Science + Technology

Collaborative Care, Training Boosts Adolescent Depression Treatment and Outcomes in Primary Care Clinics, Research Team Reports in JAMA

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A model program featuring primary care physicians, nursesand mental health providers working collaboratively to bring best-practicedepression treatments into primary care clinics significantly improves healthoutcomes, quality of life and depression care for adolescents (age 13–21), aresearch team led by a UCLA investigator reports in the Jan 19 edition of theJournal of the American Medical Association.

After recent controversies about the safety andeffectiveness of adolescent depression treatments, the study results add toevidence that clinicians can effectively treat youth depression and offer anoptimistic view for those suffering from this common and disabling condition.

The study is the first to evaluate a "collaborative careprogram" for adolescent depression in primary care clinics. This team-basedapproach strengthened partnerships between primary and specialty care, trainedpractice clinicians in depression evaluation and treatment, and used nurses andtherapists in the clinics to provide depression care. To offer anevidence-based psychotherapy option, clinic therapists were trained incognitive-behavior therapy, a type of psychotherapy for depression. Familiesand patients chose with their clinicians among possible treatment options,including cognitive-behavior therapy and medication. Collaborative care programs are widely recommended for improvingmanagement of chronic medical illnesses but, until this study, had not beentested for adolescent depression.

Compared with adolescents who received standard treatment,patients in the model program were significantly less likely to report severedepression (31 percent vs. 42 percent), reported fewer depressive symptoms,improved their quality of life and experienced greater satisfaction with theirmental health care. They also received more mental health care, particularlypsychotherapy (32 percent vs. 21 percent). When offered a choice of treatments,there was a tendency to choose psychotherapy over medication, highlighting thevalue of increasing the availability of effective talk therapies.

"Most teens visit a primary care doctor or nurse each yearand these visits provide important opportunities to identify teens sufferingfrom depression and provide them with optimal care," said Joan Asarnow, principal investigator of the study, professor ofpsychiatry and biobehavioral sciences at the UCLA Neuropsychiatric Institute, and director of the UCLA YouthStress and Mood Clinic. "Results of our study indicate that a collaborativecare program that improves access to best-practice depression care, supportsparents and youth in selecting preferred treatments, and provides anevidence-based psychotherapy option in primary-care clinics can make ameasurable difference in outcomes."

A common and impairing condition, depression can lead tosuicide — the third leading cause of death among adolescents, and is expectedto become the second-leading cause of disability worldwide over the nextdecade. By age 18, 15 percent to 20 percent of youth suffer from clinicaldepression. Impairing depressive symptoms during the past year are reported by28 percent of high school students. Research has identified effectivetreatments, yet adolescents with depression frequently receive no treatment ordo not receive the most effective treatments.

"Recent controversies about the safety and benefits ofantidepressant medications in youth have led to concerns regarding how to besttreat depression," Asarnow said. "Given the risks ofuntreated depression, the study results should encourage adolescents andparents to speak to their doctors and nurses about depressive symptoms and seekeffective care."

Researchers conducted therandomized, controlled trial between 1999 and 2003, enrolling 418 primary carepatients (ages 13–21) with depression symptoms. Participants either receivedstandard care, or care using the model program. Patient outcomes were evaluatedafter a six‑month period when the model program was offered. A grant fromthe Agency for Health Care Research and Quality supported the research.Additional support was provided by the National Institute of Mental Health.

The study authors were Joan Asarnow,Lisa Jaycox, Naihua Duan, Anne LaBorde, Margaret Rea,Pamela Murray, Martin Anderson, Christopher Landon, LingqiTang and Kenneth Wells. Please see JAMA study for authors' financialdisclosures.

Participating sites were the UCLA NeuropsychiatricInstitute and Mattel Children's Hospital, RAND Corporation, Kaiser PermanenteMedical Center Los Angeles, Children's Hospital, Pittsburgh and WesternPsychiatric Institute and Clinics, Venice Family Clinic, Ventura County MedicalCenter, Landon Pediatrics, and Ventura County Behavioral Health.

Forinformation about research and clinical programs at the UCLA Youth Stress andMood Clinic, call Asarnow at (310) 825-0408.

 

TheUCLA Neuropsychiatric Institute is aninterdisciplinary research and education institute devoted to the understandingof complex human behavior, including the genetic, biological, behavioral and sociocultural underpinnings of normal behavior, and thecauses and consequences of neuropsychiatricdisorders. More information about the institute is available at http://www.npi.ucla.edu/.

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