A new study from Seattle Children’s Research Institute suggests integrating mental health treatment into primary care may reduce depression symptoms in teens.
Challenges accessing treatment
While 14% of teens experience serious depression, few receive evidence-based treatments for mental illness. This puts them at greater risk of suicide, substance abuse, early pregnancy, low educational attainment, recurrent depression and poor long-term health.
Accessing mental health treatment can be challenging for patients and their families. In the typical clinic, teens diagnosed with depression by a primary care doctor are referred to mental health specialists for treatment, requiring their families to identify an available specialist, set up an appointment and travel to a new care setting. Dr. Laura Richardson, an adolescent medicine specialist at Seattle Children’s Hospital and principal investigator in the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, said she often sees patients who have not been able to connect with a mental health provider return to her with worse depression symptoms.
“Patients can get better,” Richardson said. “Research shows treatments like psychotherapy and antidepressants are effective in reducing depressive symptoms in teens, but patients often don’t receive these treatments, or they stop too soon.”
Reducing the burden on families
To improve outcomes for depressed adolescents, Richardson developed a primary care-based intervention for depressed teens and compared it to usual care in a study funded by the National Institute of Mental Health. The study, “Collaborative Care for Adolescents with Depression in Primary Care: A Randomized Clinical Trial,” was published in the Aug. 27 issue of the Journal of the American Medical Association (JAMA). Researchers randomly assigned 101 adolescents (ages 13-17 years) from Group Health Cooperative who had screened positive for depression to a 12-month collaborative care intervention or usual care.
Teens in the intervention group had a one-hour meeting with a care manager who discussed how depression might be impacting their lives and how different treatment options could help relieve serious symptoms. The care manager provided education on psychotherapy and antidepressant medications and worked with the teen and parent to help them choose their preferred treatment. Depending on their choice, the care manager would provide psychotherapy in the clinic and/or coordinate with the primary care physician to make sure that the patient received the antidepressant medication. The care manager followed up with all patients to see how they were responding to the treatment.
“This intervention provided important support for patients and families in order to get the ball rolling and reduce the burden of starting treatment,” Richardson said.
Intervention produces results
In the intervention group, 86% of teens received evidence-based treatment for their depression, compared to only 27% of control teens who were receiving usual care. After 12 months, the teens from the intervention group had a greater decrease in depression symptoms compared to those who received usual care. Sixty-seven percent of intervention youth had a 50% or greater reduction in depressive symptoms compared to 38.6% among control youth. The overall rate of depression remission at 12 months was 50.4% for intervention youth and 20.7% for control youth. Not only did the intervention patients have better outcomes, but they reported greater satisfaction with the care that they received.
The cost of the intervention model was $1,403 per participant. Richardson and her team plan to develop strategies to help primary care clinics and health care systems implement this model.
“Similar to what has been shown in adults, this study demonstrates that collaborative care works for depressed teens much better than the current system,” Richardson said. “Our goal is to help clinics find strategies to apply these results in a sustainable manner in order to improve outcomes for depressed teens.”
To learn more, check out the video about Richardson’s study below, produced by JAMA: