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Teens with depression may benefit from collaborative care treatment

Using substance abuse and anxiety assessments at the enrollment of collaborative care treatment for depression can help identify teenagers with depression at risk for treatment failure, findings published in Journal of Clinical Psychiatry suggest.

“While collaborative care models are demonstrating success in treating depression in adults, few studies explore the use of collaborative care in pediatric populations with depression,” Alexander D. Ginsburg, MA, MCRP, from Mayo Medical School, Mayo Clinic College of Medicine and Science, and colleagues wrote. “Adolescent depression may be particularly well suited for collaborative care approaches because it has a high prevalence, confers profound morbidity and presents a substantial societal economic burden.”

The investigators examined the connection between baseline scores on routine screening tools for substance abuse, mood disorders and anxiety with depression remission and graduation from a collaborative care program in an outpatient pediatric practice. The program, known as the Early Management and Evidence-Based Recognition of Adolescents Living with Depression (EMERALD), aims to increase the number of teens receiving outcomes-based depression treatment in primary care and offers a framework to transition the PCPs and behavioral health providers to a collaborative care model.

Researchers enrolled 182 teens aged 12 years to 17 years with depressive disorder, comparing the baseline assessment scores as measured by the Patient Health Questionnaire-9 Modified for Adolescents with scores at remission (defined as a score of less than 5) and graduation from the collaborative care program (defined as 3 consecutive months with a score of less than 5).

The overall remission rate among the 182 participants was 55% and the collaborative care program graduation rate was 27%. None of the screening tools used at baseline examination had significant links to remission; however, teens who graduated from the program were more likely to have lower scores on a screening tool for substance abuse (OR = 1.62; P = .01) and anxiety (OR = 1.03; P = .02) as measured by CRAFFT and the Spence Children’s Anxiety Scale-child version (SCAS-C) scores.

Furthermore, graduation was tied to negative assessments on screening tools for substance abuse (OR = 3.21; P = .003) and anxiety (OR = 2.35; P = .02) when Ginsburg and colleagues evaluated the scores as categorial variables.

“These results suggest that EMERALD and perhaps other collaborative care models do not currently integrate resources necessary for patients with elevated scores on anxiety and substance abuse screening tools,” the authors wrote. “Patients with elevated SCAS-C and CRAFFT scores quite likely need additional interventions specific to anxiety and substance abuse beyond the scope of the current EMERALD collaborative care model. By identifying these patients at the outset, the opportunity is greater for tailoring future treatment regimens for these patients.” – by Savannah Demko

Disclosure: Ginsburg reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.