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Counseling in Primary Care Clinics Helps Speed Recovery for Depressed Teens

Kaiser Permanente study highlights benefit of cognitive behavioral therapy for teens who decline antidepressants

April 19, 2016



Teen girl leaning against second story window which is a wall of windows looking out on the street. She has a small smile.

PORTLAND, Ore. — Depressed teenagers who received cognitive behavioral therapy in their primary care clinic recovered faster, and were also more likely to recover, than teens who did not receive the primary care-based counseling, according to a Kaiser Permanente study published today in the journal Pediatrics.

Primary care providers, such as pediatricians, are often the first to identify depression in teens, but they have few tools to treat teens. Providers can prescribe antidepressants and make referrals to mental health professionals, but teens often decline medications or stop taking them before they can have an effect. Teens may also be reluctant to follow up on referrals to mental health and it may take some time before they can get in for an appointment.

This study examined a 5 to 9-week program where counselors used traditional cognitive behavioral therapy techniques to help teens challenge unhelpful or depressive thinking, and replace those beliefs with more realistic, positive thoughts. The program also helped youth create a personalized plan to increase pleasant activities, especially social activities.

On average, teens in the program recovered 7 weeks faster (22.6 weeks vs. 30 weeks) than teens who didn’t participate in the program. After six months, 70-percent of teens in the program had recovered, compared to 43 percent of teens not in the program.

“This study shows that youth who refuse antidepressants can still be successfully treated in primary care using cognitive behavioral therapy,” said Greg Clarke, PhD, lead author and depression researcher at the Kaiser Permanente Center for Health Research in Portland, Ore. “We know from previous studies that when kids aren’t depressed, they do better in school, are less likely to have sleep and substance abuse problems, and ultimately graduate high school more often,” added Clarke.

 New online tool helps patients manage depression

A new online tool is helping people with depression improve their mood, change their thinking patterns and feel better over time. Developed by Greg Clarke, PhD, and colleagues at the Kaiser Permanente Center for Health Research, MoodHelper is based on traditional cognitive behavioral therapy techniques. The program is not meant to replace in-person therapy, but to be used along with therapy and medication.

The study, published in Pediatrics, is the first to look at the effectiveness of cognitive behavioral therapy in primary care for teenagers not taking antidepressants..
It took place from 2006 to 2012 in Kaiser Permanente primary care clinics in Washington and Oregon. Clarke and his colleagues enrolled 212 teens, ages 12 to 18, who were diagnosed with major depression and either refused an antidepressant prescription or initially filled the prescription, but did not seek refills.

The teenagers were randomized to receive standard care plus cognitive behavioral therapy in primary care or standard care only, which could have included therapy from Kaiser Permanente’s mental health department as well as outside therapy or school counseling.

Researchers followed the teenagers for two years and had them fill out surveys seven times during that period. By the end of the two-year study, 89 percent of teenagers who received primary care counseling had recovered, compared to 79 percent in the standard care group.

Recovery is defined as having no or minimal symptoms of depression for eight weeks or more. These symptoms include feelings of hopelessness, losing interest in friends and activities, changes in sleep and appetite patterns, trouble concentrating and feelings of worthlessness or excessive guilt.

Participants in both groups used about the same amount of health care services, except that significantly more teenagers in the standard care group were hospitalized for psychiatric care.

The study was funded by a grant from the National Institutes of Mental Health (R01-MH73918).

Additional authors include: Lynn DeBar, PhD, John Dickerson, PhD, Frances Lynch, PhD, and Michael Leo, PhD, from the Kaiser Permanente Center for Health Research in Portland, Oregon, and Christina Gullion, PhD, formerly with the Kaiser Permanente Center for Health Research and John Pearson, MD, formerly with Northwest Permanente Medical Group.

About the Kaiser Permanente Center for Health Research
The Kaiser Permanente Center for Health Research, founded in 1964, is a nonprofit research institution dedicated to advancing knowledge to improve health. It has research sites in Portland, Oregon and Honolulu. Find out more at www.kpchr.org.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 10 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.