Among adolescents with depression seen in primary care, a collaborative care intervention that included patient and parent engagement and education resulted in greater improvement in depressive symptoms at 12 months than usual care, according to a study in the August 27 issue of JAMA.
Depressed youth are at greater risk of suicide, substance abuse, early pregnancy, low educational attainment, recurrent depression and poor long-term health. Fourteen percent of adolescents between the ages of 13-18 years have major depression yet few receive evidence-based treatments for their depression. The failure to accurately diagnose and treat adolescents and an inadequate supply of child mental health specialists have led to increasing focus on improving the quality of depression treatment in pediatric primary care, according to background information in the article.
Laura P. Richardson, M.D., M.P.H., of Seattle Children's Research Institute and the University of Washington School of Medicine, Seattle, and colleagues randomly assigned 101 adolescents (ages 13-17 years) at Group Health Cooperative who had screened positive for depression to a 12-month collaborative care intervention or usual care. The intervention included an education and engagement session, during which perspectives on symptoms were elicited, depression education was provided, and active treatment participation of adolescents and parents was encouraged. During the session, a depression care manager helped the youth and parent choose and initiate treatment with antidepressant medication, brief cognitive behavioral therapy, or both. The intervention youth then received ongoing follow-up with care provided in the primary care clinic. In the usual care group, youth received depression screening results and could access mental health services through Group Health.
Intervention youth (n = 50), compared with those who received usual care (n = 51), had greater decreases in depressive symptoms by 12 months. Sixty-eight percent of intervention youth had a 50 percent or greater reduction in depressive symptoms compared to 39 percent among control youth. The overall rate of depression remission at 12 months was 50.4 percent for intervention youth and 20.7 percent for control youth.
These findings suggest that mental health services for adolescents with depression can be effectively integrated into primary care, the authors conclude.
Gloria M. Reeves, M.D., of the University of Maryland School of Medicine, Baltimore, and Mark A. Riddle, M.D., of the Johns Hopkins University School of Medicine, Baltimore, comment on this study in an accompanying editorial. ' A Practical and Effective Primary Care Intervention for Treating Adolescent Depression.'
"Pediatric primary care clinicians have substantial potential to improve identification and treatment of adolescent depression. This study suggests that collaborative care treatment of adolescent depression can be structured to promote care that is evidencebased, personalized, and effective. Further research on this type of model has tremendous potential to benefit both families and clinicians."