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Collaborative care, training boosts adolescent depression treatment in primary care clinics


A model program featuring primary care physicians, nurses, and mental health providers working collaboratively to bring best-practice depression treatments into primary care clinics significantly improves health outcomes, quality of life, and depression care for adolescents (age 13-21), research team led by a UCLA investigator reports in the Jan 19, 2005, edition of the Journal of the American Medical Association.

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

The study is the first to evaluate a "collaborative care program" for adolescent depression in primary care clinics. This team-based approach strengthened partnerships between primary and specialty care, trained practice clinicians in depression evaluation and treatment, and used nurses and therapists in the clinics to provide depression care. To offer an evidence-based psychotherapy option, clinic therapists were trained in cognitive-behavior therapy, a type of psychotherapy for depression. Families and patients chose with their clinicians among possible treatment options, including cognitive-behavior therapy and medication. Collaborative care programs are widely recommended for improving management of chronic medical illnesses, but until this study had not been tested for adolescent depression.

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

"Most teens visit a primary care doctor or nurse each year and these visits provide important opportunities to identify teens suffering from depression and provide them with optimal care," said Joan Asarnow, principal investigator of the study, professor of psychiatry and biobehavioral sciences at the UCLA Neuropsychiatric Institute, and director of the UCLA Youth Stress and Mood Clinic. "Results of our study indicate that a collaborative care program that improves access to best-practice depression care, supports parents and youth in selecting preferred treatments, and provides an evidence-based psychotherapy option in primary-care clinics can make a measurable difference in outcomes."

A common and impairing condition, depression can lead to suicide -- the third leading cause of death among adolescents, and is expected to become the second-leading cause of disability worldwide over the next decade. By age 18, 15 percent to 20 percent of youth suffer from clinical depression. Impairing depressive symptoms are reported by 28 percent of high school students during the past year. Research has identified effective treatments, yet adolescents with depression frequently receive no treatment or do not receive the most effective treatments.

"Recent controversies about the safety and benefits of antidepressant medications in youth have led to concerns regarding how to best treat depression," Asarnow said. "Given the risks of untreated depression, the study results should encourage adolescents and parents to speak to their doctors and nurses about depressive symptoms and seek effective care."

Researchers conducted the randomized, controlled trial between 1999 and 2003, enrolling 418 primary care patients (ages 13-21) with depression symptoms. Participants either received standard care, or care using the model program. Patient outcomes were evaluated after a six month period when the model program was offered. A grant from the 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, Lingqi Tang, and Kenneth Wells. Please see JAMA study for authors’ financial disclosures.

Participating sites were the UCLA Neuropsychiatric Institute & Mattel Children’s Hospital, RAND Corporation, Kaiser Permanente Medical Center Los Angeles, Children’s Hospital Pittsburgh and Western Psychiatric Institute and Clinics, Venice Family Clinic, Ventura County Medical Center, Landon Pediatrics, and Ventura County Behavioral Health.

Dan Page | EurekAlert!
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