Cynthia A Fontanella, J Madison Hyer, Danielle L Steelesmith, John V Campo, Mary A Fristad, Jeffrey A Bridge, Susan dosReis, Guy N Brock, Mark Olfson
{"title":"抑郁症青年的抗抑郁治疗质量:对国家医疗补助患者的评价。","authors":"Cynthia A Fontanella, J Madison Hyer, Danielle L Steelesmith, John V Campo, Mary A Fristad, Jeffrey A Bridge, Susan dosReis, Guy N Brock, Mark Olfson","doi":"10.1016/j.jaac.2025.05.011","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To examine rates of adherence to antidepressant management quality measures among youth initiating treatment for depression, and to identify demographic, clinical, and county-level factors associated with adherence.</p><p><strong>Method: </strong>This retrospective cohort study used US national Medicaid data for youth 9 to 24 years of age who were prescribed antidepressants for a new episode of major depression from January 1, 2016, to February 28, 2019 (N = 196,364). Quality measures were derived from 3 Health Effectiveness Data and Information Set (HEDIS) quality measures: (1) acute phase, the percentage of youth who remained on antidepressants for 3 months; (2) continuation phase, the percentage of youth who remained on antidepressants for 6 months; and (3) follow-up contacts, the percentage of youth who received at least 3 follow-up visits during the acute phase. Robust Poisson regression examined associations between demographic, clinical, and county-level factors and adherence.</p><p><strong>Results: </strong>Approximately half (49.6%) of the youth were adherent to acute-phase medication management and 55.2% had at least 3 follow-up visits; only 26.5% met continuation phase metrics. Older age, minoritized racial/ethnic status, and substance use disorders were associated with lower adherence. In contrast, youth with chronic medical conditions, prior use of other psychotropic medications, or in foster care had higher adherence.</p><p><strong>Conclusion: </strong>A substantial proportion of youth with depression receiving antidepressant treatment do not receive care aligned with quality measures, with notable disparities among older youth and racial/ethnic minorities. Targeted quality improvement efforts are needed to close gaps in adherence and follow-up care, particularly for underserved populations, and to promote more consistent, equitable treatment delivery.</p>","PeriodicalId":17186,"journal":{"name":"Journal of the American Academy of Child and Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":9.2000,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Antidepressant Treatment Quality of Depressed Youth: A National Evaluation of Medicaid Patients.\",\"authors\":\"Cynthia A Fontanella, J Madison Hyer, Danielle L Steelesmith, John V Campo, Mary A Fristad, Jeffrey A Bridge, Susan dosReis, Guy N Brock, Mark Olfson\",\"doi\":\"10.1016/j.jaac.2025.05.011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To examine rates of adherence to antidepressant management quality measures among youth initiating treatment for depression, and to identify demographic, clinical, and county-level factors associated with adherence.</p><p><strong>Method: </strong>This retrospective cohort study used US national Medicaid data for youth 9 to 24 years of age who were prescribed antidepressants for a new episode of major depression from January 1, 2016, to February 28, 2019 (N = 196,364). Quality measures were derived from 3 Health Effectiveness Data and Information Set (HEDIS) quality measures: (1) acute phase, the percentage of youth who remained on antidepressants for 3 months; (2) continuation phase, the percentage of youth who remained on antidepressants for 6 months; and (3) follow-up contacts, the percentage of youth who received at least 3 follow-up visits during the acute phase. Robust Poisson regression examined associations between demographic, clinical, and county-level factors and adherence.</p><p><strong>Results: </strong>Approximately half (49.6%) of the youth were adherent to acute-phase medication management and 55.2% had at least 3 follow-up visits; only 26.5% met continuation phase metrics. Older age, minoritized racial/ethnic status, and substance use disorders were associated with lower adherence. In contrast, youth with chronic medical conditions, prior use of other psychotropic medications, or in foster care had higher adherence.</p><p><strong>Conclusion: </strong>A substantial proportion of youth with depression receiving antidepressant treatment do not receive care aligned with quality measures, with notable disparities among older youth and racial/ethnic minorities. Targeted quality improvement efforts are needed to close gaps in adherence and follow-up care, particularly for underserved populations, and to promote more consistent, equitable treatment delivery.</p>\",\"PeriodicalId\":17186,\"journal\":{\"name\":\"Journal of the American Academy of Child and Adolescent Psychiatry\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":9.2000,\"publicationDate\":\"2025-05-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Academy of Child and Adolescent Psychiatry\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jaac.2025.05.011\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Child and Adolescent Psychiatry","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jaac.2025.05.011","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Antidepressant Treatment Quality of Depressed Youth: A National Evaluation of Medicaid Patients.
Objective: To examine rates of adherence to antidepressant management quality measures among youth initiating treatment for depression, and to identify demographic, clinical, and county-level factors associated with adherence.
Method: This retrospective cohort study used US national Medicaid data for youth 9 to 24 years of age who were prescribed antidepressants for a new episode of major depression from January 1, 2016, to February 28, 2019 (N = 196,364). Quality measures were derived from 3 Health Effectiveness Data and Information Set (HEDIS) quality measures: (1) acute phase, the percentage of youth who remained on antidepressants for 3 months; (2) continuation phase, the percentage of youth who remained on antidepressants for 6 months; and (3) follow-up contacts, the percentage of youth who received at least 3 follow-up visits during the acute phase. Robust Poisson regression examined associations between demographic, clinical, and county-level factors and adherence.
Results: Approximately half (49.6%) of the youth were adherent to acute-phase medication management and 55.2% had at least 3 follow-up visits; only 26.5% met continuation phase metrics. Older age, minoritized racial/ethnic status, and substance use disorders were associated with lower adherence. In contrast, youth with chronic medical conditions, prior use of other psychotropic medications, or in foster care had higher adherence.
Conclusion: A substantial proportion of youth with depression receiving antidepressant treatment do not receive care aligned with quality measures, with notable disparities among older youth and racial/ethnic minorities. Targeted quality improvement efforts are needed to close gaps in adherence and follow-up care, particularly for underserved populations, and to promote more consistent, equitable treatment delivery.
期刊介绍:
The Journal of the American Academy of Child & Adolescent Psychiatry (JAACAP) is dedicated to advancing the field of child and adolescent psychiatry through the publication of original research and papers of theoretical, scientific, and clinical significance. Our primary focus is on the mental health of children, adolescents, and families.
We welcome unpublished manuscripts that explore various perspectives, ranging from genetic, epidemiological, neurobiological, and psychopathological research, to cognitive, behavioral, psychodynamic, and other psychotherapeutic investigations. We also encourage submissions that delve into parent-child, interpersonal, and family research, as well as clinical and empirical studies conducted in inpatient, outpatient, consultation-liaison, and school-based settings.
In addition to publishing research, we aim to promote the well-being of children and families by featuring scholarly papers on topics such as health policy, legislation, advocacy, culture, society, and service provision in relation to mental health.
At JAACAP, we strive to foster collaboration and dialogue among researchers, clinicians, and policy-makers in order to enhance our understanding and approach to child and adolescent mental health.