Achieving adolescent adherence to treatment of major depression

Characterizing Measurement-Based Care in the Texas Youth Depression and Suicide Research Network (TX-YDSRN)

Integration of measurement-based care (MBC) into clinical practice has shown promise in improving treatment outcomes for depression. Yet, without a gold standard measure of MBC, assessing fidelity to the MBC model across various clinical settings is difficult. A central goal of the Texas Youth Depression and Suicide Research Network (TX-YDSRN) was to characterize MBC across the state of Texas through the development of a standardized tool to assess the use of MBC strategies when assessing depression, anxiety, side effects, and treatment adherence. A chart review of clinical visits indicated standardized depression measures (71.2%) and anxiety measures (64%) were being utilized across sites. The use of standardized measures to assess medication adherence and side effects was limited to less than six percent for both, with the majority utilizing clinical interviews to assess adherence and side effects; yet medication was changed in nearly half. Rates of utilization of standardized measures for participants with multiple MBC forms were similar to those who only provided one form.

The Impact of a Gamified Mobile Mental Health App (eQuoo) on Resilience and Mental Health in a Student Population: Large-Scale Randomized Controlled Trial

BACKGROUND

With many digital mental health interventions failing to engage clients for enough time to demonstrate substantive changes to their well-being and with only 2% of all digital solutions on app stores having undergone randomized controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital well-being apps that suit their needs.

OBJECTIVE

This study explored the effects of eQuoo, an evidence-based mental health game that teaches psychological skills through gamification, on resilience, depression, anxiety, and attrition in a student population.

METHODS

In total, 1165 students from 180 universities in the United Kingdom participated in a 5-week, 3-armed randomized controlled trial. Participants were randomly allocated into 1 of 3 groups: eQuoo users, users of a treatment-as-usual evidence-based cognitive behavioral health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-8 were administered to all participants at baseline and every 7 days until completion.

RESULTS

A repeated measures-ANOVA revealed statistically significant increases in resilience scores in the test group (P<.001) compared with both control groups (Sanvello: P=.10 and waitlist: P=.82) over 5 weeks. The app also significantly decreased anxiety and depression scores (both P<.001). With 64.5% (251/389) adherence, the eQuoo group retained 42% more participants than the control groups.

CONCLUSIONS

Digital health interventions such as eQuoo are effective, scalable, and low-cost solutions for supporting young adults and are available on all leading mobile platforms. Further investigation could clarify the extent to which specific elements of the eQuoo app (including gamification) led to better outcomes.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS) DRKS00027638; https://drks.de/search/en/trial/DRKS00027638.

A cross-sectional study on the characteristics and factors associated with the clinical course of child and adolescent patients hospitalized in a public child and adolescent psychiatric unit of Chile

Introduction

Patients of the Short-stay Child and Adolescent Unit of the Del Salvador Psychiatric Hospital (Valparaíso, Chile) exhibit different clinical and social characteristics compared to literature reports of other national centers, although published data are scarce.

Objectives

To describe the operation of the Unit, the socio-familial and clinical characteristics of its patients and analyze factors associated with their clinical evolution.

Methods

We performed a cross-sectional study to describe the patients hospitalized over a three-year period. Variables were registered in an anonymized database. Clinical evolution was evaluated over the year following hospital discharge.

Results

The Unit's model of care can be described as involving biomedical, psychodynamic, and ecological components. We included 98 patients, of which 70.4% were male, and the average age was 11.5 ± 2.3 years. 82.6% were of low socioeconomic status, and 35.7% did not attend school; 98.9% presented family dysfunction, and 91.8% of parents had a history of psychopathology. The most frequent reason for admission was the risk of harm to self or others. The most frequent discharge diagnoses were behavioral, depressive, and personality development disorders. The average length of stay was 41.8 ± 31.1 days. The most commonly used pharmacological agents were antipsychotics and mood stabilizers. Regarding clinical evolution in the first year post-discharge, 47% were evaluated as positive, 27% regular, and 26% unsatisfactory. The factor associated with an unsatisfactory clinical course was having had in-patient antidepressants. Re-admission during the first year post-discharge was associated with comorbid substance use disorder. Treatment noncompliance was associated with a history of behavioral disorder at hospital discharge and having parents with a history of suicide or consummated suicide.

Conclusions

The patient profile is one of low socioeconomic status, severe psychopathology, maladaptive behavior, family dysfunction, and parental psychopathology. Substance use disorder is also associated with readmission.

Medication Adherence Among Children and Adolescents with Severe Mental Illness: A Systematic Review and Meta-Analysis

OBJECTIVE

To perform a systematic review and meta-analysis of studies investigating predictors of medication adherence in children and adolescents with severe mental illness (SMI).

METHOD

A systematic literature search was conducted in PubMed/MEDLINE, Web of Science, and PsycINFO from 1980 through October 1st, 2017, for original peer-reviewed articles that investigated predictors of adherence to psychopharmacologic treatment among children (≤18-years-old) with a primary psychotic disorder, bipolar disorder, depression, recent suicide attempt, or psychiatric hospitalization. Effect sizes (ESs) for individual predictors were extracted and combined using DerSimonian-Laird random-effects meta-analysis. Meta-regression and moderator analyses were conducted to investigate subgroups. This review complied with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.

RESULTS

A total of 28 studies (n = 180,870) met inclusion criteria; 65.9% (±20.9%) of children and adolescents with SMI were medication adherent. Adherence was associated with patient and family attitudes toward care, adherence to psychotherapy, and insight. Nonadherence was associated with illness severity, substance use, and attention-deficit/hyperactivity disorder. Heterogeneity was moderate-to-large for most ES estimates (I² > 50%). Age, sex, underlying diagnosis, and study methodology emerged as significant moderators.

CONCLUSION

Medication nonadherence among youth with SMI is highly prevalent. Children and adolescents with more severe illness and higher comorbidity burden are at greater risk for nonadherence. Positive interpersonal care processes and adherence to nonpharmacological treatment may be protective. These findings inform development of a risk profile for nonadherence among youth with SMI. Future prospective research is needed to address the shortcomings in the existing literature and inform interventions to improve adherence.