Few adolescents with depression, substance use disorder treated for both

Between 2011 and 2019, fewer than 12% of adolescents with major depression and substance use disorder were treated for both conditions, according to results of a survey study published in JAMA Network Open.

“Research indicates that treating depression alone does not significantly reduce [substance use disorder (SUD)], and SUD treatment alone does not result in remission of depression,” study author Wenhua Lu, PhD, of the department of community health and social medicine at the City University of New York, and colleagues wrote. “Unfortunately, we lack comprehensive knowledge about trends and patterns in adolescents’ unmet treatment needs for co-occurring conditions.

“Furthermore, prior findings have identified disparities in adolescent depression and SUD based on certain demographic, family and social characteristics (eg, gender, race, family structure, residential stability),” they added.

The researchers investigated temporal trends and sociodemographic disparities in co-occurring major depression and SUD treatment. The study population consisted of 136,262 (51.1% boys; 13.8% Black; 23.2% Hispanic; 53.6% white) U.S. adolescents aged 12 to 17 years who participated in the annual cross-sectional surveys of the National Survey on Drug and Health between 2011 and 2019. Survey years, adolescent age, gender, race and ethnicity, insurance type, annual household income, family structure and residential stability served as exposures. Presence and treatment of co-occurring 12-month major depressive episode and SUD served as main outcomes and measures.

Results showed stability ranging from 1.4% to 1.7% in the annual prevalence of co-occurring major depressive episode and SUD between 2011 and 2019. Adolescents with co-occurring major depressive episode and SUD exhibited a significant increase in the prevalence of treatment for major depressive episode only, from 28.5% in 2011 to 42.5% in 2019 (OR = 1.07; 95% CI, 1.02-1.11); however, the prevalence of treatment use for SUD only decreased from 4.8% to 1.5% (OR = 0.92; 95% CI, 0.85-0.99).

Lu and colleagues noted a fluctuation in the overall prevalence of treatment use for both conditions between 4.5% and 11.6%, without a significant linear tread over time (OR = 0.95; 95% CI, 0.87-1.03). They observed extensive treatment disparities among boys for SUD and both conditions, older adolescents for major depressive episode, Hispanic adolescents for co-occurring conditions (adjusted OR [aOR] = 0.52; 95% CI, 0.27-0.98), and Asian, Native Hawaiian or Pacific Islander adolescents for major depressive episode (aOR = 0.24; 95% CI, 0.10-0.58) and co-occurring conditions (adjusted OR = 0.04; 95% CI, 0.01-0.33). Further, they noted an association between moving households at least three times in the past 12 months and increased likelihood of adolescents receiving treatment for both conditions (aOR = 2.52; 95% CI, 1.26-5.05).

“Findings from this study point to ongoing deficiencies in the current service capacity for adolescent mental health and SUD treatment, highlight the need for improved coordination between service delivery systems, and call for enhanced policy and funding support for adolescents with unmet treatment needs,” Lu and colleagues wrote.