Family Reaction: Barrier To Teen Depression Treatment

Although teen depression poses a widespread problem for which proven treatments exist, few depressed teens receive any care.
Why don’t they undergo treatment? The answer depends whether you ask parents or the adolescents themselves, according to a study in the June issue of the journal Medical Care.
“With teenagers, treatment decisions greatly involve other parties, especially parents. For instance, teenagers often rely on adults for transportation. Doctors need a sense not just of what the teen thinks or what the parent thinks, but what both think,” said Lisa Meredith, Ph.D., lead author of the new study.
The ability of their physicians to address all the perceived barriers “affects the teenager’s own ability to acknowledge their depression and do something about it,” said Meredith, a reseacher at RAND.
Teens with untreated depression more often have social and academic problems, become parents prematurely, abuse drugs and alcohol and suffer adult depression and suicide.
For the study, researchers recruited 368 adolescent patients of diverse backgrounds receiving care in seven public or private primary care practices. Of these, half had a diagnosis of depression. One parent or guardian of each enrolled teenager also participated.
Teens and parents rated the effects of seven possible barriers: 1) cost of care, 2) what others might think, 3) problems finding or making appointments with a doctor or therapist, 4) time constraints and other responsibilities, 5) not wanting family to know about the depression (this was asked of teens only), 6) good care being unavailable and 7) just not wanting care.
Parents were significantly less likely to report barriers than teens.
For teens, concerns about stigma and relatives’ reactions were among the significant issues, and those who perceived barriers were less likely to undergo therapy or take medications. Depressed teens were significantly more likely to perceive barriers to care than their non-depressed peers were.
“Adolescents do tend to go undiagnosed and untreated. They don’t want to seem abnormal. They want to fit in. Yet when they deny problems, they often act out adaptively, drinking a lot and pursuing other high-risk behaviors,” said Deborah Amdur, a psychiatrist with the Advanced Psychiatric Group in Orlando, Fla.
“This study has the potential to be significant if the findings reach the primary care physicians and help them understand their task in ensuring that adolescents have access to care,” Amdur said. “It’s not a simple one step of speaking with the teenager. They also have to coordinate care with the parent.”
“Once primary care doctors understand the perceived barriers that exist on both sides, they are better able to work with a family to get care that feels right for a particular teenager,” Meredith said.

Depression treatment enhanced program appears to reduce symptoms

Depression treatment and work productivity
Employees seeking treatment for depression who participated in a program that included a telephone outreach intervention had fewer symptoms, worked more hours and had greater job retention than participants receiving usual care, according to a study in the September 26 issue of JAMA.
Depression has enormous societal burdens, with annual U.S. economic costs of tens of billions of dollars due largely to productivity losses. Comparative cost-of-illness studies show that depression is among the most costly of all health problems to employers, according to background information in the article. Despite evidence that there are effective treatments, many depressed workers are untreated or inadequately treated. Employer-purchasers (those who purchase corporate health benefits) often do not invest in enhanced depression screening-treatment programs because of the uncertainty of the return-on-investment of such programs.
Philip S. Wang, M.D., Dr.P.H., of the National Institute of Mental Health, Rockville, Md., and colleagues examined the impact of a depression outreach-treatment program on the outcomes of depression symptom relief, job retention, sickness absence, and increased work productivity. The randomized controlled trial included 604 employees covered by a managed behavioral health plan who were identified in a 2-stage screening process as having significant depression. The telephonic outreach and care management program encouraged workers (n = 304) to enter outpatient treatment (psychotherapy and/or antidepressant medication), monitored treatment quality continuity, and attempted to improve treatment by giving recommendations to clinicians. Participants reluctant to enter treatment were offered a structured telephone cognitive behavioral psychotherapy. Three hundred participants received usual care.
The researchers found that measurements of depression severity were significantly lower in the intervention than in the usual care group by 6 months and at 12 months, and that patients in the intervention group were more likely to experience recovery (26.2 percent vs. 17.7 percent). Scores on the hours worked measure were significantly higher in the intervention than usual care group at 6 and 12 months. The data indicated that workers in the intervention group worked an average of two more hours per week than workers in the usual care group, which is equivalent to an annualized effect of more than two weeks of work. This overall effect was due to a higher rate of job retention (92.6 percent vs. 88.0 percent) and significantly more hours worked among employed respondents.
"The results suggest that enhanced depression care of workers has benefits not only on clinical outcomes but also on workplace outcomes," the authors write. "The financial value of the latter to employers in terms of recovered hiring, training, and salary costs suggests that many employers would experience a positive return on investment from outreach and enhanced treatment of depressed workers."
In an accompanying editorial, Kenneth B. Wells, M.D., M.P.H., and Jeanne Miranda, Ph.D., of the University of California, Los Angeles, comment on the challenge of depression treatment.
"Exactly how programs to improve depression care are implemented may affect the distribution of benefits – an important issue given evidence of disparities in quality of depression care and the potential for practice-based programs to overcome disparities in depression outcomes. Developers of interventions and policies should consider implications of their design for inclusion of underserved groups who may not seek behavioral health care. Despite the extensive efforts by Wang et al to reach general employees, the majority of persons had already inquired about outpatient care. Learning how to optimize personal and societal gains by improving access to quality depression care across diverse communities through employer, practice, and community-based programs and policy changes is a next agenda for evidence-based action. As a community participant in the Witness for Wellness program recently stated: ‘Depression is everybody’s business.’"