Collaborative care intervention improved depression among adolescents

An intervention that included patient and parent engagement and education improved depression in adolescents seen in primary care, recent study data published in JAMA suggest.

Laura P. Richardson, MD, MPH, of Seattle Children’s Research Institute Center for Child Health, Behavior and Development, and colleagues randomly assigned 101 adolescents diagnosed with depression (aged 13 to 17 years) to a 12-month collaborative care intervention (n=50) or usual care (n=51) to determine the effect of both on depression outcomes.

The intervention included an education and engagement session in which a depression care manager helped the participant and parent choose and initiate treatment with antidepressant medication, brief cognitive behavioral therapy, or both. Follow-up care was provided to the intervention group through a primary care clinic. The usual care group (controls) received depression screening results and could access mental health services.

Participants in the intervention group saw a greater decrease in the Child Depression Rating Scale-Revised (CDRS-R) scores from 48.3 to 27.5 compared with the control group (46 to 34.6). At 12 months, 67.6% of intervention participants had a 50% or more reduction in depressive symptoms vs. 38.6% of control participants.

Participants in the intervention group were also more likely to reach remission at 12 months (50.4%) compared with the control group (20.7%). The intervention group was also more likely to receive psychotherapy or medications that met study quality standards (86%) compared with the control group (27%).

“Among adolescents with depression seen in primary care, a collaborative care intervention resulted in significantly greater improvement in depressive symptoms at 12 months than usual care,” the researchers wrote. “These findings suggest that mental health services for adolescents with depression can be integrated into primary care.”

In an accompanying editorial, Gloria M. Reeves, MD, of the University of Maryland School of Psychiatry, and Mark A. Riddle, MD, of the Johns Hopkins University School of Medicine, wrote that identification and treatment of adolescent depression can be improved by pediatric primary care clinicians.

“This study suggests that collaborative care treatment of adolescent depression can be structured to promote care that is evidence-based, personalized, and effective,” they wrote. “Further research on this type of model has tremendous potential to benefit both families and clinicians.”

For more information:

Reeves GM. JAMA. 2014;312:797-798.

Richardson LP. JAMA. 2014;312:809-816.

Disclosure: See the full studies for a complete list of the researchers’ relevant financial disclosures.