Laura P Richardson1, Evette Ludman2, Elizabeth McCauley3, Jeff Lindenbaum2, Cindy Larison4, Chuan Zhou1, Greg Clarke5, David Brent6, Wayne Katon7. 1. Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle. 2. Group Health Research Institute, Seattle, Washington. 3. Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle4Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. 4. Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle. 5. Kaiser Permanente Center for Health Research, Portland, Oregon. 6. University of Pittsburgh, Pittsburgh, Pennsylvania7Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania. 7. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.
Abstract
IMPORTANCE: Up to 20% of adolescents experience an episode of major depression by age 18 years yet few receive evidence-based treatments for their depression. OBJECTIVE: To determine whether a collaborative care intervention for adolescents with depression improves depressive outcomes compared with usual care. DESIGN: Randomized trial with blinded outcome assessment conducted between April 2010 and April 2013. SETTING:Nine primary care clinics in the Group Health system in Washington State. PARTICIPANTS: Adolescents (aged 13-17 years) who screened positive for depression (Patient Health Questionnaire 9-item [PHQ-9] score ≥10) on 2 occasions or who screened positive and met criteria for major depression, spoke English, and had telephone access were recruited. Exclusions included alcohol/drug misuse, suicidal plan or recent attempt, bipolar disorder, developmental delay, and seeing a psychiatrist. INTERVENTIONS: Twelve-month collaborative care intervention including an initial in-person engagement session and regular follow-up by master's-level clinicians. Usual care control youth received depression screening results and could access mental health services through Group Health. MAIN OUTCOMES AND MEASURES: The primary outcome was change in depressive symptoms on a modified version of the Child Depression Rating Scale-Revised (CDRS-R; score range, 14-94) from baseline to 12 months. Secondary outcomes included change in Columbia Impairment Scale score (CIS), depression response (≥50% decrease on the CDRS-R), and remission (PHQ-9 score <5). RESULTS:Intervention youth (n = 50), compared with those randomized to receive usual care (n = 51), had greater decreases in CDRS-R scores such that by 12 months intervention youth had a mean score of 27.5 (95% CI, 23.8-31.1) compared with 34.6 (95% CI, 30.6-38.6) in control youth (overall intervention effect: F2,747.3 = 7.24, P < .001). Both intervention and control youth experienced improvement on the CIS with no significant differences between groups. At 12 months, intervention youth were more likely than control youth to achieve depression response (67.6% vs 38.6%, OR = 3.3, 95% CI, 1.4-8.2; P = .009) and remission (50.4% vs 20.7%, OR = 3.9, 95% CI, 1.5-10.6; P = .007). CONCLUSIONS AND RELEVANCE: Among adolescents with depression seen in primary care, a collaborative care intervention resulted in greater improvement in depressive symptoms at 12 months than usual care. These findings suggest that mental health services for adolescents with depression can be integrated into primary care. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01140464.
RCT Entities:
IMPORTANCE: Up to 20% of adolescents experience an episode of major depression by age 18 years yet few receive evidence-based treatments for their depression. OBJECTIVE: To determine whether a collaborative care intervention for adolescents with depression improves depressive outcomes compared with usual care. DESIGN: Randomized trial with blinded outcome assessment conducted between April 2010 and April 2013. SETTING: Nine primary care clinics in the Group Health system in Washington State. PARTICIPANTS: Adolescents (aged 13-17 years) who screened positive for depression (Patient Health Questionnaire 9-item [PHQ-9] score ≥10) on 2 occasions or who screened positive and met criteria for major depression, spoke English, and had telephone access were recruited. Exclusions included alcohol/drug misuse, suicidal plan or recent attempt, bipolar disorder, developmental delay, and seeing a psychiatrist. INTERVENTIONS: Twelve-month collaborative care intervention including an initial in-person engagement session and regular follow-up by master's-level clinicians. Usual care control youth received depression screening results and could access mental health services through Group Health. MAIN OUTCOMES AND MEASURES: The primary outcome was change in depressive symptoms on a modified version of the ChildDepression Rating Scale-Revised (CDRS-R; score range, 14-94) from baseline to 12 months. Secondary outcomes included change in Columbia Impairment Scale score (CIS), depression response (≥50% decrease on the CDRS-R), and remission (PHQ-9 score <5). RESULTS: Intervention youth (n = 50), compared with those randomized to receive usual care (n = 51), had greater decreases in CDRS-R scores such that by 12 months intervention youth had a mean score of 27.5 (95% CI, 23.8-31.1) compared with 34.6 (95% CI, 30.6-38.6) in control youth (overall intervention effect: F2,747.3 = 7.24, P < .001). Both intervention and control youth experienced improvement on the CIS with no significant differences between groups. At 12 months, intervention youth were more likely than control youth to achieve depression response (67.6% vs 38.6%, OR = 3.3, 95% CI, 1.4-8.2; P = .009) and remission (50.4% vs 20.7%, OR = 3.9, 95% CI, 1.5-10.6; P = .007). CONCLUSIONS AND RELEVANCE: Among adolescents with depression seen in primary care, a collaborative care intervention resulted in greater improvement in depressive symptoms at 12 months than usual care. These findings suggest that mental health services for adolescents with depression can be integrated into primary care. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01140464.
Authors: Taryn L Mayes; Ira H Bernstein; Charlotte L Haley; Betsy D Kennard; Graham J Emslie Journal: J Child Adolesc Psychopharmacol Date: 2010-12 Impact factor: 2.576
Authors: C W Hughes; G J Emslie; M L Crismon; K D Wagner; B Birmaher; B Geller; S R Pliszka; N D Ryan; M Strober; M H Trivedi; M G Toprac; A Sedillo; M E Llana; M Lopez; A J Rush Journal: J Am Acad Child Adolesc Psychiatry Date: 1999-11 Impact factor: 8.829
Authors: B Birmaher; D A Brent; L Chiappetta; J Bridge; S Monga; M Baugher Journal: J Am Acad Child Adolesc Psychiatry Date: 1999-10 Impact factor: 8.829
Authors: John March; Susan Silva; Stephen Petrycki; John Curry; Karen Wells; John Fairbank; Barbara Burns; Marisa Domino; Steven McNulty; Benedetto Vitiello; Joanne Severe Journal: JAMA Date: 2004-08-18 Impact factor: 56.272
Authors: E Jane Costello; Jian-ping He; Nancy A Sampson; Ronald C Kessler; Kathleen Ries Merikangas Journal: Psychiatr Serv Date: 2014-03-01 Impact factor: 3.084
Authors: Wayne Katon; Joan Russo; Elizabeth H B Lin; Julie Schmittdiel; Paul Ciechanowski; Evette Ludman; Do Peterson; Bessie Young; Michael Von Korff Journal: Arch Gen Psychiatry Date: 2012-05
Authors: Andrea E Spencer; Cindy Chiang; Natalie Plasencia; Joseph Biederman; Ying Sun; Carolina Gebara; Michael Jellinek; J Michael Murphy; Bonnie T Zima Journal: J Health Care Poor Underserved Date: 2019
Authors: Azeesat Babajide; Ana Ortin; Chiaying Wei; Laura Mufson; Cristiane S Duarte Journal: J Behav Health Serv Res Date: 2020-04 Impact factor: 1.505
Authors: Reem M A Shafi; Paul A Nakonezny; Magdalena Romanowicz; Aiswarya L Nandakumar; Laura Suarez; Paul E Croarkin Journal: J Child Adolesc Psychopharmacol Date: 2019-06-24 Impact factor: 2.576
Authors: Carolyn A McCarty; Douglas Zatzick; Elizabeth Stein; Jin Wang; Robert Hilt; Frederick P Rivara Journal: Pediatrics Date: 2016-09-13 Impact factor: 7.124