title: Intensity and predictors of treatment received by adolescents with unipolar major depression prior to hospital admission.
abstract: We sought to characterize the type and intensity of treatment received in the community by 80 adolescents with unipolar major depressive disorder prior to hospital admission for this index episode of illness. Structured clinical interviews were used to rate the presence and severity of a wide range of depressive symptoms and to derive global measures of episode subtype and degree of impairment. Multiple sociodemographic and clinical variables were considered as predictors of level of antidepressant treatment exposure. Although the majority of patients sought help prior to admission, only 58% received antidepressant medication, and fewer than half of these treated patients received levels of treatment deemed adequate by conventional standards. More aggressive levels of pharmacotherapy were received by only a small minority of the sample, and overall severity of illness had little effect on intensity of treatment. Specific clinical features associated with endogeneity were the most robust predictors of more intense antidepressant pharmacotherapy. A disturbingly high proportion of adolescents with serious depressive illness receive less than optimally aggressive treatment in the community relative to the seriously handicapping nature of their illness. The potential implications of these observations are considered.
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles 90024-1759, USA. MStrober@NPIH.MEDSCH.UCLA.EDU
authors.forename: M
authors.initials: M
authors.lastname: Strober
authors.forename: M
authors.initials: M
authors.lastname: DeAntonio
authors.forename: C
authors.initials: C
authors.lastname: Lampert
authors.forename: J
authors.initials: J
authors.lastname: Diamond
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data; D000296:Adolescent Psychiatry / Q000379:methods / Q000706:statistics & numerical data*; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000928:Antidepressive Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016001:Confidence Intervals; D003866:Depressive Disorder / Q000145:classification / Q000628:therapy*; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D004565:Electroconvulsive Therapy; D017050:Episode of Care; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D011613:Psychotherapy / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000928:Antidepressive Agents