The Natural Course of Adolescent Depression Treatment in the Primary Care Setting.
Allison McCord Stafford, Tamila Garbuz, Dillon J Etter and 4 others
PMID 31548140WHAT IT FOUND
83% of adolescents screening positive for moderate or severe depression received some treatment, but 45% stopped early and many SSRI users quit before one year.
Side effects, inability to afford treatment, refill problems and negative attitudes were recorded.
Key findings
0183% of adolescents screening positive for moderate or severe depression received some depression treatment during the review period.
02Among adolescents who received treatment, 45% discontinued; 69% of those prescribed an antidepressant discontinued, most SSRI users stopped before one year, and recorded reasons included side effects, refill problems, inability to afford treatment, negative attitudes and family resistance.
03Of patients whose follow-up visits addressed depression, 61% had a PHQ-9 reassessment, and 23% of those reassessed were reassessed within 6 to 8 weeks.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was small and came from two clinics, so the rates may not apply to other settings. Most patients were female and Black, and most providers were trained in pediatrics, which may limit generalizability. The study used only primary care records, so care outside the hospital system or in other provider notes may be missed. Reasons for stopping treatment were limited to what providers wrote in the medical record. The electronic health record migration caused missing appointment information, and incomplete records were excluded. The design was descriptive and had no comparison group, so it cannot show whether the decision support system caused the rates. Follow-up was judged against the 2007 guideline, not the 2018 update.
Declared interests
The paper is listed as supported by NIH and U.S. government research sources. One author is a co-founder of Digital Health Solutions, LLC, a company created to market the decision support software used in the study. The other authors reported no conflicts.
The easy way to misread this
Do not conclude that a computerized screening system guarantees guideline-recommended follow-up. The records showed many adolescents stopped treatment and few had timely symptom reassessment.