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AHCPR funds new study on treating depression in teenagers

The Agency for Health Care Policy and Research has awarded a 4-year, $2.3 million grant to the Kaiser Permanente Center for Health Research in Portland, OR, to find a more effective way of treating depression in teenagers seen in managed care practices—the source of health care for most Americans.

The new award is one of five grants totaling nearly $10 million in projected funding—over half of which comes from AHCPR—made in response to a child mental health research solicitation published in 1998. The call for research was published by AHCPR in conjunction with the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse.

As noted by AHCPR Administrator John M. Eisenberg, M.D., this study is particularly important because of recent questions raised about the possible relationship between teen mental health problems and school violence. Over 8 percent of teenagers suffer from depression—the most common mental disorder in the United States. Not only is depression becoming more prevalent in adolescents, but the age at which it first appears is going down.

A major concern is suicide. Over the last decade, the suicide rate in young people has increased dramatically, and by 1996, the last year for which data are available, it ranked as the fourth leading cause of death among 10-to-14-year-old children, and it was third among those aged 15 to 24. Depression can cause loss of energy and problems in concentrating, thinking, and remembering, and it increases the risk of problems such as teenage pregnancy, school dropout, and accidents.

Under the terms of AHCPR's new grant award, a team of researchers led by Gregory N. Clarke, Ph.D., an internationally recognized expert on cognitive behavioral therapy for depressed youths, will examine the effectiveness of the therapy—a form of psychotherapy with proven efficacy—when used as an adjunct to antidepressant medication therapy to treat adolescents ages 12 to 18 who are experiencing depression for the first time. The researchers will test whether adolescents provided this combined therapy will be more likely to adhere to medication instructions, recover faster from initial depression, stay in remission longer, function better socially and academically, and be more satisfied with their treatment than those treated only with medication.

The researchers also predict that, while the combination may initially cost managed care more money, in the long run it will be more cost effective than the current way of treating depressed adolescents. The randomized clinical trial will be conducted in four large managed care practices in the Northwest that provide primary care, and it will involve the teaming of pediatricians and trained mental health therapists.

The other child mental health studies are:

  • Youth Partners in Care, AHCPR grant HS09908, led by Joan R. Asarnow, Ph.D., of the University of California, Los Angeles. This AHCPR-funded project is examining the impact of a program designed to improve the outcomes of mental health care for children in managed care practices and reduce their families' stress by educating them and their primary care physicians about depression treatment.
  • Treating Oppositional Defiant Disorder in Primary Care, grant MH59462, funded jointly by AHCPR and NIMH. This research is being led by John V. Lavigne, Ph.D., of Chicago's Children's Memorial Hospital. The study is testing the effectiveness of a psychological intervention in primary pediatric care designed to help identify and treat preschool children with oppositional defiant disorder. This is the most common psychiatric disruptive behavior in preschool-aged children, and it has long-term consequences ranging from delinquency and substance abuse to high-risk sexual behavior in adolescence.
  • The final two studies are (1) Enhancing ADHD (Attention Deficit Hyperactivity Disorder) Treatment Effectiveness in Pediatrics and Schools, grant MH59461, led by Mark L. Wolraich, M.D., of Vanderbilt University and funded by NIMH; and Effectiveness of Interpersonal Psychotherapy (IPT-A) in School-Based Health Clinics, grant SM52671, led by Laura H. Mufson, Ph.D., of Columbia University, and funded by SAMHSA.

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