Development of a Prevention Care Cascade for Adolescent Depression

 

Background: According to U.S. national surveys, approximately 9.1% of youth aged 12-17, approximately 2 million youth, have experienced an episode of major depression within the past year.  Deplorably, only one-third of these youth have received treatment for their depressive symptoms and around 30% had less than 3 visits. Over the past twenty years, adolescent depression prevention and treatment programs have been found to be effective by the research field, yet many of these interventions do not reach those in need and have little evidence of population level impact.  In an effort to estimate the impact of disseminating these interventions on youth outcomes, as well as to develop a metric by which decision makers can compare their reach towards detecting and treating youth, we developed a cascade of care for adolescent depression treatment and for depression prevention among youth.  This cascade is modeled upon the National Plan for HIV/AIDS Prevention and Treatment’s cascade that tracks how many of the expected infected population is identified, who is connected to care, who continues to receive care, and who becomes virally suppressed.  In contrast to the HIV cascade that is primarily focused on treatment, we model our cascade on prevention.  Methods: We collaborated with members of the Institute of Medicine’s Forum for Children’s Collaborate, Affective, and Cognitive Health to generate estimates of the population, the state of youth depression care, and potential population level impact from different prevention and treatment strategies.  Our data included results from both national surveys and randomized trials. Results: We estimate that 10-30% of depressed youth are currently receiving adequate care to reduce their symptoms.  We also present estimates in the variability of sub-clinical levels of depression across populations so as to begin a discussion of which populations would benefit most from available prevention efforts. There are different strategies that would improve depression outcomes significantly.  In one scenario, if we increased the number of youth identified as having sub-threshold or clinically significant symptoms through universal screening in 6^th grade, and delivered the best available treatments as estimated through randomized clinical trials, we could increase this proportion to two-thirds.  Discussion: This presentation will present the available data used to estimate population preventive effects, highlight research needs such as increased focus on mechanisms of intervention effects so that we are better able to pinpoint what interventions work and for whom, and introduce opportunities for increasing the availability of depression prevention and treatment through efforts to leverage opportunities available in this era of health reform.