Receipt of Evidence-Based Pharmacotherapy and Psychotherapy Among Children and Adolescents With New Diagnoses of Depression

Objective: Little is known about utilization rates of the various depression treatment options available in the private sector for children and adolescents. For privately insured youths, this study examined the utilization frequency of six treatment options for depression with varying degrees of empirical support. Methods: A nationally representative administrative claims database of privately insured individuals (Truven Analytics database, 2008-2010) was used to construct a cohort of 61,599 youths (ages six to 17 years) with depression. Multi-variable logistic regression controlling for insurance type, region, and illness severity and complexity assessed, by physician specialty, the likelihood of receiving six different depression treatments (medication combined with psychotherapy, first-line medication, second-line medication, non-evidence-based medication, second-generation antipsychotics, and psychotherapy alone). Results: Only 58.4% of depressed youths received at least one type of depression treatment; 33.6% received psychotherapy alone, 24.8% received medication alone, and 2.7% received combination treatment. Of depressed youths receiving only medication, 24.8% received medications unsupported by empirical evidence (non-evidence-based or second-generation antipsychotics) and 50.6% received medications with equivocal support. Mental health specialists were approximately nine times (odds ratio=8.61) more likely than primary care providers to prescribe combination treatment. Other predictors of receiving combination treatment included having diagnosed major depressive disorder, being a young adolescent (ages 12-14), and residing in the Northeast. Conclusions: Large proportions of depressed youths are not receiving any treatment or are receiving treatments unsupported or equivocally supported by empirical evidence. Additional research is warranted to assess factors associated with nonrecommended use of pharmacotherapies for youths with depression.