1. The utilization of a collaborative care model for adolescents with depression resulted in a greater symptomatic improvement at 12 months when compared to the standard of care.
2. The inclusion of a collaborative care model in pediatrics practices represents a promising method for treating adolescent depression.
Evidence Rating Level: 2 (Good)
Study Rundown: Adolescent depression is an important problem with many long-term ramifications. Nevertheless, only roughly 60% of adolescents with depression receive appropriate treatment. The many obstacles faced in diagnosing and treating adolescent depression, including the paucity of available pediatric mental health specialists, make managing adolescent depression in primary care settings an important yet challenging goal. In this study, 151 adolescents (13-17 years old) diagnosed with depression using both screening and confirmatory tests were randomized to receive either the standard of care or to be enrolled in a collaborative care model. The collaborative care model involved receiving care from a trained depression case manager (DCM) who assisted with pharmacological management and cognitive behavioral therapy (ROAD Intervention). The primary outcome was change in Child Depression Rating Scale—Revised (CDRS-R) scores at 12 months.
Overall, the adolescents enrolled in the intervention had a greater decrease in CDRS-R score than those in the control group. The greatest strength of this study was the high level of compliance to treatment regimens noted in each group. This study was however limited by its small sample size and the homogeneity of its study population; participants were predominantly female and the subject pool was derived from one healthcare system. While all hospitals may not have the available resources to train and utilize DCMs, the results of this study underscore the utility of such collaborative care models in the primary care setting.
Relevant Reading: Collaborative care for depression and anxiety problems
In-Depth [randomized controlled trial]: 151 adolescents (13-17 years old) who were diagnosed with depression based on a Patient Health Questionnaire (PHQ)-2 screening test and PHQ-9 confirmatory test were randomized to receive either the standard of care or a collaborative care intervention in their pediatricians’ offices. The collaborative care intervention involved trained DCMs who provided care related to pharmacologic management and cognitive behavioral therapy (ROAD Intervention) for depression. All included adolescents, 72% of whom were female, had baseline CDRS-R scores recorded, which were compared to their CDRS-R scores at 12 months. In the intervention group, the mean CDRS-R score went from 48.3 (95% CI 45.5-51.0) to 27.5 (95% CI 23.8-31.1) over 12 months. In the control group, the mean CDRS-R score went from 46.0 (95% CI 43.1-48.9) to 34.6 (95% CI 30.6-38.6) over 12 months. Regression model analysis indicated that the intervention group had a 9.4-point greater decrease than the control group over 12 months (p=0.001). Interaction analysis for time showed that the ROAD intervention yielded more improvement in CDRS-R score over time (Wald c2=7.24, p<0.001).
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