Abstract
BackgroundThe worldwide prevalence of depressive disorders among children and youth has been reported in ranges from just under 3% to over 10%. In Canada, 7% of youth report past year depression, which is higher than any other age demographic. Yet, many of these youth do not receive evidence based interventions, increasing their risk for serious lifetime consequences. To better understand low service use, it is crucial to map and evaluate current services. This study aimed to determine the scope and nature of services available to depressed children and youth, and compare services to best evidence treatment guidelines.MethodsSeveral government and non-government resources were utilized to develop a new multi-sectoral database of depression services for children and youth across Ontario. An online survey was sent to program managers serving children/youth with depression, examining agency characteristics, populations served, services provided, patterns of service use, evaluation activities, and research priorities.Results413 agencies with 869 program managers participated, representing mental health, addictions and other sectors. Age groups served included children up to 12 years of age (31%), adolescents aged 13–17 (70%) and transition aged youth (18–25 years) (81%). Over half of respondents worked in the mental health (43.4%) or mental health and addiction (24.4%) sectors. The most frequently provided services were assessment, psychotherapy, case management, and psychoeducation; the most common types of psychotherapy provided included cognitive behavioral therapy, social skills training, and solution-focused therapy. Psychotherapies are offered in widely varying formats, frequencies and durations. Discontinuation rates varied, with higher discontinuation among transition aged youth as compared to children. Respondents identified effective treatment, improving access, and reducing service gaps as top future research priorities.ConclusionsThis study provides important new data on service provision and uptake for depressed children and youth. Comparing these results with best-evidence practice guidelines raises significant concerns about the services most commonly offered and their delivery formats. In addition, high early discontinuation rates raise questions about the service experiences of children, youth and their families. Other factors which may contribute to ongoing treatment engagement challenges include access barriers, service or client characteristics, and unintentional treatment impacts.
Highlights
The worldwide prevalence of depressive disorders among children and youth has been reported in ranges from just under 3% to over 10%
The database was developed through an iterative process in which we examined existing databases from government and nongovernmental agencies and conducted online searches using search terms including “depression” and “mood” and noted contact information for programs for children, adolescents, youth, young adults and/or transitions-age youth
The median number of years respondents reported working with youth was 16 (Interquartile range [IQR] = 10–25 years)
Summary
The worldwide prevalence of depressive disorders among children and youth has been reported in ranges from just under 3% to over 10%. Major depressive disorder occurs at high rates among youth, but most will not receive professional evidence based mental health treatment for this illness. Studies of adolescents and transition-aged youth (TAY), show that approximately 40% of depressed youth had never received professional mental health services [8] Simultaneous with these low rates of service use, there appears to be a worsening trend for depression among youth [2, 9,10,11], suggesting that the number of untreated depressed youth may be growing. An increased prevalence of depression with low rates of professional treatment has serious implications for adolescent and lifelong mental health [8, 12]: in one longitudinal cohort study, adolescents with a mental disorder who did not receive professional treatment had seven times higher odds of clinical depression by age 17 than adolescents who did access services earlier in adolescence [13]
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