About half of Medicaid-covered children and adolescents in Ohio who are in treatment for depression complete their first three months of prescribed antidepressants, and only one-fifth complete the recommended minimum six-month course of drugs to treat depression, new research suggests. Among those at the highest risk for not completing treatment are adolescents – as opposed to younger children – and minority youths, particularly African Americans, according to the analysis of Medicaid prescription data over a three-year period.
Optimal follow-up visits and adequacy of antidepressant dosing was associated with better adherence during both the acute and continuation phases of treatment.
Though the study was conducted in Ohio, the findings are likely to have broad relevance to Medicaid-eligible children and adolescents across the United States who share similar problems affecting their access to quality mental health care, researchers say.
“There have been a lot of great advances in terms of medication and therapy interventions for depression. The best treatment is a combination of cognitive behavioral therapy and antidepressants,” said Cynthia Fontanella, an assistant professor of social work and psychiatry at Ohio State University and lead author of the study.
“But there is a huge gap between the science and what is happening in the real world. And the gap is even greater for kids who live in poverty.”
The findings underscore the need for clinicians treating this population to deliver care according to guidelines established by the American Academy of Child and Adolescent Psychiatry, and to develop interventions that improve adherence in the most vulnerable groups, the study authors conclude.
Untreated or poorly treated depression can lead to recurrence, which can increase suicidal behavior and drive up health care costs by increasing the likelihood of hospitalization.
The study is published in the current issue of The Annals of Pharmacotherapy.
Studies suggest that depression affects as many as 20 percent of youths by age 18, and that antidepressant use in people under age 20 has increased three- to five-fold in the past decade. Those experiencing depression are at risk for a number of problems, ranging from school failure and teen pregnancy to substance abuse and suicide.
Compared to youths covered by private insurance, children on Medicaid use more mental health services and are more likely to be prescribed psychotropic medications. They are considered at higher risk for psychiatric disturbances because of the multiple stresses associated with living in poverty.
“This population is very vulnerable,” Fontanella said. “Not only do they have to deal with poverty and other psychosocial issues, but also issues commonly associated with poverty, such as transportation limitations, single-parent households and unemployment. All this makes them even more vulnerable to receiving not just a poor quality of care, but poor access to mental health care.”
The researchers examined data from Medicaid eligibility and claims files for children and adolescents between the ages of 5 and 17 years who were diagnosed with a new episode of depression between Jan. 1, 2005, and Dec. 30, 2007. They examined cases