Study Identifies Barriers to Prevention for Depression

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Nearly one-fifth of adolescents will have experienced a major depressive episode by the time they reach adulthood.
Nearly one-fifth of adolescents will have experienced a major depressive episode by the time they reach adulthood.

ATLANTA, Georgia – By the time they reach adulthood, up to 20% of adolescents experience  a major depressive episode, and approximately 11.4% of US adolescents had at least 1 episode in 2014 alone.1,2

According to researchers at the University of Wisconsin Hospital and Clinics and the University of Illinois at Chicago, “considering its association with extensive social problems and physical morbidity, depression is one of the most prevalent chronic diseases” to target for prevention, they wrote in a new study presented at the 2016 Annual Meeting of the American Psychiatric Association (APA) in Atlanta, Georgia.1 In addition, the US Preventive Services Task Force recently recommended that adolescents be screened for depression with adequate systems in place to support accurate diagnosis and effective treatment.3


There is a growing emphasis on early intervention in public health efforts, and technology-based interventions “offer a low-cost mass distribution and highly feasible model to prevent mental health disorders,” the authors of the new study noted. In practice, however, there are a number of barriers within healthcare systems that hinder the adoption of prevention-based programs. The researchers aimed to elucidate these issues by studying the implementation of an Internet-based depression prevention program at 21 pediatric primary care clinics in Chicago and Boston. They defined internal and external barriers and examined their impact on “REACH,” which refers to the proportion of patients identified through screening or enrolled in the CATCH-IT program, over a 28-month period.

Adolescents were screened using 2 items from the Patient Health Questionnaire-Adolescent (PHQ-A), in addition to the Center for Epidemiologic Studies Depression scale (CES-D). The findings show that “the clinics achieved a mean REACH screening score of 0.209 and REACH enrollment of 0.174” during the study period, according to the paper. While a REACH loss of 0.133 was due to external barriers, internal barriers accounted for a loss of 0.394, and “research” barriers led to a loss of 1.41.

The authors identified themes pertaining to the barriers overall.  Challenges primary care clinics currently face when delivering preventive medicine include insufficient resources and limited provider time, as well as lack of confidence of staff in administering the screening tool.  The influence of the primary care provider on the medical staff and patient, as well as the relationship between the staff and patient, also have the potential to influence the potential for success of a depression screening program.

Despite the demonstrated potential of technology-based programs to facilitate the early intervention goals often endorsed by healthcare systems, they “may be subject to degradation of public health impact related to external and internal barriers,” said the authors. They explain that relational communication strategies between all involved–primary care provider, patients, study staff, and clinic staff–are necessary for successful implementation of the program.

Click here for more research from the 2016 Annual Meeting of the American Psychiatric Association.

References

  1. Mahoney N, Van Voorhees BW, DeFrino D, et al. Innovation in the age of health care reform: Implementing a “behavioral vaccine” to prevent adolescent depression. Poster presentation at: 2016 Annual Meeting of the American Psychiatric Association; May 14-18, 2016; Atlanta, GA. Young Investigators' New Research 1-46.
  2. National Institutes of Health: National Institute of Mental Health. Major depression among adolescents. Available at: http://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adolescents.shtml. Accessed May 16, 2016.
  3. Siu AL, US Preventive Services Task Force. Screening for depression in children and adolescents: US Preventive Services Task Force Recommendation Statement. Pediatrics. 2016;137(3):1-8. 
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