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01-11-2019 | Mood Disorders | Original Contribution

Trajectories of change of youth depressive symptoms in routine care: shape, predictors, and service-use implications

Authors: Elisa Napoleone, Chris Evans, Praveetha Patalay, Julian Edbrooke-Childs, Miranda Wolpert

Published in: European Child & Adolescent Psychiatry | Issue 11/2019

Abstract

Depression is one of the main reasons for youth accessing mental health services, yet we know little about how symptoms change once youth are in routine care. This study used multilevel modeling to examine the average trajectory of change and the factors associated with change in depressive symptoms in a large sample of youth seen in routine mental health care services in England. Participants were 2336 youth aged 8–18 (mean age 14.52; 77% females; 88% white ethnic background) who tracked depressive symptoms over a period of up to 32 weeks while in contact with mental health services. Explanatory variables were age, gender, whether the case was closed, total length of contact with services, and baseline severity in depression scores. Faster rates of improvement were found in older adolescents, males, those with shorter time in contact with services, closed cases, and those with more severe symptoms at baseline. This study demonstrates that when youth self-report their depressive symptoms during psychotherapy, symptoms decrease in a linear trajectory. Attention should be paid to younger people, females, and those with lower than average baseline scores, as their symptoms decrease at a slower pace compared to others.

We conducted a sensitivity analysis on the uncensored sample. The results were broadly similar, the only notable difference being the fixed main effect of total length of contact being significant in the uncensored sample, which we attribute to the larger variability in this variable that followed from including the top 10% of contact lengths.

Model building was also approached including all scores from baseline in the outcome variable, and the results were similar.

Pseudo R² = 1 − (Final model intercept variance/model 2b intercept variance).

Pseudo R² = 1 − (Final model slope variance/model 2b slope variance).

Pseudo R² = 1 − (Final model within-subjects residual/model 1 within-subjects residual).

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Title: Trajectories of change of youth depressive symptoms in routine care: shape, predictors, and service-use implications
Authors: Elisa Napoleone
Chris Evans
Praveetha Patalay
Julian Edbrooke-Childs
Miranda Wolpert
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Keywords: Mood Disorders
Care
Affective Disorder
Published in: European Child & Adolescent Psychiatry / Issue 11/2019
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-019-01317-5

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Trajectories of change of youth depressive symptoms in routine care: shape, predictors, and service-use implications

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