NCQA Adolescent Depression Study Finds Troubling Trends

February 3, 2016 · NCQA Communications

An NCQA adolescent depression study finds troubling trends in health care.  While most adolescents with newly identified depression symptoms received treatment within three months of the diagnosis, some did not get follow-up care. In fact, 40 percent of adolescents prescribed antidepressant medication did not have any documented follow-up care in the next three months, according to a study led by the National Committee for Quality Assurance (NCQA) and published online by JAMA Pediatrics.

Major depression is a chronic and disabling condition that affects 12 percent of adolescents—and up to 26 percent of adolescents experience at least mild depressive symptoms. The timing of treatment is critical; failing to achieve remission of depression is associated with a higher likelihood of recurrent depression and impaired long-term functioning.

Sarah Hudson Scholle, NCQA Vice President of Research and Analysis, was principal investigator and conducted the study along with lead author Briannon C. O’Connor, PhD, who completed the work while at New York University School of Medicine and is now with Coordinated Care Services Inc., of Rochester, NY.

The study originated while creating standards for adolescent depression care for NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS measures). Authors recognized there was little information about what routine care looked like for the adolescents who showed up at their primary care visits with significant symptoms of depression.

The authors examined routine care in three large health care systems—two large HMOs in the western United States and a network of community health centers in the Northeast—and assessed whether adolescents with newly identified depression symptoms received appropriate care in the three months subsequent to identification. Appropriate follow-up care included initiating antidepressant or psychotherapy treatment, having at least one follow-up visit and monitoring symptoms using a validated questionnaire (Patient Health Questionnaire).

Adolescent Depression Study Key findings:

• Most adolescents (nearly two-thirds) with newly identified depression symptoms received treatment, usually including psychotherapy, within the first three months after identification.
• Among adolescents prescribed antidepressant medications, 40 percent had no follow-up care for the three months following the initial prescription, in spite of current black box warnings highlighting the suicide risk for youths prescribed antidepressants and clear recommendations for close monitoring during that time.
• Follow-up care for adolescents with newly identified depression was generally low in the three-month follow-up period: 19 percent did not have any follow-up care; 36 percent did not receive any treatment; and 68 percent had no documentation that symptoms were monitored or reassessed using a valid questionnaire
• Because sites that participated in the study are highly regarded health care institutions, often looked to as leaders in cutting-edge care, results from this study—discouraging as they may be—might overstate the quality of care in other settings.

The authors report that among 4,612 participants (16 years old, on average, more than half [66 percent] female), treatment was initiated for 2,934. Most received psychotherapy alone or in conjunction with medications.

“Our work highlights the magnitude of the problem,” says Scholle. “Even though there are a number of professional standards and guidelines that outline appropriate care for adolescent depression, clearly the quality of care in routine practice diverges from these standards.”

O’Connor says, “The primary importance of this study is not only to highlight the magnitude of the problem, but to inform providers, policy makers, and even parents, that the current health care system is not doing a good enough job getting adolescents with depression symptoms the care they need.”

“These results raise concerns about the quality of care for adolescent depression,” the study concludes.