Long-term benefits of short-term quality improvement interventions for depressed youths in primary care

Asarnow, Joan Rosenbaum; Jaycox, Lisa H.; Tang, Lingqi; Duan, Naihua; LaBorde, Anne P.; Zeledon, Luis R.; Anderson, Martin; Murray, Pamela J.; Landon, Christopher; Rea, Margaret M.; Wells, Kenneth B.

doi:10.1176/appi.ajp.2009.08121909

Cited by 85Health Policy Implementation ScienceMental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Long-term benefits of short-term quality improvement interventions for depressed youths in primary care

Asarnow, Joan Rosenbaum, Jaycox, Lisa H., Tang, Lingqi, Duan, Naihua, LaBorde, Anne P., Zeledon, Luis R., Anderson, Martin, Murray, Pamela J. +3 more·2009·American Journal of Psychiatry

DOI 10.1176/appi.ajp.2009.08121909

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Abstract

OBJECTIVE: Quality improvement programs for depressed youths in primary care settings have been shown to improve 6-month clinical outcomes, but longer-term outcomes are unknown. The authors examined 6-, 12-, and 18-month outcomes of a primary care quality improvement intervention. METHOD: Primary care patients 13-21 years of age with current depressive symptoms were randomly assigned to a 6-month quality improvement intervention (N=211) or to treatment as usual enhanced with provider training (N=207). The quality improvement intervention featured expert leader teams to oversee implementation of the intervention; clinical care managers trained in cognitive-behavioral therapy for depression to support patient evaluation and treatment; and support for patient and provider choice of treatments. RESULTS: The quality improvement intervention, relative to enhanced treatment as usual, lowered the likelihood of severe depression (Center for Epidemiological Studies Depression Scale score > or =24) at 6 months; a similar trend at 18 months was not statistically significant. Path analyses revealed a significant indirect intervention effect on long-term depression due to the initial intervention improvement at 6 months. CONCLUSIONS: In this randomized effectiveness trial of a primary care quality improvement intervention for depressed youths, the main effect of the intervention on outcomes was to decrease the likelihood of severe depression at the 6-month outcome assessment. These early intervention-related improvements conferred additional long-term protection through a favorable shift in illness course through 12 and 18 months.

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Multiple randomized controlled trials of adolescents with depression in primary care have shown that collaborative care models reduce depression and increase adherence to evidence-based treatments.
“Additionally, several randomized controlled trials focusing on adolescents with depression in primary care settings have demonstrated the effectiveness of CCMs in decreasing depression and improving adherence to evidenced-base treatments.107-110”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [109]
Disappointing evidence from studies of the effect of collaborative care on depression indicates that clinical improvement may not be maintained after discontinuing multidisciplinary treatment.
“disappointing evidence from studies of the effect of collaborative care on depression indicate that the clinical improvement may not be maintained after discontinuing the multidisciplinary treatment [101]”
From Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care? (2020) · cites this paper as [101]

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Long-term Effectiveness of Disseminating Quality Improvement for Depression in Primary Care
Sherbourne, C. D., Wells, K. B., Duan, N., Miranda, J. M., Unützer, J., Jaycox, L. H., Schoenbaum, M., Meredith, L. S., & Rubenstein, L. V. (2001) · Archives of General Psychiatry · doi:10.1001/archpsyc.58.7.696 · Cited by 147 · see citing works
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Improving quality of primary care reduces depression and improves quality of life in adolescents
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METHODS
(2016)
The Effects of Quality Improvement for Depression in Primary Care at Nine Years
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Self-citation

Authors: Asarnow, J. R., Jaycox, L. H., Tang, L., Duan, N., LaBorde, A. P., Zeledon, L. R., Anderson, M., Murray, P. J., Landon, C., Rea, M. M., & Wells, K. B.
Affiliations: University of California, Los Angeles (US)
ORCID: Asarnow, Joan Rosenbaum
Jaycox, Lisa H.
Tang, Lingqi
Duan, Naihua
Murray, Pamela J.
Rea, Margaret M.
Wells, Kenneth B.
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2009-09
Volume: 166
Issue: 9
Pages: 1002-1010
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.2009.08121909
OpenAlex: W2030911911
Cited by: 85
References: 37
Citations by year: 2026: 1 · 2025: 2 · 2024: 8 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 7 · 2018: 11 · 2017: 10 · 2016: 7 · 2015: 6 · 2014: 5 · 2013: 5 · 2012: 9
FWCI: 9.68
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5p30mh068639-05)
Agency for Healthcare Research and Quality (HS09908)
National Institute of Mental Health (P30-MH068639)
Topics: Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: adolescent depression, primary care, quality improvement intervention, long-term outcomes, severe depression, care managers, provider training, clinical course, usual care
MeSH terms: Adolescent, Adult, Community Mental Health Services, Cost-Benefit Analysis, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Primary Health Care, Psychiatric Status Rating Scales, Quality Assurance, Health Care, Quality of Life, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome, Outcome Assessment, Health Care, Total Quality Management

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Long-term benefits of short-term quality improvement interventions for depressed youths in primary care

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