286 - Time to Remission in Adolescent Collaborative Care for Depression

Publication Number: 3275.286

Megan Cassidy, Mayo Clinic Children's Center, Rochester, MN, United States; Gregory Garrison, Mayo Clinic, Rochester, MN, United States; Samuel T. Savitz, Mayo Clinic, Rochester, MN, United States; Eric R. Pease, Mayo Clinic Children's Center, Rochester, MN, United States; Mark D. Williams, Mayo Clinic, Rochester, MN, United States

Background: U.S. prevalence rates of adolescent depression have more than doubled in the past two decades, and suicide is the second leading cause of death for this age group. Despite this high need for intervention, fewer than half of U.S. adolescents with a major depression diagnosis receive depression treatment. Effective treatment options are needed to address this crisis. Collaborative care management (CCM) is a team-based approach located in a primary care setting that has a strong research base in adults and an emerging research base in adolescents.

Objective: In this study, we compared the rate at which adolescents improve when treated for depression by either CCM or usual care. After controlling for baseline demographic characteristics and depression severity, we hypothesized that enrollment in CCM will result in a faster rate of remission when compared with usual care.

Design/Methods: This retrospective cohort study included 17,111 adolescents (ages 12-18) with depression cared for at 4 outpatient primary care clinics from Jan 1, 2007 to Feb 28, 2023. Adolescent patients with a 9-item Patient Health Questionnaire (PHQ-9) score of ≥10 were included. Kaplan-Meier survival curves for time to remission, defined as a PHQ-9 < 5, were plotted. A Cox proportional hazards model was used to estimate the effect CCM has on the time it takes to achieve remission while controlling for demographics, comorbidities, and baseline PHQ-9.

Results: The final sample included 959 (5.6%) CCM patients and 16,152 (94.4%) usual care patients. Patients enrolled in CCM achieved remission of depressive symptoms sooner than those receiving usual care (Hazard Ratio (HR)=1.85, 95% CI 1.70-2.00). Adolescents with more severe initial depression symptoms took longer to achieve remission (Moderately Severe HR=0.81, Severe HR=0.70). Males were more likely to achieve remission sooner than females (HR=1.25). The presence of comorbid anxiety or recurrent depression did not impact time to remission. While no statistically significant differences in time to remission were observed between Black or Hispanic patients and White patients, Asian patients achieved remission sooner, (HR=1.20) and those in the 'other' category took longer to achieve remission (HR=0.87) when compared to White patients.

Conclusion(s): Consistent with our hypothesis, adolescent patients enrolled in CCM were almost 2 times more likely to experience remission of depression symptoms sooner than patients treated with usual care. This study adds to the emerging evidence base supporting CCM as an effective treatment for adolescents with depression.

Demographics, Depression Severity, and Co-morbidities by Group


Cox Proportional Hazards Model for Remission
Note: The Hazard is remission of depression symptoms defined as first PHQ9 <5. Thus, in this case, Hazard Ratios above 1.0 represent greater likelihood of remission.

Time to Remission (PHQ9 <5)