Antidepressant Treatment Quality of Depressed Youth: A National Evaluation of Medicaid Patients.

OBJECTIVE

To examine rates of adherence to antidepressant management quality measures among youth initiating treatment for depression, and to identify demographic, clinical, and county-level factors associated with adherence.

METHOD: This retrospective cohort study used US national Medicaid data for youth 9 to 24 years of age who were prescribed antidepressants for a new episode of major depression from January 1, 2016, to February 28, 2019 (N = 196,364). Quality measures were derived from 3 Health Effectiveness Data and Information Set (HEDIS) quality measures: (1) acute phase, the percentage of youth who remained on antidepressants for 3 months; (2) continuation phase, the percentage of youth who remained on antidepressants for 6 months; and (3) follow-up contacts, the percentage of youth who received at least 3 follow-up visits during the acute phase. Robust Poisson regression examined associations between demographic, clinical, and county-level factors and adherence.

RESULTS

Approximately half (49.6%) of the youth were adherent to acute-phase medication management and 55.2% had at least 3 follow-up visits; only 26.5% met continuation phase metrics. Older age, minoritized racial/ethnic status, and substance use disorders were associated with lower adherence. In contrast, youth with chronic medical conditions, prior use of other psychotropic medications, or in foster care had higher adherence.

CONCLUSION

A substantial proportion of youth with depression receiving antidepressant treatment do not receive care aligned with quality measures, with notable disparities among older youth and racial/ethnic minorities. Targeted quality improvement efforts are needed to close gaps in adherence and follow-up care, particularly for underserved populations, and to promote more consistent, equitable treatment delivery.

PLAIN LANGUAGE SUMMARY: Using national Medicaid data, this study examined whether youth and young adults aged 9 to 25 years receiving antidepressants adhered to medication management quality measures for the acute phase (first 3 months after diagnosis) and continuation phase (first 6 months after diagnosis), as well as follow-up care (at least 3 outpatient visits in the first 3 months). Only about half were adherent to antidepressant medication management and follow-up during the first 3 months, and a little over a quarter adhered to quality measures for the recommended 6 months. Young adults, racial/ethnic minorities, and those with substance use disorders were less likely to adhere to quality measures. In contrast, youth with chronic medical conditions or prior use of other psychotropic medications were more likely to adhere to quality measures. These findings highlight the need for targeted efforts to improve antidepressant management, particularly for underserved populations at risk for nonadherence.