Original article
Depression treatment during outpatient visits by U.S. children and adolescents

https://doi.org/10.1016/j.jadohealth.2005.07.012Get rights and content

Abstract

Purpose

Depression affects approximately 2–8% of all children and adolescents, and treatment of depression in children and adolescents has been the center of recent serious debates. We examined national trends in depression visits and treatment among outpatients aged 7 to 17 years.

Methods

We analyzed visit-based data between 1995 and 2002 in two national ambulatory care surveys.

Results

The number of visits by children and adolescents during which depression was reported more than doubled from 1995–1996 (1.44 million) to 2001–2002 (3.22 million). The proportion of these visits during which antidepressants were prescribed rose slightly from 47% in 1995–1996 to 52% in 2001–2002, whereas the proportion during which psychotherapy or mental health counseling was provided declined from 83% to 68%. Selective serotonin reuptake inhibitors (SSRI) represented 76% of all antidepressants prescribed in 1995–1996 and 81% in 2001–2002. In absolute terms, SSRIs were reported in 1.35 million visits in 2001–2002, reflecting a 2.6-fold increase from 1995–1996. Fluoxetine was prescribed in 207,914 visits in 1995–1996 and increased 100% to 415,580 visits in 2001–2002. The use of sertraline increased by 62% to 345,576 visits and paroxetine by 269% to 279,275 visits.

Conclusions

We observed a declining trend in the provision of psychotherapy/mental health counseling during outpatient visits by children and adolescents diagnosed with depression. Although the likelihood of receiving antidepressants remained essentially unchanged, the number of children and adolescents whose visits involved prescription of antidepressants, particularly SSRIs, has increased markedly through 2002. Although fluoxetine remained the most commonly prescribed, other SSRIs were increasingly prescribed through 2002. These trends raise concerns regarding the widespread off-label use of antidepressants lacking reliable evidence of safety and efficacy for use in children and adolescents.

Section snippets

Data sources

Annual data from1995 through 2002 were obtained from the National Ambulatory Medical Care Survey (NAMCS) and the Outpatient Department (OPD) component of the National Hospital Ambulatory Medical Care Survey (NHAMCS). At the time of the study, 2002 data were the latest release from NAMCS and NHAMCS. The National Center for Health Statistics (NCHS) provides complete descriptions of both surveys and yearly data at http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm. These surveys, particularly

Volume and composition of depression visits

The number of annual visits by children and adolescents aged 7 to 17 years who were diagnosed with a depressive disorder increased markedly from 1.44 million (M) (99% CI: 1.08–1.80 M) in 1995–1996 to 3.22 M (2.50 M–3.94 M) in 2001–2002 (Figure 1). During this period, there were fewer diagnoses of major depressive disorder compared with other depression diagnoses. The number of visits with a diagnosis of depression not otherwise specified (suggesting moderate severity) increased by 138% from

Discussion

Our study supports other research that finds children and adolescents to be increasingly seen and diagnosed with depressive disorders [3], [7], [17], [18]. In concordance with the underlying epidemiology [19], depression visits were most common among 15–17-year-olds, girls, and non-Hispanic Caucasians. The absolute increase in depression visits was much greater than expected when compared with the moderate increase in the population of children and adolescents during these years. The greater

Acknowledgment

This study was supported by a research grant from Agency for Healthcare Research and Quality (AHRQ) (R01- HS11313).

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