Collaborative Care for Adolescents With Depression in Primary Care: A Randomized Clinical Trial
Open accessAbstract
IMPORTANCE: 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. DESIGN: Randomized trial with blinded outcome assessment conducted between April 2010 and April 2013. SETTING: Nine primary care clinics in the Group Health system in Washington State. PARTICIPANTS: 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. INTERVENTIONS: 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. MAIN OUTCOMES AND MEASURES: 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 AND RELEVANCE: 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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01140464.
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There is weak evidence to support suicide watch and the close monitoring prescribed by most guidelines.
“there is weak evidence to support suicide watch and the close monitoring prescribed by most guidelines. 656”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [656]
Research in older adults shows that collaborative care models can markedly lower suicidal ideation and depressive symptoms.
“Although no studies have evaluated the effectiveness of CCM on suicidal behaviors in pediatric populations, research on older adults has shown that CCMs can significantly reduce suicidal ideation and symptoms of depression.105,106”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [106]
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Self-citation
- Authors
- Richardson, L. P., Ludman, E., McCauley, E., Lindenbaum, J., Larison, C., Zhou, C., Clarke, G., Brent, D., & Katon, W.
- Affiliations
- University of Washington (US)
- Kaiser Permanente Washington Health Research Institute (US)
- Seattle Children's Research Institute (US)
- Kaiser Permanente Center for Health Research, Portland, Oregon
- University of Pittsburgh (US)
- Corresponding author
- Richardson, Laura P.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2014-08-27
- Volume
- 312
- Issue
- 8
- Pages
- 809
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC4492537
- OpenAlex
- W2075922892
- Cited by
- 281
- References
- 39
- Citations by year
- 2026: 12 · 2025: 15 · 2024: 35 · 2023: 17 · 2022: 15 · 2021: 19 · 2020: 24 · 2019: 32 · 2018: 34 · 2017: 24 · 2016: 28 · 2015: 22 · 2014: 3
- FWCI
- 37.97
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH085645)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- adolescent depression, collaborative care, primary care, depression screening, PHQ-9, depression remission, functional disability, telephone follow-up, usual care comparison, Group Health, access to mental health care, usual care
- MeSH terms
- Adolescent, Depression, Female, Humans, Male, Mental Health Services, Patient Care Team, Primary Health Care, Treatment Outcome
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