Detecting and Evaluating Childhood and Anxiety and Depression Effectively in Subspecialties
Condition: Anxiety; Depression
MeSH terms: Depression; Depressive Disorder; Anxiety Disorders
Study type: Interventional

Summary: 
      The DECADES trial seeks to determine the comparative effectiveness of specialist-centered
      management of anxiety and depression vs. an imbedded and automated psychology referral for
      all subjects who screen positive for anxiety or depression.
    

Detailed description: 
      SPECIFIC AIMS: Mental Health and Quality of Life in Children with Gastrointestinal Disorders
      Depression and anxiety are two of the most common and dangerous disorders in childhood and
      adolescence. Currently, a large proportion of children with these disorders remain
      unrecognized or untreated resulting in considerable morbidity and mortality. The rates of
      depression and anxiety are significantly higher in children with chronic illnesses, including
      gastrointestinal disorders, than in the general population. Furthermore, children with
      depression or anxiety are far more likely to have somatic complaints, and have greater
      utilization of subspecialty care, especially in gastroenterology. Functional gastrointestinal
      disorders such as irritable bowel syndrome, chronic recurrent abdominal pain, and functional
      dyspepsia frequently have comorbid anxiety or depression.

      Efforts to recognize and treat mental health problems in children with chronic medical
      illness, such as gastrointestinal disorders, have been shown to improve adherence to therapy,
      as well as other clinical outcomes. More importantly, improving such mental health problems
      might go far to addressing the outcomes patients care about most with respect to their
      gastroenterological disease. Unfortunately, mental health resources are often difficult for
      families to access, even when these disorders are recognized.

      Validated screening tools exist to screen for anxiety and depression in children and
      adolescents, including the Screen for Childhood Anxiety Related Emotional Disorders (SCARED)
      and the Patient Health Questionnaire (PHQ-9). Despite the established importance of
      depression and anxiety in the gastrointestinal health of children and adolescents, few data
      exist describing the treatment of anxiety and depression by pediatric gastroenterologists.
      Furthermore, little is known about how families or patients view the subspecialty office as
      the setting to detect or care for mental illness. Additionally, if anxiety and depression are
      identified by the gastroenterologist, many practitioners find either they have limited
      training and expertise in the management of adolescent mental health disorders, or they
      encounter barriers to referral to a mental health specialist, especially in children with
      public insurance.

      Therefore, the specific aims of this research project are to:

      Aim 1: Determine family and patient attitudes towards tools to screen for mental illness in a
      pediatric subspecialty office utilizing structured interviews.

      Sub Aim 1a: Determine patient and family attitudes toward anxiety and depression screening in
      a subspecialty office.

      Sub Aim 1b: Determine outcomes of importance to patients and families related to anxiety and
      depression in a pediatric subspecialty office.

      Aim 2: Develop an integrated approach that accounts for family and patient preferences as
      determined in Aim 1, to deliver anxiety and depression screening instruments to new and
      established patients in a pediatric gastroenterology clinic.

      Aim 3: Perform a pre-post comparative effectiveness trial comparing screening in a pediatric
      gastroenterological clinic with notification of the physician to screening in a pediatric
      gastroenterological clinic with the addition of a psychologist, with respect to the
      patient-centered outcomes identified in Aim 1.

      Completion of these aims will allow the investigators to develop an integrated process to
      screen for depression and anxiety in a high-risk population. Furthermore, the knowledge
      gained from piloting depression and anxiety screening will help the investigators to
      determine attitudes towards this approach in the pediatric subspecialty setting, which will
      maximize outcomes from the visit that are important to patients and their families.

      The investigators hypothesize that a combined approach that screens for depression and
      anxiety within the gastroenterology clinic and also provides for access to a psychologist who
      is integrated with the clinic will lead to superior clinical and patient-centered outcomes.
      However the investigators may find that screening patients and then alerting the
      gastroenterology provider may be sufficient to recognize and treat mental health disorders
      effectively. Comparing the effectiveness of these two strategies is therefore important and
      is the overall focus of this proposal.
    

Intervention name(s): Automated Psychology Services; Notification of Subspecialist
Intervention type(s): Other; Other
Intervention description(s): The automated screening tool determines a positive or negative screen, then informs the clinician, and also automates a psychology visit.; The automated screening tool determines a positive or negative screen, then informs the clinician.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment