title: Receipt of Evidence-Based Pharmacotherapy and Psychotherapy Among Children and Adolescents With New Diagnoses of Depression.
abstract: OBJECTIVE
  Little is known about utilization rates of the various depression treatment options available in the private sector for children and adolescents. For privately insured youths, this study examined the utilization frequency of six treatment options for depression with varying degrees of empirical support.
  
  
  METHODS
  A nationally representative administrative claims database of privately insured individuals (Truven Analytics database, 2008-2010) was used to construct a cohort of 61,599 youths (ages six to 17 years) with depression. Multivariable logistic regression controlling for insurance type, region, and illness severity and complexity assessed, by physician specialty, the likelihood of receiving six different depression treatments (medication combined with psychotherapy, first-line medication, second-line medication, non-evidence-based medication, second-generation antipsychotics, and psychotherapy alone).
  
  
  RESULTS
  Only 58.4% of depressed youths received at least one type of depression treatment; 33.6% received psychotherapy alone, 24.8% received medication alone, and 2.7% received combination treatment. Of depressed youths receiving only medication, 24.8% received medications unsupported by empirical evidence (non-evidence-based or second-generation antipsychotics) and 50.6% received medications with equivocal support. Mental health specialists were approximately nine times (odds ratio=8.61) more likely than primary care providers to prescribe combination treatment. Other predictors of receiving combination treatment included having diagnosed major depressive disorder, being a young adolescent (ages 12-14), and residing in the Northeast.
  
  
  CONCLUSIONS
  Large proportions of depressed youths are not receiving any treatment or are receiving treatments unsupported or equivocally supported by empirical evidence. Additional research is warranted to assess factors associated with nonrecommended use of pharmacotherapies for youths with depression.
authors.affiliation: Dr. Soria-Saucedo, Dr. England, and Dr. Kazis are with the Department of Health Policy and Management and Dr. Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston. Dr. Soria-Saucedo is also with the Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville. Dr. Walter is with the Department of Psychiatry, Boston University School of Medicine. Send correspondence to Dr. Kazis (e-mail: lek@bu.edu ).
authors.forename: Rene
authors.initials: R
authors.lastname: Soria-Saucedo
authors.affiliation: Dr. Soria-Saucedo, Dr. England, and Dr. Kazis are with the Department of Health Policy and Management and Dr. Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston. Dr. Soria-Saucedo is also with the Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville. Dr. Walter is with the Department of Psychiatry, Boston University School of Medicine. Send correspondence to Dr. Kazis (e-mail: lek@bu.edu ).
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Walter
authors.affiliation: Dr. Soria-Saucedo, Dr. England, and Dr. Kazis are with the Department of Health Policy and Management and Dr. Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston. Dr. Soria-Saucedo is also with the Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville. Dr. Walter is with the Department of Psychiatry, Boston University School of Medicine. Send correspondence to Dr. Kazis (e-mail: lek@bu.edu ).
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.affiliation: Dr. Soria-Saucedo, Dr. England, and Dr. Kazis are with the Department of Health Policy and Management and Dr. Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston. Dr. Soria-Saucedo is also with the Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville. Dr. Walter is with the Department of Psychiatry, Boston University School of Medicine. Send correspondence to Dr. Kazis (e-mail: lek@bu.edu ).
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: England
authors.affiliation: Dr. Soria-Saucedo, Dr. England, and Dr. Kazis are with the Department of Health Policy and Management and Dr. Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston. Dr. Soria-Saucedo is also with the Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville. Dr. Walter is with the Department of Psychiatry, Boston University School of Medicine. Send correspondence to Dr. Kazis (e-mail: lek@bu.edu ).
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D016208:Databases, Factual; D003863:Depression / Q000628:therapy*; D003865:Major Depressive Disorder / Q000628:therapy*; D055317:Evidence-Based Practice; D005260:Female; D006264:Health Benefit Plans, Employee; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017149:Private Sector; D011613:Psychotherapy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000928:Antidepressive Agents