National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 43 Research Studies DisplayedViswanathan M, Wallace IF, Cook Middleton J
Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
The authors sought to review the evidence on screening for depression or suicide risk in children and adolescents to inform the US Preventive Services Task Force. They found indirect evidence that suggested some screening instruments were reasonably accurate for detecting depression. Further, psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions.
AHRQ-funded; 290201500011I.
Citation: Viswanathan M, Wallace IF, Cook Middleton J .
Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Oct 18;328(15):1543-56. doi: 10.1001/jama.2022.16310..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Depression, Behavioral Health, Screening, Primary Care, Guidelines, Evidence-Based Practice, Prevention
Ivlev I, Beil TL, Haynes JS
Rapid evidence review of digital cognitive-behavioral therapy for adolescents with depression.
This rapid evidence review was conducted to explore the benefits and harms of digital cognitive-behavioral therapy (dCBT) and the barriers to and facilitators of implementing dCBT for adolescents. An extensive literature review was done through December 6, 2021 for controlled trials conducted in settings highly applicable to the US. Additionally, the authors searched relevant systematic reviews for eligible studies. They identified 12 trials that examined the effects of nine dCBT programs. Overall, dCBT was slightly superior to other therapies in improving depression symptoms immediately, but not at a longer follow-up. There did not appear to be an increased risk for suicidal attempts or ideation with dCBT, however the number of events was very small. Potential barriers to implementing and maintaining dCBT included challenges engaging/retaining patients, developing infrastructure, and training therapists to facilitate dCBT. No data on harms or unintended negative consequences were reported in the included studies.
AHRQ-funded; HS026370.
Citation: Ivlev I, Beil TL, Haynes JS .
Rapid evidence review of digital cognitive-behavioral therapy for adolescents with depression.
J Adolesc Health 2022 Jul;71(1):14-19. doi: 10.1016/j.jadohealth.2022.01.220..
Keywords: Children/Adolescents, Depression, Behavioral Health, Evidence-Based Practice, Patient-Centered Outcomes Research
Morden E, Byron S, Roth L
Health plans struggle to report on depression quality measures that require clinical data.
This study examined challenges and opportunities for reporting 5 HEDIS measures which used electronic clinical data to assess adolescent and perinatal depression care quality. Two learning collaboratives were convened with 10 health plans from 5 states. The authors conducted analysis of notes from collaborative meetings and individual calls with health plans to identify key challenges and strategies for reporting. The challenges most reported included: 1) lack of access to clinical data sources where the results of patient-reported tools were documented; 2) unavailability of the results of patient-reported tools in usable data fields; 3) lack of routine depression screening and ongoing assessment occurring in provider practices.
AHRQ-funded; HS025296.
Citation: Morden E, Byron S, Roth L .
Health plans struggle to report on depression quality measures that require clinical data.
Acad Pediatr 2022 Apr;22(3s):S133-s39. doi: 10.1016/j.acap.2021.09.022..
Keywords: Children/Adolescents, Depression, Behavioral Health, Quality Indicators (QIs), Quality Measures, Quality of Care
Darling KE, Rancourt D, Evans EW
Adolescent weight management intervention in a nonclinical setting: changes in eating-related cognitions and depressive symptoms.
The present study was a secondary data analysis of a randomized controlled trial (RCT) to examine changes in depressive symptoms and eating-related cognitions in teens who participated in a non-clinic-based adolescent behavioral weight control treatment delivered by YMCA coaches. The results demonstrated some positive and no detrimental effects of a non-clinic-based behavioral weight control intervention on adolescents' eating-related cognitions and depressive symptoms.
AHRQ-funded; HS027071.
Citation: Darling KE, Rancourt D, Evans EW .
Adolescent weight management intervention in a nonclinical setting: changes in eating-related cognitions and depressive symptoms.
J Dev Behav Pediatr 2021 Sep 1;42(7):579-87. doi: 10.1097/dbp.0000000000000929..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Depression, Behavioral Health
Chen H, Upadhyay N, Lyu N
Association of primary and behavioral health integrated care upon pediatric mental disorder treatment.
This study’s objective was to examine whether linkage with mental health (MH) treatment differed across 3 different integrated care agreements (ICAs) following diagnosis for Attention Deficit Hyperactive Disorder (ADHD) or Major Depressive Disorder (MDD) given by primary care providers (PCPs) in the pediatric setting. The ICAs were categorized as PCPs who practiced alone (non-co-located); PCPs practiced with specialist outside the practice but co-located at the practice site; and employed specialists who were co-located. A total of 4203 incident ADHD and 298 incident MDD diagnoses were identified, of which 74% of ADHD cases and 67% of MDD cases received treatment within 90 days of diagnosis. Children with ADHD were twice as likely to receive treatment if they were diagnosed by non-co-located or co-affiliated PCPs than those diagnosed by non-co-located PCPs. Those treated children were also 2 times more likely to receive guideline recommended psychotherapy and treated at the diagnosing site versus elsewhere.
AHRQ-funded; HS025251.
Citation: Chen H, Upadhyay N, Lyu N .
Association of primary and behavioral health integrated care upon pediatric mental disorder treatment.
Acad Pediatr 2021 Sep-Oct;21(7):1187-94. doi: 10.1016/j.acap.2021.05.021..
Keywords: Children/Adolescents, Behavioral Health, Patient-Centered Healthcare, Primary Care, Healthcare Delivery, Depression
Rapp AM, Chavira DA, Sugar CA
Incorporating family factors into treatment planning for adolescent depression: perceived parental criticism predicts longitudinal symptom trajectory in the Youth Partners in Care trial.
This study aimed to clarify the predictive significance of youth perceptions of parental criticism assessed using a brief measure designed to enhance clinical utility. The investigators hypothesized that high perceived parental criticism would be associated with more severe depression over 18-months of follow-up. The investigators concluded that results did support perceived parental criticism as a predictor of youth depression outcomes over 18-months.
AHRQ-funded; HS009908.
Citation: Rapp AM, Chavira DA, Sugar CA .
Incorporating family factors into treatment planning for adolescent depression: perceived parental criticism predicts longitudinal symptom trajectory in the Youth Partners in Care trial.
J Affect Disord 2021 Jan 1;278:46-53. doi: 10.1016/j.jad.2020.09.028..
Keywords: Children/Adolescents, Depression, Behavioral Health, Care Management
Liu FF, Lew A, Andes E
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
The objective of this study was to share key strategies that led to successful mental health screening (MHS) implementation in one pediatric cystic fibrosis center and to report implementation and screening outcomes. Results showed that leveraging coproduction to address stakeholder needs led to successful implementation of a sustainable MHS process.
AHRQ-funded; HS026393.
Citation: Liu FF, Lew A, Andes E .
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
Pediatr Pulmonol 2020 Dec;55(12):3328-36. doi: 10.1002/ppul.24951..
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Depression, Anxiety, Behavioral Health, Screening, Implementation, Quality Improvement, Quality of Care, Diagnostic Safety and Quality
Radovic A, Odenthal K, Flores AT
Prescribing technology to increase uptake of depression treatment in primary care: a pre-implementation focus group study of SOVA (Supporting Our Valued Adolescents).
Supporting Our Valued Adolescents (SOVA) is a web-based technology intervention designed to increase depression and anxiety treatment uptake by adolescents in the context of an anonymous peer community with an accompanying website for parents. With a goal of informing the design of a hybrid effectiveness-implementation randomized controlled trial, we conducted a pre-implementation study in two primary care practices to guide implementation strategy development. We conducted focus groups with primary care providers (PCPs) at three different timepoints with PCPs (14 total) from two community practices.
AHRQ-funded; HS022989.
Citation: Radovic A, Odenthal K, Flores AT .
Prescribing technology to increase uptake of depression treatment in primary care: a pre-implementation focus group study of SOVA (Supporting Our Valued Adolescents).
J Clin Psychol Med Settings 2020 Dec;27(4):766-82. doi: 10.1007/s10880-019-09669-5.
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Keywords: Children/Adolescents, Depression, Anxiety, Behavioral Health, Primary Care, Health Information Technology (HIT), Implementation
Darling KE, Ranzenhofer LM, Hadley W
Negative childhood experiences and disordered eating in adolescents in a weight management program: the role of depressive symptoms.
This cross-sectional study examined the association between stressful life events and weight-related outcomes including weight status, disordered eating behaviors, and insulin sensitivity in treatment-seeking adolescents with overweight and obesity. The authors were also looking at the potential mediating role of depression. The study included 170 adolescents (mean age 14.8, 62% female) enrolled in an interdisciplinary weight management program. Findings were that stressful childhood experiences were significantly related to weight status and disordered eating but not insulin sensitivity. Depressive symptoms were related to stressful experiences and disordered eating patterns but not weight status or insulin sensitivity.
AHRQ-funded; HS027071.
Citation: Darling KE, Ranzenhofer LM, Hadley W .
Negative childhood experiences and disordered eating in adolescents in a weight management program: the role of depressive symptoms.
Eat Behav 2020 Aug;38:101402. doi: 10.1016/j.eatbeh.2020.101402..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Stress, Depression, Behavioral Health, Trauma
Stafford AM, Garbuz T, Etter DJ
The natural course of adolescent depression treatment in the primary care setting.
Little is known about how adolescents receive depression follow-up in primary care. The purpose of this study was to describe the rates of symptom assessment and depression treatment over time in a group of adolescents screening positive for moderate or severe depression in the primary care setting. Retrospective chart reviews were conducted to gather information related to symptom reassessments, antidepressant prescriptions, psychotherapy referrals, and treatment discontinuation.
AHRQ-funded; HS022681.
Citation: Stafford AM, Garbuz T, Etter DJ .
The natural course of adolescent depression treatment in the primary care setting.
J Pediatr Health Care 2020 Jan-Feb;34(1):38-46. doi: 10.1016/j.pedhc.2019.07.002..
Keywords: Children/Adolescents, Depression, Behavioral Health, Primary Care
Liu FF, Adrian MC
Is treatment working? Detecting real change in the treatment of child and adolescent depression.
Effectiveness of evidence-based treatments for youth remain modest at best; while practice parameters recommend measurement-based care to enhance youth depression treatment, the literature offers few guidelines on how to use assessment results to inform care decisions or to detect real and clinically meaningful change. The purpose of this study was to produce reliable change indices for two commonly used standardized assessments of youth depression: Patient Health Questionnaire-9 items, Modified for Adolescents (PHQ-9A) and the Short Moods and Feelings Questionnaire (SMFQ).
AHRQ-funded; HS022982.
Citation: Liu FF, Adrian MC .
Is treatment working? Detecting real change in the treatment of child and adolescent depression.
J Am Acad Child Adolesc Psychiatry 2019 Dec;58(12):1157-64. doi: 10.1016/j.jaac.2019.02.011..
Keywords: Children/Adolescents, Depression, Behavioral Health, Evidence-Based Practice, Patient-Centered Outcomes Research
Bardach NS, Neel C, Kleinman LC
Depression, anxiety, and emergency department use for asthma.
This study examined whether pediatric patients with asthma who use the emergency department (ED) experience increased depression and anxiety in the same way that adult asthma patients do. Out of 65,342 patients identified from the Massachusetts All-Payer Claims Database for 2014 to 2015 who had ED visits, 24.7% had a diagnosis of anxiety, depression, or both. Asthma rates were shown to be higher than those of patients who had no diagnosis of anxiety or depression.
AHRQ-funded; HS025297; HS020518.
Citation: Bardach NS, Neel C, Kleinman LC .
Depression, anxiety, and emergency department use for asthma.
Pediatrics 2019 Oct;144(4). doi: 10.1542/peds.2019-0856..
Keywords: Asthma, Depression, Anxiety, Children/Adolescents, Emergency Department, Behavioral Health
Brunsberg KA, Landrigan CP, Garcia BM
Association of pediatric resident physician depression and burnout with harmful medical errors on inpatient services.
The objective of this paper was to determine whether higher rates of medical errors were associated with positive screenings for depression or burnout among resident physicians. Results of this prospective cohort study showed that resident physicians with a positive depression screen were three times more likely than those who screened negative to make harmful errors, indicating the importance of determining what interventions might mitigate the patient safety risk.
AHRQ-funded; HS019456.
Citation: Brunsberg KA, Landrigan CP, Garcia BM .
Association of pediatric resident physician depression and burnout with harmful medical errors on inpatient services.
Acad Med 2019 Aug;94(8):1150-56. doi: 10.1097/acm.0000000000002778..
Keywords: Children/Adolescents, Provider: Physician, Provider, Medical Errors, Adverse Events, Burnout, Patient Safety, Depression, Behavioral Health
Adrian M, Jenness JL, Kuehn KS
Emotion regulation processes linking peer victimization to anxiety and depression symptoms in adolescence.
This study examined emotional regulation processes linked to anxiety and depression symptoms in adolescents experiencing peer victimization. A total of 287 adolescents aged 16-17 years were recruited in three urban centers in the United States. They completed baseline and follow-up assessments 4 months apart. Three models of emotion regulation were evaluated using confirmatory factor analysis. Difficulties with emotion regulation were associated with increased depression in adolescents experiencing peer victimization and increased anxiety associated with cognitive regulation difficulties.
AHRQ-funded; HS022982.
Citation: Adrian M, Jenness JL, Kuehn KS .
Emotion regulation processes linking peer victimization to anxiety and depression symptoms in adolescence.
Dev Psychopathol 2019 Aug;31(3):999-1009. doi: 10.1017/s0954579419000543..
Keywords: Anxiety, Depression, Children/Adolescents, Behavioral Health
Rinke ML, German M, Azera B
Effect of mental health screening and integrated mental health on adolescent depression-coded visits.
This article describes a retrospective primary care network natural cohort study to analyze how mental health screening and integrated mental health practitioners affect adolescent depression identification. The percentage of depression-coded adolescent visits were compared between practices with and without mental health screening and with and without integrated mental health practitioners, using difference-in-differences analyses. The authors conclude that adolescent mental health screening and integrated mental health practitioners increase depression-coded visits in primary care.
AHRQ-funded; HS0203608.
Citation: Rinke ML, German M, Azera B .
Effect of mental health screening and integrated mental health on adolescent depression-coded visits.
Clin Pediatr 2019 Apr;58(4):437-45. doi: 10.1177/0009922818821889..
Keywords: Children/Adolescents, Depression, Diagnostic Safety and Quality, Primary Care, Screening
Lifland B, Wright DR, Mangione-Smith R
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
The purpose of this study was to examine the association between level of adherence to an adolescent depressive disorders inpatient clinical pathway with psychiatric patients’ length of stay (LOS), cost, and readmissions. Patients in the high-adherence category were found to have significantly longer LOS and higher costs when compared to those in the low-adherence category. The authors conclude that understanding which of the care processes within the pathway are most cost-effective for improving patient-centered outcomes requires further investigation.
AHRQ-funded; HS024299.
Citation: Lifland B, Wright DR, Mangione-Smith R .
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
Adm Policy Ment Health 2018 Nov;45(6):979-87. doi: 10.1007/s10488-018-0878-6..
Keywords: Care Management, Children/Adolescents, Depression, Healthcare Costs, Healthcare Utilization, Hospital Readmissions, Hospitalization, Inpatient Care, Behavioral Health, Outcomes, Patient-Centered Outcomes Research
Brunwasser SM, Freres DR, Gillham JE
Youth cognitive-behavioral depression prevention: testing theory in a randomized controlled trial.
This study tested the plausibility of a theoretical model of change for the Penn Resiliency Program (PRP), a cognitive-behavioral (CB) depression prevention program for adolescents. The authors assert that when effective, PRP's CB training provides incremental value over non-specific components and there are indirect effects on depressive symptoms through improvements in explanatory style.
AHRQ-funded; HS022990.
Citation: Brunwasser SM, Freres DR, Gillham JE .
Youth cognitive-behavioral depression prevention: testing theory in a randomized controlled trial.
Cognit Ther Res 2018 Aug;42(4):468-82..
Keywords: Children/Adolescents, Behavioral Health, Depression, Patient-Centered Healthcare, Prevention
Radovic A, DeMand AL, Gmelin T
SOVA: design of a stakeholder informed social media website for depressed adolescents and their parents.
This paper describes iterative stakeholder interviews conducted with adolescents, young adults, parents, advocates, and clinicians and use of human computer interaction techniques to inform major design changes for two social media website for depressed adolescents and for parents.
AHRQ-funded; HS022989.
Citation: Radovic A, DeMand AL, Gmelin T .
SOVA: design of a stakeholder informed social media website for depressed adolescents and their parents.
J Technol Hum Serv 2018;35(3):169-82. doi: 10.1080/15228835.2017.1347552..
Keywords: Children/Adolescents, Depression, Patient and Family Engagement, Social Media
Aalsma MC, Zerr AM, Etter DJ
Physician intervention to positive depression screens among adolescents in primary care.
The objective of this study was to determine the effectiveness of computer-based screening and physician feedback to guide adolescent depression management within primary care. The investigators found that when a computer-based decision support system algorithm focused on adolescent depression and was implemented in two primary care clinics, a majority of physicians utilized screening results to guide clinical care.
AHRQ-funded; HS022681.
Citation: Aalsma MC, Zerr AM, Etter DJ .
Physician intervention to positive depression screens among adolescents in primary care.
J Adolesc Health 2018 Feb;62(2):212-18. doi: 10.1016/j.jadohealth.2017.08.023..
Keywords: Care Management, Children/Adolescents, Shared Decision Making, Depression, Health Information Technology (HIT), Behavioral Health, Primary Care, Primary Care: Models of Care, Screening
Etter DJ, McCord A, Ouyang F
Suicide screening in primary care: use of an electronic screener to assess suicidality and improve provider follow-up for adolescents.
The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. The authors concluded that incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care was feasible and well utilized by providers.
AHRQ-funded; HS022681.
Citation: Etter DJ, McCord A, Ouyang F .
Suicide screening in primary care: use of an electronic screener to assess suicidality and improve provider follow-up for adolescents.
J Adolesc Health 2018 Feb;62(2):191-97. doi: 10.1016/j.jadohealth.2017.08.026..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Shared Decision Making, Depression, Behavioral Health, Primary Care, Screening
Dickerson JF, Feeny DH, Clarke GN
Evidence on the longitudinal construct validity of major generic and utility measures of health-related quality of life in teens with depression.
This study examined the longitudinal construct validity in the assessment of changes in depressive symptoms of widely used utility and generic health-related quality of life (HRQL) instruments in teens. Its findings support the longitudinal construct validity of included HRQL instruments for the assessment of change in depression outcomes in teens.
AHRQ-funded; HS017720.
Citation: Dickerson JF, Feeny DH, Clarke GN .
Evidence on the longitudinal construct validity of major generic and utility measures of health-related quality of life in teens with depression.
Qual Life Res 2018 Feb;27(2):447-54. doi: 10.1007/s11136-017-1728-9.
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Keywords: Children/Adolescents, Depression, Genetics, Quality of Life
Brunwasser SM, Gillham JE
Identifying moderators of response to the Penn Resiliency Program: a synthesis study.
Researchers sought to identify moderators of a cognitive-behavioral depression prevention program's effect on depressive symptoms among youth in early adolescence. Data from three randomized controlled trials of the Penn Resiliency Program (PRP) were aggregated to maximize statistical power and sample diversity. The primary analyses suggested that PRP's effects are limited to youth whose parents are unmarried.
AHRQ-funded; HS022990.
Citation: Brunwasser SM, Gillham JE .
Identifying moderators of response to the Penn Resiliency Program: a synthesis study.
Prev Sci 2018 Feb;19(Suppl 1):38-48. doi: 10.1007/s11121-015-0627-y.
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Keywords: Behavioral Health, Children/Adolescents, Depression, Patient-Centered Outcomes Research, Prevention
Joyce NR, Schuler MS, Hadland SE
Variation in the 12-month treatment trajectories of children and adolescents after a diagnosis of depression.
The purpose of this longitudinal cohort study was to characterize heterogeneity in 12-month trajectories of psychotherapy and antidepressant treatment in youths with depression. The investigators examined variation in baseline health, health care utilization, and health outcomes across classes with similar patterns of psychotherapy and antidepressant use.
AHRQ-funded; HS022998.
Citation: Joyce NR, Schuler MS, Hadland SE .
Variation in the 12-month treatment trajectories of children and adolescents after a diagnosis of depression.
JAMA Pediatr 2018 Jan;172(1):49-56. doi: 10.1001/jamapediatrics.2017.3808..
Keywords: Depression, Children/Adolescents, Behavioral Health, Medication
Carson NJ, Progovac AM, Wang Y
A decline in depression treatment following FDA antidepressant warnings largely explains racial/ethnic disparities in prescription fills.
The Food and Drug Administration's 2004 antidepressant warning was followed by decreases in antidepressant prescribing for youth. Little is known about how antidepressant prescribing patterns varied by race/ethnicity. This study analyzed Medicaid claims data from four U.S. states (2002-2009) for youth ages 5-17. The authors found that antidepressant prescription fills declined most post-warning for White youth, suggesting that risk information may have diffused less rapidly to prescribers or caregivers of minorities.
AHRQ-funded; HS021486.
Citation: Carson NJ, Progovac AM, Wang Y .
A decline in depression treatment following FDA antidepressant warnings largely explains racial/ethnic disparities in prescription fills.
Depress Anxiety 2017 Dec;34(12):1147-56. doi: 10.1002/da.22681..
Keywords: Medication, Children/Adolescents, Depression, Guidelines, Racial and Ethnic Minorities
Mistry KB, Forrest CB
AHRQ Author: Mistry KB
Applying evidence from clinical trials: need for pediatric learning health system research.
The authors argue that to fill the many gaps in the understanding of major depressive disorder management (and more generally, the pediatric knowledge base), a new approach for augmenting the conventional randomized controlled trial is needed. They believe that the emerging field of learning health system research addresses this need.
AHRQ-authored.
Citation: Mistry KB, Forrest CB .
Applying evidence from clinical trials: need for pediatric learning health system research.
Pediatrics 2017 Dec;140(6). doi: 10.1542/peds.2017-3098.
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Keywords: Depression, Evidence-Based Practice, Health Systems, Children/Adolescents