Outpatient treatment of child and adolescent depression in the United States

Background: Although psychotherapy has traditionally been the dominant form of treatment for children and adolescents With depression, there has been a recent increase in the prescription of antidepressants for this age group. Objective: To describe patterns of outpatient treatment for children and adolescents with depression. Design and Setting: Analysis of health service-use data from 4 consecutive years.(1996-1999) of the Medical Expenditure Panel Survey, a nationally representative annual survey of the general population that is sponsored by the Agency for Healthcare Quality and Research, Rockville, Md. Subjects: Patients aged 6 to 18 years who made 1 or more outpatient visits for the treatment of depression. Main Outcome Measures: Rate of treatment, mental health problems, psychotropic medication use, psychotherapy use, number,of outpatient treatment visits, and type of provider. Results:Across the 4 survey years, the mean annual rate of outpatient treatment for depression was 0.93 per 100 individuals. The rate of treatment was especially low for African American individuals (0.23 per 100) and uninsured individuals (0.43 per 100). Approximately three quarters (79%) of treated children and adolescents received psychotherapy and more than half (56.9%) were prescribed antidepressant medications. The mean number of treatment visits for depression was 7.8 per year. As compared with children and adolescents with depression who were treated without antidepressants, those who received antidepressants were significantly more likely to have evidence of anhedonia, to live in large urban communities, to have parents who graduated from high school, and to have health insurance. Conclusions: The rate and pattern of treatment suggest that serious gaps exist in access to community outpatient treatment for children and adolescents with depression. At the same time, antidepressant medications are used far more commonly than would be expected on the basis of published treatment recommendations.