Adolescent Primary Care Patients’ Preferences for Depression Treatment
Despite efficacious treatments for depression in youth, current data indicate low rates of care. To better understand reasons for these low rates of care, we examined treatment preferences for depression treatment. Adolescents (N=444) who screened positive for depression at a primary care visit completed measures of predisposing, enabling, and need characteristics thought to be related to help seeking. Results indicated a strong tendency for adolescents to prefer active treatment (72%) versus watchful waiting (28%), and for youth to prefer counseling (50%) versus medication (22%). Female gender, prior treatment experience, and current depression and anxiety were related to preference for active treatment over watchful waiting. In multivariable analyses, female gender and current anxiety symptoms remained significant predictors of preference for active treatment. Ethnicity, attitudes about depression care, prior treatment experience, and anxiety symptoms were related to preference for medication over counseling. In multivariable analyses, those with negative attitudes about depression treatment generally, with positive attitudes about treatment via medication, or with current anxiety symptoms were more likely to prefer medication. Youth preference for counseling over medication may contribute to low adherence to medication treatment and underscores the importance of patient education aimed at promoting positive expectations for treatments.
Available from: Marc S Karver
- "Consumers are more likely to seek and adhere to acceptable treatments (e.g., Bannon & McKay, 2005; Chavira, Stein, Bailey, & Stein, 2003; Kazdin, 2000), resulting in fewer dropouts and greater symptom reduction (e.g., Reimers, Wacker, Cooper, & DeRaad, 1992a). Further, providing consumers with a choice of depression treatments appears to improve outcomes (e.g., Asarnow et al., 2005; Lin et al., 2005). Given ethnic disparities in unmet needs for mental health services and the underrepresentation of Hispanics in treatment studies , it is important to examine whether the acceptability of depression treatments differs by ethnicity. "
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ABSTRACT: Efficacious treatments are only valuable to the extent that they are used. Given ethnic disparities in mental health service utilization, this preliminary study examined differences between Hispanic and non-Hispanic White (NHW) adolescents' ratings of the acceptability of depression treatments and related constructs. Female high school students (N = 67; 54% Hispanic) read a vignette describing a depressed adolescent and rated the acceptability of four single treatments for depression (i.e., cognitive-behavioral therapy, interpersonal therapy, family therapy, and pharmacotherapy) and three treatment combinations. Hispanic adolescents completed a self-report measure of acculturation and all adolescents were interviewed about their beliefs of the causes of depression. Results showed more similarities than differences between ethnic groups, with Hispanic and NHW adolescents favoring psychological treatments over pharmacotherapy. Among Hispanic participants, overall ratings of treatment acceptability were significantly higher for bicultural adolescents than Hispanic adolescents immersed predominantly in non-Hispanic culture. Hispanic and NHW adolescents generally showed similar beliefs about the causes of depression, with both groups endorsing personality and cognitions at high rates, but Hispanics were significantly less likely than NHWs to endorse trauma as a cause of depression. Implications for decreasing ethnic disparities in unmet need for treatment are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Available from: William Gardner
- "Some prior research suggests that African Americans are less likely to agree with the prescription of psychiatric medication (Schnittker 2003). The impact of such attitudes can be seen in an effectiveness trial for the treatment of adolescent depression in primary care, where African American youths were significantly more likely than other participants to prefer counseling to medication ( Jaycox et al. 2006). "
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ABSTRACT: We assessed parental perceptions of benefits and risks of pediatric antidepressant use relative to another common treatment option, psychotherapy. We also explored sociodemographic and treatment variables that might influence these perceptions.
A total of 501 caregivers of children presenting to community mental health centers completed a questionnaire assessing demographic characteristics, treatment history, and attitudes toward psychotherapy and antidepressant medications.
Counseling was perceived as beneficial and having few risks, whereas antidepressant medications were perceived as both beneficial and risky. Fifty two percent of parents believed "somewhat" to "strongly" that antidepressants could make children want to harm themselves. African-American parents had less favorable views of antidepressants relative to parents of other ethnicities. Parental perceptions of benefits and risks of antidepressants predicted future medication visits, but only benefits predicted when controlling for other variables. A slight majority of all parents expected their children to see the physician at least every few weeks if prescribed an antidepressant.
When educating parents about medication, prescribers should be aware that African American parents may hold more negative perceptions than other parents, and that many caregivers may expect a higher level of physician monitoring of pediatric antidepressant use than is available in most communities.
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ABSTRACT: Pediatric mental disorders are among the most common disorders of childhood and are routinely seen in primary care. We review innovative management strategies, treatment technologies, and models of collaboration with behavioral health specialists in general medical settings. Our goal is to advance the integration of behavioral health services into primary care.
The application of mental health interventions with proven efficacy holds great promise for youths with mental disorders. Unfortunately, traditional primary-care management of pediatric mental disorders is characterized by nonspecific counseling, low-dose prescribing, and referrals to specialty settings that are often not completed.
The development, study, and refinement of new assessment and treatment technologies, supplemental treatments, and collaborative models of care delivery will be necessary to ensure more effective care for youths with mental disorders and their families. The promise of pediatric mental healthcare will not be fulfilled unless primary-care clinicians and behavioral health specialists forge new collaborative relationships that enhance the delivery of evidence-based care to affected children and their families.
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