title: Collaborative care for adolescents with depression in primary care: a randomized clinical trial.
abstract: OBJECTIVE
  Up to 20% of adolescents experience an episode of major depression by age 18 years yet few receive evidence-based treatments for their depression.
  
  
  OBJECTIVE
  To determine whether a collaborative care intervention for adolescents with depression improves depressive outcomes compared with usual care.
  
  
  METHODS
  Randomized trial with blinded outcome assessment conducted between April 2010 and April 2013.
  
  
  METHODS
  Nine primary care clinics in the Group Health system in Washington State.
  
  
  METHODS
  Adolescents (aged 13-17 years) who screened positive for depression (Patient Health Questionnaire 9-item [PHQ-9] score ≥10) on 2 occasions or who screened positive and met criteria for major depression, spoke English, and had telephone access were recruited. Exclusions included alcohol/drug misuse, suicidal plan or recent attempt, bipolar disorder, developmental delay, and seeing a psychiatrist.
  
  
  METHODS
  Twelve-month collaborative care intervention including an initial in-person engagement session and regular follow-up by master's-level clinicians. Usual care control youth received depression screening results and could access mental health services through Group Health.
  
  
  METHODS
  The primary outcome was change in depressive symptoms on a modified version of the Child Depression Rating Scale-Revised (CDRS-R; score range, 14-94) from baseline to 12 months. Secondary outcomes included change in Columbia Impairment Scale score (CIS), depression response (≥50% decrease on the CDRS-R), and remission (PHQ-9 score <5).
  
  
  RESULTS
  Intervention youth (n = 50), compared with those randomized to receive usual care (n = 51), had greater decreases in CDRS-R scores such that by 12 months intervention youth had a mean score of 27.5 (95% CI, 23.8-31.1) compared with 34.6 (95% CI, 30.6-38.6) in control youth (overall intervention effect: F2,747.3 = 7.24, P < .001). Both intervention and control youth experienced improvement on the CIS with no significant differences between groups. At 12 months, intervention youth were more likely than control youth to achieve depression response (67.6% vs 38.6%, OR = 3.3, 95% CI, 1.4-8.2; P = .009) and remission (50.4% vs 20.7%, OR = 3.9, 95% CI, 1.5-10.6; P = .007).
  
  
  CONCLUSIONS
  Among adolescents with depression seen in primary care, a collaborative care intervention resulted in greater improvement in depressive symptoms at 12 months than usual care. These findings suggest that mental health services for adolescents with depression can be integrated into primary care.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01140464.
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Richardson
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
authors.affiliation: Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle4Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McCauley
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Jeff
authors.initials: J
authors.lastname: Lindenbaum
authors.affiliation: Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle.
authors.forename: Cindy
authors.initials: C
authors.lastname: Larison
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle.
authors.forename: Chuan
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: Greg
authors.initials: G
authors.lastname: Clarke
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania7Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Brent
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
mesh_terms: D000293:Adolescent; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D010348:Patient Care Team; D011320:Primary Health Care; D016896:Treatment Outcome