Treatment Outcomes of an Adolescent Intensive Outpatient Program for Depressed and Suicidal Youth

Abstract

Objective

Intensive outpatient programs (IOPs) provide an intermediate level of care for high-risk youth and were required to rapidly pivot to telehealth services amid the COVID-19 pandemic. This article aimed to compare symptom outcomes among adolescents treated in IOPs before vs during the pandemic and during the latter period to examine outcomes among adolescents who attended in-person vs via telehealth IOPs.

Method

Depressed adolescents recommended for IOPs between December 2014 and April 2022 (N = 1,152) completed validated self-reports throughout treatment. Patients treated during the pandemic completed treatment in person, via telehealth, or a combination of both. Mixed-effects models were used to examine changes in symptoms over time in treatment.

Results

Compared with pre-pandemic patients (n = 828), adolescents who presented for treatment after the pandemic onset (n = 324) reported increased depression, anxiety, and nonsuicidal self-injury (ps ≤. 006) at intake. Adolescents treated in IOPs (n = 855) demonstrated significant improvement over each week in treatment (ps < .001) across measures of depression (b = −0.79, 95% CI [−0.88, −0.71]), suicidal ideation and behavior (odds ratio = 0.59, 95% CI [0.55, 0.62]), and nonsuicidal self-injury (odds ratio = 0.51, 95% CI [0.46, 0.56]). Significant interactions between time and patient cohort indicated that the slopes of improvement for all outcomes were steeper during the pandemic (ps < .001). There were no differences in improvement of depression, suicidal thoughts and behaviors, or nonsuicidal self-injury for in-person vs telehealth treatment during the pandemic.

Conclusion

These findings indicate similar treatment response to both IOP treatment modalities for suicidal adolescents. Future research should discern factors leading to faster response after the pandemic onset.

Plain language summary

This study examined treatment response in an intensive outpatient program (IOP) for depressed and suicidal adolescents before and during the COVID-19 pandemic, and compared response based on IOP delivery modality (ie, in-person vs telehealth). Depressed and suicidal adolescents presenting for IOP after the pandemic onset reported more severe symptoms at IOP intake than those who presented prior to the pandemic; however, their symptoms improved more quickly. Youth showed similar response to treatment regardless of whether IOP was delivered in person, via telehealth, or in combination. Clinicians providing treatment for depressed and suicidal youth may consider community-based IOPs that incorporate evidence-based programming delivered either in person or virtually as a promising treatment option for those in need of more intensive treatment, hospital diversion and/or step-down care.