FROM JAMA PEDIATRICS
Integrating care for behavioral/mental problems into primary health care is beneficial for children and adolescents, as it has been shown to be for adults, according to a report published online Aug. 10 in JAMA Pediatrics.
A meta-analysis of 79 randomized clinical trials involving nearly 25,000 patients established the clinical superiority of collaborative care in the primary care setting over usual care for adults with depression or anxiety, but until now there hasn’t been a similar attempt to compare these two approaches in the pediatric population.
“We conducted a systematic review and meta-analysis of the literature to address the empirical question: Does integrated behavioral health and primary medical care for children and adolescents lead to improved behavioral health outcomes, compared with usual care?” said Joan Rosenbaum Asarnow, Ph.D., of the Semel Institute for Neuroscience and Human Behavior, department of psychiatry and biobehavioral sciences, University of California, Los Angeles, and her associates.
The investigators included 31 randomized clinical trials in their analysis, with a total population of 13,129 patients aged 1-21 years: the sample sizes of the individual trials ranged from 28 to 3,111 participants. These studies compared usual primary care against integrated primary care that included cognitive-behavioral therapy, parenting education, interpersonal psychotherapy, medication management, substance-use treatment, peer counseling, and motivational interviewing. The most common behavioral/mental disorders that these children and adolescents sought treatment for were depression, anxiety, somatic concerns, attention deficit–hyperactivity disorder (ADHD), substance use, and the catch-all category of “behavior problems.”
Integrated behavioral/mental health care within the primary care setting consistently showed a small-to-medium but significant advantage over usual care. In particular, collaborative care involving a team of primary care physicians, care managers, and mental health specialists was very beneficial, “with a 73% probability that a randomly selected youth would experience better outcomes after receiving collaborative care than a randomly selected youth receiving usual care,” Dr. Asarnow and her associates wrote (JAMA Pediatr. 2015 Aug 10 doi: 101001/jamapediatrics.2015.1141).
The Patient Protection and Affordable Care Act incentivizes this integrated approach, in part by identifying behavioral health treatment as an “essential health benefit” and by increasing insurance coverage for behavioral/mental problems (Adm Policy Ment Health. 2013;40:258-63). This meta-analysis documents the benefits of such an integrated approach, which enhances confidence that “we are on a course that will yield improvements in the lives of youth and families,” the investigators added.
This study was supported in part by the National Institute of Mental Health and the Society for Clinical Child and Adolescent Psychology. Dr. Asarnow and her associates reported having no relevant financial disclosures.