Depression
Conditions
Keywords
depression, quality improvement, treatment, adolescents
Brief summary
This randomized effectiveness trial evaluates a quality improvement intervention aimed at providing access to evidence-based depression treatments (particularly cognitive-behavior therapy for depression and or pharmacotherapy) through primary care for youth ages 13-21, as compared to enhanced usual care. The major hypothesis is that the quality improvement intervention will be associated with improved outcomes, relative to enhanced usual care.
Interventions
OTHERQuality Improvement (QI) for depression
Major intervention components included a) expert leader teams who planned and implemented the intervention at each clinic, b) care managers who supported primary care clinicians with depression evaluation and management, c) access to cognitive-behavior therapy for depression within each primary care clinic, and d) patient and provider choice regarding treatment modality.
OTHERUsual Care
Usual care enhanced by provider education regarding depression evaluation and management
Sponsors
RAND
Kaiser Permanente
University of Pittsburgh
Venice Family Clinic
Agency for Healthcare Research and Quality (AHRQ)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
13 Years to 21 Years
Healthy volunteers
No
Inclusion criteria
* Met either of two criteria: 1) endorsed stem items for major depression or dysthymia from the 12-month Composite International Diagnostic Interview(CIDI-12,2.1) modified slightly to conform to diagnostic criteria for adolescents, 1-week or more of past-month depressive symptoms, and a total Center for Epidemiological Studies- Depression Scale(CES-D)40 score ≥ 16, or 2) CES-D score ≥ 24. * Age 13-21 * Presented at primary care clinic
Exclusion criteria
* not English-speaking * provider not in study * sibling already in study * completed eligibility screener previously
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Self-reported depressive symptoms on the CES-D (Center for Epidemiologic Studies Depression Scale) | 6-months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| mental health related quality of life as assessed using self-report on the Medical Outcomes Study Short Form 12 Health Survey. | 6 months, with follow up at 12 and 18 months | — |
| satisfaction with care | 6 months with follow up at 12 and 18 months | — |
| Rates of mental health care, counseling/psychotherapy, and medication treatment. | 6-months with follow-up at 12 and 18 months | Youth self report on the study version of the Service Assessment for Children & Adolescents provided measures of rates of mental health care(dichotomous indicator of whether any mental health treatment received), counseling/psychotherapy (dichotomous indicator of whether counseling/psychotherapy was received, number of counseling/psychotherapy sessions), and medication treatment (dichotomous indicator of whether youth received any medication treatment for mental health problems). These measures were obtained using . |
Countries
United States
Outcome results
None listed