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Original Article
December 2003

Outpatient Treatment of Child and Adolescent Depression in the United States

Author Affiliations

From the New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (Drs Olfson, Gameroff, and Waslick); and the School of Social Work, University of Pennsylvania, Philadelphia (Dr Marcus).

Arch Gen Psychiatry. 2003;60(12):1236-1242. doi:10.1001/archpsyc.60.12.1236

Background  Although psychotherapy has traditionally been the dominant form of treatment for children and adolescents with depression, there has been a recent increase in the prescription of antidepressants for this age group.

Objective  To describe patterns of outpatient treatment for children and adolescents with depression.

Design and Setting  Analysis of health service–use data from 4 consecutive years (1996-1999) of the Medical Expenditure Panel Survey, a nationally representative annual survey of the general population that is sponsored by the Agency for Healthcare Quality and Research, Rockville, Md.

Subjects  Patients aged 6 to 18 years who made 1 or more outpatient visits for the treatment of depression.

Main Outcome Measures  Rate of treatment, mental health problems, psychotropic medication use, psychotherapy use, number of outpatient treatment visits, and type of provider.

Results  Across the 4 survey years, the mean annual rate of outpatient treatment for depression was 0.93 per 100 individuals. The rate of treatment was especially low for African American individuals (0.23 per 100) and uninsured individuals(0.43 per 100). Approximately three quarters (79%) of treated children and adolescents received psychotherapy and more than half (56.9%) were prescribed antidepressant medications. The mean number of treatment visits for depression was 7.8 per year. As compared with children and adolescents with depression who were treated without antidepressants, those who received antidepressants were significantly more likely to have evidence of anhedonia, to live in large urban communities, to have parents who graduated from high school, and to have health insurance.

Conclusions  The rate and pattern of treatment suggest that serious gaps exist in access to community outpatient treatment for children and adolescents with depression. At the same time, antidepressant medications are used far more commonly than would be expected on the basis of published treatment recommendations.