title: Treatment of youth depression in primary care under usual practice conditions: observational findings from Youth Partners in Care.
abstract: OBJECTIVE
  The effectiveness of treatments for youth depression in primary care, under usual practice conditions, is largely unstudied. This study aims at estimating the effect of "appropriate treatment," defined as treatment that approximates guideline standards, on clinical outcomes for depressed primary care youth patients by using observational analyses from a randomized trial.
  
  
  METHODS
  Participants were 344 youths aged 13-21 enrolled in the Youth Partners in Care trial. Youths screening positive for depression from six primary care practices in five different health care organizations were randomly assigned to either (1) usual care enhanced by provider education on depression evaluation and management, or (2) a quality improvement (QI) intervention designed to improve access to antidepressant medications and/or cognitive behavior therapy for depression; usual practice conditions otherwise applied. Observational analysis was conducted on the effects of appropriate treatment (antidepressant medication use by algorithms or 6 or more psychotherapy visits) on severe depression (Center for Epidemiologic Studies-Depression score ≥ 24) at 6 months. Selection into treatment is accounted for by using instrumental variables analysis, with randomized QI intervention status as the instrument.
  
  
  RESULTS
  At 6 months, youths receiving "appropriate treatment," compared with others, were significantly less likely to have severe depression (10.9% vs. 45.2%, p<0.0001). Similar findings were observed among youths with depressive disorders and sub-syndromal depressive symptoms, and among Latino and other youths.
  
  
  CONCLUSIONS
  Among depressed primary care youths, care that approximates guideline standards but retains leniency substantially reduces the likelihood of severe depression at 6 months. Such findings apply to youths with or without depressive disorder, and among Latino youth.
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California 90095, USA.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Wells
authors.forename: Lingqi
authors.initials: L
authors.lastname: Tang
authors.forename: Gabrielle A
authors.initials: GA
authors.lastname: Carlson
authors.forename: Joan Rosenbaum
authors.initials: JR
authors.lastname: Asarnow
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D011785:Quality Assurance, Health Care; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents