Evans-Chase Michelle, Solomon Phyllis, Peralta Bethany, Kornmann Rachel, Fenkel Caroline
School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, United States.
Charlie Health, Inc, Bozeman, MT, United States.
JMIR Form Res. 2023 Apr 11;7:e44756. doi: 10.2196/44756.
Youth and young adults face barriers to mental health care, including a shortage of programs that accept youth and a lack of developmentally sensitive programming among those that do. This shortage, along with the associated geographically limited options, has contributed to the health disparities experienced by youth in general and by those with higher acuity mental health needs in particular. Although intensive outpatient programs can be an effective option for youth with more complex mental health needs, place-based intensive outpatient programming locations are still limited to clients who have the ability to travel to the clinical setting several days per week.
The objective of the analysis reported here was to assess changes in depression between intake and discharge among youth and young adults diagnosed with depression attending remote intensive outpatient programming treatment. Analysis of outcomes and the application of findings to programmatic decisions are regular parts of ongoing quality improvement efforts of the program whose results are reported here.
Outcomes data are collected for all clients at intake and discharge. The Patient Health Questionnaire (PHQ) adapted for adolescents is used to measure depression, with changes between intake and discharge regularly assessed for quality improvement purposes using repeated measures t tests. Changes in clinical symptoms are assessed using McNamar chi-square analyses. One-way ANOVA is used to test for differences among age, gender, and sexual orientation groups. For this analysis, 1062 cases were selected using criteria that included a diagnosis of depression and a minimum of 18 hours of treatment over a minimum of 2 weeks of care.
Clients ranged in age from 11 to 25 years, with an average of 16 years. Almost one-quarter (23%) identified as nongender binary and 60% identified as members of the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community. Significant decreases (mean difference -6.06) were seen in depression between intake and discharge (t=-24.68; P<.001), with the symptoms of a significant number of clients (P<.001) crossing below the clinical cutoff for major depressive disorder between intake and discharge (388/732, 53%). No significant differences were found across subgroups defined by age (F=0.47; P=.63), gender identity (F=1.20; P=.30), or sexual orientation (F=0.47; P=.86).
Findings support the use of remote intensive outpatient programming to treat depression among youth and young adults, suggesting that it may be a modality that is an effective alternative to place-based mental health treatment. Additionally, findings suggest that the remote intensive outpatient program model may be an effective treatment approach for youth from marginalized groups defined by gender and sexual orientation. This is important given that youth from these groups tend to have poorer outcomes and greater barriers to treatment compared to cisgender, heterosexual youth.
青少年和青年在获得心理健康护理方面面临障碍，包括接纳青少年的项目短缺，以及现有项目中缺乏适合其发育阶段的服务。这种短缺，再加上地理上可选择的服务有限，导致了青少年普遍存在健康差异，尤其是那些心理健康需求更迫切的青少年。尽管强化门诊项目对于有更复杂心理健康需求的青少年可能是一种有效的选择，但基于地点的强化门诊项目地点仍然仅限于那些有能力每周几天前往临床机构就诊的客户。
本文报告的分析目的是评估被诊断为抑郁症的青少年和青年在接受远程强化门诊治疗期间，从入院到出院时抑郁症状的变化。对结果的分析以及将研究结果应用于项目决策是该项目持续质量改进工作的常规部分，本文报告了该项目的结果。
在入院和出院时收集所有客户的结果数据。采用适用于青少年的患者健康问卷（PHQ）来测量抑郁，为了质量改进目的，使用重复测量t检验定期评估入院和出院之间的变化。使用McNamar卡方分析评估临床症状的变化。单向方差分析用于检验年龄、性别和性取向组之间的差异。对于本次分析，根据包括抑郁症诊断以及在至少2周的护理期间至少接受18小时治疗的标准，选择了1062个病例。
客户年龄在11至25岁之间，平均年龄为16岁。近四分之一（23%）的人认定为非二元性别，60%的人认定为女同性恋、男同性恋、双性恋、跨性别、酷儿（LGBTQ+）群体成员。入院和出院之间抑郁症状有显著下降（平均差异-6.06）（t=-24.68；P<.001），大量客户的症状（P<.001）在入院和出院之间降至重度抑郁症的临床临界值以下（388/732，53%）。在按年龄（F=0.47；P=.63）、性别认同（F=1.20；P=.30）或性取向（F=0.47；P=.86）定义的亚组之间未发现显著差异。
研究结果支持使用远程强化门诊项目来治疗青少年和青年的抑郁症，表明这可能是一种有效的替代基于地点的心理健康治疗的方式。此外，研究结果表明，远程强化门诊项目模式可能是针对由性别和性取向定义的边缘化群体青少年的有效治疗方法。鉴于与顺性别、异性恋青少年相比，这些群体的青少年往往治疗效果较差且治疗障碍更大，这一点很重要。
