disorder at some point in their lives. Depression can lead to suicide, the second leading cause of death in Canadian adolescents. Having depression between the ages of 14 and 16 has been found to predict anxiety, nicotine dependence, alcohol use disorder, suicide attempt, leaving secondary school before graduation, unemployment, and early parenthood from age 16 to 21. Although many evidence-based treatments for major depressive disorder exist, 40 per cent of young people do not respond to treatment. There are barriers to implementing evidence-based care that may contribute to sub-optimal response rates:

• Clinicians may lack knowledge about evidence-based care
• Care providers are not sufficiently engaged in the process of implementing evidence-based recommendations, which contributes to poor adherence
• A standardized approach that evaluates change in adolescent depression symptoms and informs treatment decisions at key points (a measurement-based framework) is under-used

The CARIBOU – Care for Adolescents who Receive Information ‘Bout Outcomes – project tackles these barriers and provides solutions that aim to enhance treatment for adolescents with major depressive disorder.


• CARIBOU is an Integrated Care Pathway for adolescents with depression based on the National Institute of Healthcare Excellence (NICE) clinical practice guidelines. A systematic review and quality appraisal conducted at the Cundill Centre for Child and Youth Depression found the NICE guidelines were of the highest quality.
• The CARIBOU pathway was developed collaboratively with care providers, who continue to be engaged throughout the implementation process.
• CARIBOU uses a measurement-based care framework. Changes in depression symptoms are measured every four weeks, and results are provided to the clinician, patient and family. This helps inform treatment decisions.
• Through CARIBOU, young people are guided through a detailed plan that includes family education, 16 sessions of group cognitive behavioural therapy and could include medication for those with more serious depression.


As a pilot study for a multi-centre, randomized controlled trial, CARIBOU is being compared to adolescent depression treatment as usual at Sunnybrook Health Sciences Centre. The team is considering a number of factors, including feasibility, recruitment, and tolerance of the intervention.

Through a treatment pathway that is based on high-quality clinical practice guidelines, engages care providers, and includes an optimized measurement-based care framework, it’s hoped young people with depression will receive the care they need to recover.


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