Teen Depression Awareness Project (TDAP)
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional
Phase: Phase 1

Summary: 
      The main objective of this research project is to describe the impact of depression on
      adolescent and family functioning compared to that of healthy adolescents and to understand
      the impact of Feedback and Patient Activation (FPA) on teen and family decision-making
      regarding seeking care for depressive disorders.
    

Detailed description: 
      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.
    

Intervention name(s): Education
Intervention type(s): Behavioral
Intervention description(s): Individuals will receive information about depression
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Keywords: Depression