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Treatment initiation high, follow-up low among adolescents with depressive symptoms

Although treatment initiation was high among adolescents with newly identified depression symptoms, follow-up care was not, according to recent findings.

“Little empirical research has evaluated routine care for adolescent depression. What is known suggests the need for vast improvements. Despite recommendations from several national bodies, screening for adolescent depression in primary care is rare,” Briannon C. O’Connor, PhD, New York University Child Study Center, New York University School of Medicine, New York City, and colleagues wrote. “In pediatric primary care settings with policies specifically targeting universal screening for adolescent depression, 36% of youths exhibit significant symptoms. However, only 17% to 27% of adolescents with depression receive treatment in usual care settings.”

To assess rates of appropriate follow-up care for adolescents with newly identified depression symptoms, researchers analyzed electronic health records data from three large health systems for 3 months following initial symptom identification. The study cohort included 4,612 adolescents, who had a mean age at index event of 16 years.

Treatment was initiated for approximately two-thirds of adolescents and 79% of those diagnosed with major depression. Most received psychotherapy alone or in combination with medication.

During the 3 months following identification, 36% of adolescents received no treatment, 68% did not have a follow-up symptom assessment and 19% did not receive any follow-up care.

Further, 40% of adolescents prescribed antidepressants did not have any documentation of follow-up care for 3 months.

Treatment initiation was significantly associated with younger age (P = .008), more severe initial symptoms (P < .001) and receiving a diagnosis (P < .001).

Rates of follow-up care varied between sites, suggesting differences within health systems may affect care received.

“Current standards of care recommend that adolescents identified with depression symptoms receive further assessment, initiate antidepressant medication and/or psychotherapy treatment, and are monitored for changes in symptoms, especially following an antidepressant prescription,” O’Connor and colleagues wrote. “Evidence from this study suggests that quality of care in routine practice diverges from these standards. Given the negative outcomes associated with untreated adolescent depression, greater attention to improving adherence to quality standards is warranted.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.