Outpatient treatment in German adolescents with depression: an analysis of nationwide health insurance data.
OBJECTIVE
Data on medical treatment of adolescents with depression are scarce. This study aimed to examine outpatient health services utilisation of depressive disorders in adolescents.


METHODS
Data of a statutory health insurance company were analysed and outpatients from 12 to 18 years old with diagnosed depression during a 1-year period (2009) were identified. For this cohort, the prescription of antidepressants and psychotherapy was evaluated with respect to age and sex.


RESULTS
A total of 4295 patients (41.2% males; mean age, 15.5 years) matched the inclusion criteria. Of the patients, 29.7% consulted a child and adolescent psychiatrist. A total of 59.6% were treated with psychotherapy only, 9.6% were treated with a combination of psychotherapy and antidepressants, and 1.9% received only antidepressants. For 28.8% of patients, no specific depression-related treatment was prescribed. A total of 1357 packages of antidepressants were analysed, of which fluoxetine (24.4% of prescriptions), citalopram (14.0%), and mirtazapine (9.7%) were the most frequently prescribed substances. Regarding substance classes, selective serotonin reuptake inhibitors (SSRIs; 55.6%), tricyclic antidepressants (TCAs; 17.9%), and hypericum (St. John's wort; 8.5%) were most common.


CONCLUSIONS
Although the underlying data were coded for insurance purposes, which might result in some data impreciseness, this naturalistic study furnishes evidence that outpatient treatment of adolescents with depressive disorders in Germany only partly complies with guideline recommendations for first-line treatment: Although the prescriptions of SSRI for adolescent depression have risen over recent years, still, a quarter of antidepressant prescriptions for adolescents with depression were TCA or hypericum. Therefore, dissemination of knowledge on state-of-the-art treatment for adolescent depression remains a major educational goal.
Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, University of Bremen, Bremen, Germany. hoffmann@zes.uni-bremen.de
Falk
F
Hoffmann
Gerd
G
Glaeske
Franz
F
Petermann
Christian J
CJ
Bachmann
D000293:Adolescent; D000367:Age Factors; D000553:Ambulatory Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003866:Depressive Disorder / Q000188:drug therapy* / Q000628:therapy; D005260:Female; D005858:Germany; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011613:Psychotherapy / Q000379:methods*; D012737:Sex Factors
D000928:Antidepressive Agents