Mayo Medical School, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
Division of Child and Adolescent Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.
J Clin Psychiatry. 2018 Jul 17;79(4):17m11543. doi: 10.4088/JCP.17m11543.
Collaborative care models for treatment of adolescent depression are rapidly evolving. However, a dearth of information exists regarding patient characteristics associated with positive outcomes. We explored the association between baseline scores on routine screening tools for substance abuse, mood disorders, and anxiety with depression remission and graduation from a collaborative care program in an outpatient pediatric practice.
Adolescents (aged 12-17 years) with Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9A) score ≥ 10 and a diagnosis of depressive disorder based on DSM-IV criteria between July 2011 and August 2015 were eligible for enrollment in a collaborative care model and inclusion in this study. Remission was defined as a single PHQ-9A score < 5; the criterion for graduation was 3 consecutive months with PHQ-9A score < 5. Analyses compared baseline assessment scores with those at remission and graduation.
Of the 182 patients included in the analysis, the overall remission rate was 55%; program graduation rate was 27%. There was no association between scores on baseline screening tools and remission. Graduation was associated with lower scores on a screening tool for substance abuse (unit odds ratio [OR] = 1.62; P = .01) and anxiety (unit OR = 1.03; P = .02). When the scores were examined as categorical variables, graduation was associated with negative assessments on screening tools for substance abuse (OR = 3.21; P = .003) and anxiety (OR = 2.35; P = .02).
Baseline substance abuse and anxiety assessments may have utility in identifying depressed adolescents who are less likely to maintain remission and graduate from a collaborative care program, suggesting that these patients may need additional intervention to achieve sustained remission.
针对青少年抑郁症的协作式护理模式正在迅速发展。然而，关于与治疗结果呈正相关的患者特征的信息却很匮乏。我们在一个儿科门诊的协作式护理项目中，探索了常规用于筛查物质滥用、心境障碍和焦虑的工具在基线时的评分与抑郁缓解及完成该项目的相关性。
2011 年 7 月至 2015 年 8 月间，我们对符合下列条件的青少年进行了研究：青少年（年龄 12-17 岁）的青少年患者健康问卷-9 修订版（PHQ-9A）评分≥10 分，且根据 DSM-IV 标准诊断为抑郁症。他们有资格参与协作式护理模式，并被纳入本研究。缓解的定义为 PHQ-9A 评分＜5 分的单一评分；毕业的标准为 PHQ-9A 连续 3 个月评分＜5 分。我们比较了基线评估的评分与缓解和毕业时的评分。
在分析中纳入的 182 名患者中，总体缓解率为 55%；项目毕业率为 27%。基线筛查工具的评分与缓解之间没有关联。毕业与物质滥用筛查工具（单位优势比[OR] = 1.62；P =.01）和焦虑（单位 OR = 1.03；P =.02）的评分较低有关。当将评分作为分类变量进行检查时，毕业与物质滥用（OR = 3.21；P =.003）和焦虑（OR = 2.35；P =.02）的筛查工具呈阴性评估有关。
基线时的物质滥用和焦虑评估可能有助于识别不太可能维持缓解并从协作式护理项目毕业的抑郁青少年，这表明这些患者可能需要额外的干预措施以实现持续缓解。
