- Email: [email protected]
188. Long-term Effects of Primary Care Provider Training in Screening, Assessment, and Treatment of Adolescent Depression
Poster Abstracts / 56 (2015) S85eS129
with public insurance (OR¼1.51, 95% CI:1.40-1.64, vs. private). In both adolescents and young adults, comorbid conditions of alcoholism and obesity were associated with increased odds of SII (OR¼2.08, 95% CI:1.74-2.48 (alcoholism); OR¼1.59, 95% CI:1.222.09 (obesity)). Adolescents and young adults with a SII had higher odds of death compared to those visiting for other injuries (OR¼7.80, 95% CI: 7.01-8.66 (adolescents); OR¼5.51, 95% CI:5.165.88, (young adults)). Odds of death differed by SII mechanism. Adolescents and young adults with cut/pierce injuries had a dramatically reduced risk of death compared to those with other SIIs (OR¼0.04, 95% CI:0.03-0.05). Young adults were more likely to have a SII compared to early adolescents (OR¼3.88, 95% CI:3.584.20) and late adolescents (OR¼1.36, 95% CI: 1.30-1.42). Young adults were more likely to self-pay for their hospitalization compared to adolescents (28.9% vs. 9.2%), and were less likely to have private insurance (20.1% vs. 32.8%). Conclusions: Our finding that cut/pierce was the most common mechanism in both adolescents and young adults differs from trends in earlier years and may reflect an increase in self-mutilation behavior with no suicidal intent in these age groups. Young adults had a higher likelihood of SII compared to adolescents, indicating that the transition to young adulthood may be an important time for the monitoring and prevention of self-harming behavior. Sources of Support: Internal - Children’s Hospitals and Clinics of Minnesota.
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rates of depression diagnosis and discussion of treatment were tested using c2. Results: Two cohorts of adolescent patients of trained PCPs reported on SAT-D practices at baseline (n¼390) and at long-term follow-up (n¼178). At follow-up, adolescent patients were 51% female with mean age ¼ 14.3 years, SD 1.8 (range 12-18). Adolescent race/ethnicity was 86% Caucasian, 13% Hispanic, and 6% African American. The follow-up sample had significantly more Caucasian adolescents and fewer African American adolescents than the baseline sample. Even when controlling for adolescent and provider demographics, there was a significant increase in PCP screening for depression at follow-up (47% pre vs. 74% follow-up, OR 3.2, 95% CI 2.1 to 4.7, p < .0001).There was a significant increase in diagnosis of depression (3.3% pre vs. 11.9% follow-up, c2 ¼15.6, p < .0001) and discussion of evidence based treatment among depressed adolescents (46% pre vs. 86% follow-up, c2 ¼ 6.1, p ¼.01). Conclusions: Adolescent patient reports indicated that trained PCPs maintained significant increases in adolescent depression screening, diagnosis, and discussion of evidence-based treatment for depression at 18-24 months post training. Future studies should use a randomized controlled design to further examine effects of SAT-D training on PCP SAT-D practices and adolescent patient outcomes. Sources of Support: This study was funded by the Nemours Foundation and by a Substance Abuse and Mental Health Services Agency (SAMHSA) grant, # 5U79SM059939-04, to the Partnership for Child Health and to the Jacksonville Children’s Commission.
188. 189. LONG-TERM EFFECTS OF PRIMARY CARE PROVIDER TRAINING IN SCREENING, ASSESSMENT, AND TREATMENT OF ADOLESCENT DEPRESSION Elise M. Fallucco, MD 1, Carolina M. Bejarano, BS 1, Chelsea B. Kozikowski, BA 1, Ali Talwar 2, Tim Wysocki, PhD 1. 1
Nemours Children’s Clinic; 2Tulane University.
Purpose: The American Academy of Pediatrics (AAP) recommends routine screening for adolescent depression in primary care, yet many primary care providers (PCPs) lack adequate training in screening, assessment, and treatment for adolescent depression (SAT-D). A SAT-D training program for PCPs (Fallucco et al, under review) resulted in significant increases in PCP rates of depression screening and discussion of evidence-based depression treatment at annual well visits up to 10 months post training. The objective of this study was to determine long-term (i.e. 18-24 months) posttraining PCP SAT-D practices in a subsample of trained PCPs. Methods: Adolescent patients of PCPs in Jacksonville, Florida reported anonymously on whether or not their PCP screened them for depression, diagnosed them with depression, and discussed treatment for depression (yes/no) at 3 time points. We measured frequency of SAT-D practices among the 21 PCPs for whom data were available before training, just after training (not reported here) and at long-term follow-up 18-24 months post-training. The primary outcome was PCP rates of screening for adolescent depression. A multivariable stepwise logistic regression model was used to compare the presence or absence of screening for depression at baseline vs. long-term follow-up. Adolescent age, gender, race/ethnicity, as well as provider gender and degree were included as variables in our logistic regression. Odds ratios were calculated for depression screening. Secondary outcomes included rates of PCP diagnosis of depression and discussion of evidence based depression treatment. Changes in baseline vs. follow-up PCP
RELATIONSHIP BETWEEN DEPRESSIVE SYMPTOMS AND BIRTH CONTROL SABOTAGE IN ADOLESCENT FEMALES INITIATING CONTRACEPTION Jenny K.R. Francis, MD, MPH 1, Katherine Malbon, MD 2, Debra Braun-Courville, MD 3, Lordes Oriana Linares, PhD 3, Susan L. Rosenthal, PhD 4. 1
Columbia University Medical Center; 2Tribeca Pediatrics; 3Mount Sinai Adolescent Health Center; 4Columbia University College of Physicians and Surgeons. Purpose: “Birth control sabotage,” or reproductive coercion by a partner who specifically interferes with contraceptive pursuits, has been associated with increased risk of unintended pregnancy and partner violence. [1] However, less remains known about psychosocial factors that might influence relationship dynamics and perhaps predispose an adolescent female to episodes of a partner attempting to sabotage one’s birth control. We hypothesize that female adolescents with depressive symptoms likely have impaired motivations and lower self-efficacy within a relationship and therefore more likely to disclose a partner who has attempted “birth control sabotage” in the past. Methods: This cross-sectional study analyzes baseline data of 220 urban, minority adolescent females (ages 15-19 years) presenting for contraceptive initiation in a comprehensive, free-of-cost, adolescent health center in NYC. Birth control sabotage (a partner’s interference with contraception) was assessed by responses to a previous published scale of five items (internal consistency, a ¼ 0.704) [2,3] evaluating reproductive coercion (e.g., “Has someone you were dating or going out with ever put holes in the condom so you would get pregnant?”). Factors that might influence birth control sabotage include demographics, current relationship characteristics e age difference of partner, length of relationship, having sex with current
with public insurance (OR¼1.51, 95% CI:1.40-1.64, vs. private). In both adolescents and young adults, comorbid conditions of alcoholism and obesity were associated with increased odds of SII (OR¼2.08, 95% CI:1.74-2.48 (alcoholism); OR¼1.59, 95% CI:1.222.09 (obesity)). Adolescents and young adults with a SII had higher odds of death compared to those visiting for other injuries (OR¼7.80, 95% CI: 7.01-8.66 (adolescents); OR¼5.51, 95% CI:5.165.88, (young adults)). Odds of death differed by SII mechanism. Adolescents and young adults with cut/pierce injuries had a dramatically reduced risk of death compared to those with other SIIs (OR¼0.04, 95% CI:0.03-0.05). Young adults were more likely to have a SII compared to early adolescents (OR¼3.88, 95% CI:3.584.20) and late adolescents (OR¼1.36, 95% CI: 1.30-1.42). Young adults were more likely to self-pay for their hospitalization compared to adolescents (28.9% vs. 9.2%), and were less likely to have private insurance (20.1% vs. 32.8%). Conclusions: Our finding that cut/pierce was the most common mechanism in both adolescents and young adults differs from trends in earlier years and may reflect an increase in self-mutilation behavior with no suicidal intent in these age groups. Young adults had a higher likelihood of SII compared to adolescents, indicating that the transition to young adulthood may be an important time for the monitoring and prevention of self-harming behavior. Sources of Support: Internal - Children’s Hospitals and Clinics of Minnesota.
S97
rates of depression diagnosis and discussion of treatment were tested using c2. Results: Two cohorts of adolescent patients of trained PCPs reported on SAT-D practices at baseline (n¼390) and at long-term follow-up (n¼178). At follow-up, adolescent patients were 51% female with mean age ¼ 14.3 years, SD 1.8 (range 12-18). Adolescent race/ethnicity was 86% Caucasian, 13% Hispanic, and 6% African American. The follow-up sample had significantly more Caucasian adolescents and fewer African American adolescents than the baseline sample. Even when controlling for adolescent and provider demographics, there was a significant increase in PCP screening for depression at follow-up (47% pre vs. 74% follow-up, OR 3.2, 95% CI 2.1 to 4.7, p < .0001).There was a significant increase in diagnosis of depression (3.3% pre vs. 11.9% follow-up, c2 ¼15.6, p < .0001) and discussion of evidence based treatment among depressed adolescents (46% pre vs. 86% follow-up, c2 ¼ 6.1, p ¼.01). Conclusions: Adolescent patient reports indicated that trained PCPs maintained significant increases in adolescent depression screening, diagnosis, and discussion of evidence-based treatment for depression at 18-24 months post training. Future studies should use a randomized controlled design to further examine effects of SAT-D training on PCP SAT-D practices and adolescent patient outcomes. Sources of Support: This study was funded by the Nemours Foundation and by a Substance Abuse and Mental Health Services Agency (SAMHSA) grant, # 5U79SM059939-04, to the Partnership for Child Health and to the Jacksonville Children’s Commission.
188. 189. LONG-TERM EFFECTS OF PRIMARY CARE PROVIDER TRAINING IN SCREENING, ASSESSMENT, AND TREATMENT OF ADOLESCENT DEPRESSION Elise M. Fallucco, MD 1, Carolina M. Bejarano, BS 1, Chelsea B. Kozikowski, BA 1, Ali Talwar 2, Tim Wysocki, PhD 1. 1
Nemours Children’s Clinic; 2Tulane University.
Purpose: The American Academy of Pediatrics (AAP) recommends routine screening for adolescent depression in primary care, yet many primary care providers (PCPs) lack adequate training in screening, assessment, and treatment for adolescent depression (SAT-D). A SAT-D training program for PCPs (Fallucco et al, under review) resulted in significant increases in PCP rates of depression screening and discussion of evidence-based depression treatment at annual well visits up to 10 months post training. The objective of this study was to determine long-term (i.e. 18-24 months) posttraining PCP SAT-D practices in a subsample of trained PCPs. Methods: Adolescent patients of PCPs in Jacksonville, Florida reported anonymously on whether or not their PCP screened them for depression, diagnosed them with depression, and discussed treatment for depression (yes/no) at 3 time points. We measured frequency of SAT-D practices among the 21 PCPs for whom data were available before training, just after training (not reported here) and at long-term follow-up 18-24 months post-training. The primary outcome was PCP rates of screening for adolescent depression. A multivariable stepwise logistic regression model was used to compare the presence or absence of screening for depression at baseline vs. long-term follow-up. Adolescent age, gender, race/ethnicity, as well as provider gender and degree were included as variables in our logistic regression. Odds ratios were calculated for depression screening. Secondary outcomes included rates of PCP diagnosis of depression and discussion of evidence based depression treatment. Changes in baseline vs. follow-up PCP
RELATIONSHIP BETWEEN DEPRESSIVE SYMPTOMS AND BIRTH CONTROL SABOTAGE IN ADOLESCENT FEMALES INITIATING CONTRACEPTION Jenny K.R. Francis, MD, MPH 1, Katherine Malbon, MD 2, Debra Braun-Courville, MD 3, Lordes Oriana Linares, PhD 3, Susan L. Rosenthal, PhD 4. 1
Columbia University Medical Center; 2Tribeca Pediatrics; 3Mount Sinai Adolescent Health Center; 4Columbia University College of Physicians and Surgeons. Purpose: “Birth control sabotage,” or reproductive coercion by a partner who specifically interferes with contraceptive pursuits, has been associated with increased risk of unintended pregnancy and partner violence. [1] However, less remains known about psychosocial factors that might influence relationship dynamics and perhaps predispose an adolescent female to episodes of a partner attempting to sabotage one’s birth control. We hypothesize that female adolescents with depressive symptoms likely have impaired motivations and lower self-efficacy within a relationship and therefore more likely to disclose a partner who has attempted “birth control sabotage” in the past. Methods: This cross-sectional study analyzes baseline data of 220 urban, minority adolescent females (ages 15-19 years) presenting for contraceptive initiation in a comprehensive, free-of-cost, adolescent health center in NYC. Birth control sabotage (a partner’s interference with contraception) was assessed by responses to a previous published scale of five items (internal consistency, a ¼ 0.704) [2,3] evaluating reproductive coercion (e.g., “Has someone you were dating or going out with ever put holes in the condom so you would get pregnant?”). Factors that might influence birth control sabotage include demographics, current relationship characteristics e age difference of partner, length of relationship, having sex with current