A collaborative care intervention in a primary care setting was more effective than was usual care for the treatment of adolescents with depressive symptoms in the randomized, controlled Reaching Out to Adolescents in Distress study.
The findings support the integration of mental health services for adolescents into the primary care setting, noted Dr. Laura P. Richardson of the University of Washington, Seattle, and her colleagues. The report was published online Aug. 26 in JAMA.
The investigators recruited adolescents aged 13-17 from nine pediatric and family medicine clinics in Washington State. Seventy-two percent were female, and 31% were nonwhite.
After 12 months, 50 of the adolescents who screened positive for depression at baseline and who then received an initial in-person education and engagement session and regular follow-up by specially trained depression care managers had a significantly greater 9.4-point decrease in mean Child Depression Rating Scale–Revised scores than did 51 adolescents who received usual care (a decrease from 48.3 to 27.5 vs. from 46 to 34.6). Those in the intervention group also were more likely than were controls – who were screened for depression and encouraged to access depression care through their group health coverage – to achieve depression response (67.6% vs. 38.6%; odds ratio, 3.3) and remission (50.4% vs. 20.7%; OR, 3.9), the researchers noted (JAMA 2014 Aug. 26 [doi:10.1001/jama.2014.9259]).
Despite having good access to mental health services, few control group patients in this study received evidence-based psychotherapy or antidepressant medication, suggesting that screening alone is unlikely to result in increased mental health treatment even if benefits are available to cover the cost, the researchers wrote. "To increase receipt of evidence-based treatments, resources are needed to identify and engage youth," they added.
Dr. Richardson and her associates cited the relatively small sample size a study limitation. "In addition, the sample selection of English speakers who were mostly white and female from a single integrated care system in the Pacific Northwest may limit generalizability," they wrote.
The National Institute of Mental Health funded the study. Dr. Richardson disclosed ties with the Palo Alto Medical Foundation. Her coauthor, Elizabeth McCauley, Ph.D., reported ties with Do Education and the Washington State Psychological Association. Coauthor Dr. David Brent reported having received fees for continuing medical education events and royalties from Guilford Press, ERT, and UpToDate.