Youth depression is a major public health concern nationwide – and especially in Texas, which ranks last for access to mental healthcare. Research from the Center for Depression Research and Clinical Care at UT Southwestern and Children’s Health℠ shows that youth from low-income Texas households are less likely to receive the most effective depression treatment. These findings highlight critical gaps in care and point to strategies already underway to expand access for children and teens.
“Our study suggests that children from low-income households in Texas are less likely to receive the recommended treatment for major depressive disorder – even when they express a desire for those treatments,” says Emine Rabia Ayvaci, M.D., Child and Adolescent Psychiatrist at Children’s Health and Assistant Professor of Psychiatry at UT Southwestern, and first author of the study.
Sobering stats of youth depression and state-wide efforts to improve mental health care
In 2023, 21% of Texas youth reported serious thoughts of suicide and 12% attempted suicide, according to the Youth Risk Behavior Survey. Some 42% of Texas high school students reported feeling sad or hopeless almost daily for two weeks or more.
To address the crisis, the Texas state legislature created the Texas Child Mental Health Care Consortium. The consortium was designed to leverage the expertise and capacity of health-related institutions of higher education to address urgent mental health challenges and improve the mental health care system for children and adolescents in Texas. The project includes the Texas Youth Depression and Suicide Research Network (TX-YDSRN), a collaborative effort between 12 Texas health-related institutions, with UT Southwestern serving as the hub.
“The network’s first step was to create a large prospective registry of participants so we can characterize youth depression and suicidality in the state,” Madhukar Trivedi, M.D., the Scientific Lead of TX-YDSRN, says. Participants are referred to the study when they seek treatment for depression. Since opening, the study has enrolled more than 2,600 participants ages 8 to 20. Researchers collect baseline clinical data along with information about treatments and social determinants of health – with a goal to follow participants for 10 years. The study will help identify mental health needs for youth across Texas.
Key details: Examining treatment options in youth with depression
To learn more about treatment utilization, Dr. Ayvaci and colleagues assessed data from 646 youth with major depressive disorder enrolled in the TX-YDSRN study, publishing their findings in Psychiatric Research & Clinical Practice. In their first month of care, 7% of participants received no treatment, 5% received therapy only, 35% received medication only and 53% received combination treatment.
Previous research showed that the combination of behavioral therapy and antidepressant medication is superior to either therapy or medication alone for adolescents with moderate to severe depression. Dr. Ayvaci says, “Almost half of participants were not receiving that gold standard of care.”
The researchers found no significant differences in treatment utilization based on race or sex. But rates of medication-only treatment were more than three times higher for children from households earning less than $25,000 annually compared to patients from households earning $200,000 or more. Nevertheless, 40% of youth receiving medication only – and 66% of their guardians – expressed a preference for combination treatment. The findings suggest that many young people with mental health challenges are not getting the treatment they want.
While the study did not assess reasons for the disparity, most practicing physicians are familiar with the usual culprits. Dr. Ayvaci says, “It’s very difficult to find psychiatrists, psychotherapists, and counselors for pediatric patients, especially in rural areas.” She adds, “Other challenges can include problematic insurance coverage and logistical barriers such as lack of transportation or an inability to take time off work to get children to appointments.”
Next steps to improve youth mental health
This study aimed to provide a baseline snapshot of treatment utilization. “My hope is that as we collect more data, we’ll understand how treatment is shifting over time and continue to improve access to care,” Dr. Ayvaci says.
Clinicians can help, she adds, by engaging patients and their families about their preferences. “When a mismatch exists between the treatment they’re getting and the treatment they want, providers can help families find resources to overcome the barriers,” she says.
Meanwhile, the TX-YDSRN is taking steps to improve treatment access for youth with depression. The network created Activ8, an 8-week behavioral activation program for teens and their caregivers. The program provides services via telehealth, reducing barriers related to time, geography and cost. Activ8 also trains and certifies interventionists to lead treatment sessions, with the goal of building a more robust mental health workforce. “The program is still new and collecting data, but we’re hopeful that it will help to expand access to treatment in underserved communities across the state,” Dr. Ayvaci says.
Children’s Health: A leader in pediatric and adolescent mental health
Children’s Health is among the top-ranked children’s hospitals for pediatric and adolescent behavioral health. The Pediatric Psychiatry and Psychology program provides a wide variety of treatment options for youth experiencing mental and behavioral health challenges.
The Pediatric Depression Clinic treats patients from age 7 to 17. To refer a patient, call 214-456-8899 or refer a patient online.
