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Factors Associated with Detection and Receipt of Treatment for Youth with Depression and Anxiety Disorders

  • Laura P. Richardson
    Correspondence
    Address correspondence to Laura Richardson, MD, MPH, Center for Child, Health, Behavior and Development, Seattle Children's Hospital Research Institute, 1100 Olive Way, Suite 500; M/S MPW 8-1, Seattle, Washington 98101.
    Affiliations
    Departments of Pediatrics (Dr Richardson and Dr Lozano), and Psychiatry and Behavioral Sciences (Drs Russo, McCauley, and Katon), University of Washington School of Medicine, Seattle, Wash; Center for Health Studies, Group Health Research Institute of Puget Sound, Seattle, Wash (Dr Lozano); and Seattle Children's Hospital Research Institute, Seattle, Wash (Drs McCauley, Richardson, and Lozano)
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  • Joan E. Russo
    Affiliations
    Departments of Pediatrics (Dr Richardson and Dr Lozano), and Psychiatry and Behavioral Sciences (Drs Russo, McCauley, and Katon), University of Washington School of Medicine, Seattle, Wash; Center for Health Studies, Group Health Research Institute of Puget Sound, Seattle, Wash (Dr Lozano); and Seattle Children's Hospital Research Institute, Seattle, Wash (Drs McCauley, Richardson, and Lozano)
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  • Paula Lozano
    Affiliations
    Departments of Pediatrics (Dr Richardson and Dr Lozano), and Psychiatry and Behavioral Sciences (Drs Russo, McCauley, and Katon), University of Washington School of Medicine, Seattle, Wash; Center for Health Studies, Group Health Research Institute of Puget Sound, Seattle, Wash (Dr Lozano); and Seattle Children's Hospital Research Institute, Seattle, Wash (Drs McCauley, Richardson, and Lozano)
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  • Elizabeth McCauley
    Affiliations
    Departments of Pediatrics (Dr Richardson and Dr Lozano), and Psychiatry and Behavioral Sciences (Drs Russo, McCauley, and Katon), University of Washington School of Medicine, Seattle, Wash; Center for Health Studies, Group Health Research Institute of Puget Sound, Seattle, Wash (Dr Lozano); and Seattle Children's Hospital Research Institute, Seattle, Wash (Drs McCauley, Richardson, and Lozano)
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  • Wayne Katon
    Affiliations
    Departments of Pediatrics (Dr Richardson and Dr Lozano), and Psychiatry and Behavioral Sciences (Drs Russo, McCauley, and Katon), University of Washington School of Medicine, Seattle, Wash; Center for Health Studies, Group Health Research Institute of Puget Sound, Seattle, Wash (Dr Lozano); and Seattle Children's Hospital Research Institute, Seattle, Wash (Drs McCauley, Richardson, and Lozano)
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      Objective

      Anxiety and depression are common among youth and are associated with significant morbidity. Few youth with depression are diagnosed and receive treatment for these disorders. The purpose of this study was to examine the rate of recognition and management among an insured population and the factors associated with evidence of detection among youth.

      Methods

      Structured mental health interviews assessing depression and anxiety diagnoses were completed with a random sample of 581 youth (age range 11–17 years) from an integrated health care system. Administrative data on medical and pharmacy services were used to examine any evidence of detection by the medical system in the prior 12 months.

      Results

      Fifty-one youth met criteria for an anxiety or depressive disorder. Twenty-two percent of these youth with an anxiety or depressive disorder as defined in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition had evidence of detection or treatment. Factors associated with detection and treatment included having diagnosis of a depressive disorder (with or without an anxiety disorder), more depressive symptoms, greater functional impairment, a higher number of primary care visits in the prior year, and higher parent-reported externalizing symptoms. On multivariate analysis, having more depressive symptoms and a higher number of primary care visits were significant predictors of detection and receipt of treatment.

      Conclusions

      The rate of detection and treatment of anxiety and depressive disorders is very low in this age group and suggests a need for increased focus on detection, particularly in light of recent evidence suggesting decreases in diagnosis and treatment among youth following the black box warning regarding antidepressant medications.

      Key Words

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