TUESDAY, Jan. 18, 2005 (HealthDayNews) -- Integrating mental health care for adolescents into primary-care practices can reduce depression in teens and increase their use of mental health services.
That's what a new study found after researchers compared depressed teens who received the new enhanced care -- dubbed quality improvement intervention -- to depressed teens who received standard care.
Teens receiving quality improvement intervention had fewer depressive symptoms overall. And about 10 percent fewer teens on the enhanced care reported severe depression after treatment, vs. teens on usual care.
"Kids with quality improvement intervention had less depression and were more satisfied with their care," said study author Joan Asarnow, a professor of psychiatry and biobehavioral sciences, and director of the youth stress and mood clinic at the University of California, Los Angeles. "I think these results should create a sense of optimism, and they suggest that we can effectively treat depression."
The results appear in the Jan. 19 issue of the Journal of the American Medical Association.
Depression is a common pediatric condition, affecting about one in five children, according to Asarnow. She emphasized that depression is not a harmless condition in teens, and often leads them to bad choices that can result in substance abuse, teen pregnancy, suicide attempts and poor performance in school.
Asarnow recruited help from five health-care organizations in California and Pennsylvania to implement quality improvement intervention in their programs.
The main components of this intervention are education programs for doctors, patients and parents, and integration of services so there are mental health-care managers available in primary-care clinics to aid doctors in diagnosing depression and offering psychotherapy.
The researchers compared a group of 211 teens on quality improvement intervention to 207 adolescents receiving standard care. All of the teens were between 13 and 21, and 78 percent were female. All had symptoms of depression.
At six months of follow-up, teens in the intervention program were much more likely to have received mental health care, 32 percent vs. 17 percent for children in standard care. The largest difference was for severe depression. The quality improvement group reported a treatment rate of 31 percent for severe depression, compared to 42 percent for the usual care group.
Teens in the quality improvement group were also more likely to receive psychotherapy or counseling than children in the usual care group -- 32 percent compared to 21 percent, respectively.
Dr. Luis Zeledon, the physician-in-charge of teenage medicine at Kaiser Permanente in Los Angeles, was one of the doctors involved in the study. He said he felt that teenage "patients were getting their needs addressed sooner than they usually would."
Zeledon said that as a physician, he really liked the program, and by the end of the study felt very comfortable talking to patients and parents about depression and prescribing medications.
Dr. Christopher Lucas, an associate professor of psychiatry at the New York University Child Study Center, said this was an excellent study that "highlights the way to improve mental health care by embedding mental health services into primary care."
Such integration, Lucas said, is critical because there are "far more kids that need treatment than there are qualified mental health professionals, so to make a difference, we need primary care to be involved. But we need to devise systems that make the primary-care doctor feel competent [in treating mental health disorders]."
Neither Lucas nor Zeledon said they were surprised that many teens chose psychotherapy initially.
"Being put on a medication seems very serious and more scary. Talking to someone is less threatening," said Zeledon.
The study was done before information came to light that prompted the U.S. Food and Drug Administration's new requirement that antidepressants carry warnings about increased agitation and suicidal thoughts.
Lucas said that while some studies found an increased risk of suicide for teens on antidepressants, those research projects that controlled for the severity of the depression didn't find the medicine was to blame.
"There are real benefits to these medications, but as with any treatment there needs to be monitoring," said Lucas.
Zeledon added, "I hope a good therapy isn't completely pushed aside, because some kids do benefit from it."
Zeledon said parents were often surprised when he told them their child was depressed. He said many parents attributed signs such as poor school performance to more difficult school work or the child not applying him or herself.
Asarnow said parents should be alert to any abrupt change in their child's behavior. If they are constantly bored, irritable, withdrawn or stressed, and these behaviors are accompanied by trouble sleeping or excessive sleeping, changes in weight, problems with attention, or talk about being worthless, parents should seek help for their child.
Lucas said depression isn't a transient problem in teens, and that as many as half of those who experience depression as teens will have another depressive episode in adulthood.
More information
The National Institutes of Health offers more information on teens and depression.
