Teen Depression Awareness Project (TDAP)

Background: Depressive disorders are common among adolescents, and efficacious treatments
are available. However, few adolescents receive appropriate care, and the effects of these
disorders on adolescents' functioning and family burden are not well understood. Documenting
these effects could make identifying and treating adolescents with mental health problems a
higher priority for providers and parents, and for the adolescents themselves, than it is
now.

Primary care settings provide the most important opportunities to improve care for mood and
anxiety disorders among adolescents, since most children and adolescents have some contact
with a primary care provider each year for well-child visits, school physicals, or acute
care. However, an ongoing trial of a quality improvement intervention for depressed
adolescents in primary care settings (RAND's Youth Partners in Care study) suggests that
there are significant barriers to implementing quality improvement protocols in primary
care.

Study Goals: The main objective of this research is to build an empirical foundation for
developing effective strategies to improve treatment of adolescent mood and anxiety
disorders in primary care settings. Our specific goals are to:

1. Describe the impact of depression on adolescent and family functioning compared to that
of healthy adolescents.

2. Evaluate the effect of two interventions--depression diagnosis feedback and an
educational brochure, with or without patient activation, on care received.

3. Identify barriers and facilitators to receiving appropriate care for identified
adolescent depression from the perspective of adolescents, parents, and the primary
care providers.

Methodology: Participants for this study will be recruited from three to four study sites in
each of two cities selected from among eligible general health care settings that serve high
volumes of adolescent patients, including a large community-based clinic and a set of small
clinics; a high school-based health clinic; and a public/free clinic.

Specific aim 1: We will describe the impact of depression on adolescent and family
functioning compared to healthy controls using a 2-group longitudinal comparison between 400
adolescents identified at baseline with major depression, and 400 adolescents with no
detectable mental disorders. Primary data will be collected from three types of respondents:
adolescents aged 13-17, their parents, and their health care providers. Adolescent baseline
and follow-up assessments (for behavioral problems, physical health, health-related quality
of life, use of psychotropic medications, etc.) will be conducted through telephone
interviews supplemented by mailed questionnaires. Parents will be asked to complete baseline
and follow-up assessments to determine family burden, health insurance, demographics, and
the adolescent's functioning at school. Study participants will be assessed twice, 6 months
apart, with an interim contact at 3 months. Primary care providers (PCPs) will complete
written questionnaires that will include data on demographic characteristics, medical
background and training, professional practices, as well as knowledge, attitudes and
reported treatment behaviors.

Specific aim 2: We will evaluate the effect of the intervention on care received by
randomizing half of the 400 adolescents with major depression to one of two
conditions--Feedback and Educational Brochure, with and without Patient Activation (FPA) and
then observing service use over the next 6 months. The minimal intervention consists of
feedback about the diagnosis to the primary care provider, teen and parent, and also
includes an educational brochure to teens and parents. In the more active FPA intervention,
in addition to feedback and educational brochure, telephone calls will be made to depressed
teens and their parents to discuss symptoms and alternative treatment options with the aim
of encouraging help-seeking. We will compare the two groups on whether they received mental
health care, what kind, and their satisfaction with that care.

Specific aim 3: For the 400 depressed teens in the study, we will conduct a descriptive
analysis of the preferences for treatment, barriers encountered, and use of services. We
will obtain this information from the teens', parents', and providers' perspectives in order
to identify barriers and facilitators to receiving appropriate care.