In 1978, Regier and colleagues pointed out the central role of primary care clinicians in caring for persons with mental disorders in the United States. Noting that the vast majority of persons with mental disorders, including adolescents, are only seen in primary care settings, they called for increased identification by primary care physicians. Primary care settings are especially important to adolescents since it may be the only health care contact youths have during a critical time period. 

Since the Regier article, there has been three decades of research on clinician identification and screening, consensus groups, guidelines, screening tool development, and improved residency training in behavioral pediatrics. Authors report findings from two different data sources on teen reported emotional assessments by primary care clinicians. First, they analyzed the California Health Insurance Survey for a random digit dial telephone sample asked to report on whether or not emotional symptoms were discussed with them by their primary care providers. Just less than one-third of the teens remembered any such discussion with their providers. This is the first study of screening for depression in adolescents in primary care to use a population sample. Next, they analyzed data from a similar set of questions administered to youth actually using primary care services in a large health system in the same state.