Running head: COLLABORATIVE CARE INTERVENTION FOR TEENAGE DEPRESSION

Marwa Hammoud
Wayne State University
Dr. O, SW 3810
April 14, 2015

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Abstract:
Very little things are more harmful to a teenager than depression that is not properly
addressed. Depression can go on to be the cause of many other challenges in life such as suicide,
teenage pregnancy, drug abuse, dropping out of school and much worse. This research study
thoroughly discusses a twelve-month collaborative care intervention conducted to find out
whether collaborative studies for adolescents with depression improves the outcomes compared
to usual care. This study is a randomized one designed to advance the evidence-based treatments
for teenagers that screened positive for depression. The goal is to prove that the intervention will
result in a greater reduction in the level of depression compared to the patients that are receiving
regular care.
Key Words: Adolescent depression, collaborative intervention, randomized sample.

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Teenage Depression is Cancerous to Society:
I like to pride myself on being observant and aware of the world around me at all times.
That being the case, I tend to analyze what I think are prominent problems in society. What I
have been the most directly affected by is the alarming rise in teenage depression. Levels of
depression in teenagers are higher now than they have ever been. The fear lies in the fact that
depression often times leads to suicide and a tough life if not properly addressed. Clinical
depression which entails a number of extremely debilitating physical and psychological
symptoms is a serious disease that can do terrible and even permanent damage to a teenagers
developmental progress (Empfield, 47).
Many books written have discussed the dangers of adolescent depression but the most
important one that I have found is one that discusses it as a mental health problem. Mental
Health Disorders in Adolescents states that During adolescence, depression is a common but
serious problem and affects mood, sleep, energy, appetite and ability to concentrate (Hazen, 96).
Depression is not a problem that is easily eradicable because the causes are ample and ongoing.
The media is the main contributor to depression rates because they portray an impossible
ideological image for teenagers, which sets them up to feel like failures when they do not meet
the expectations they have set for themselves mentally. People do not realize the effect that selfdoubt can have on an adolescent who is just looking for a reason to live.
Technology is so advanced today that we find that we have connection to the entire world
at our fingertips. With that kind of connectivity, privacy is a thing of the past. Since teenagers do
not know any better, they put their entire life out there for public scrutiny, and society is ruthless.
Cyberbullying is a problem that is here to stay so long as the internet is around and people have
opposing opinions. People do not realize the weight of their words and the very real harm they

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can do. There have been movies, documentaries, and studies done about cyberbullying and what
a serious problem it is. In the field of social work, there are job positions specifically in place for
this ailing population of adolescents. With this said, it only makes sense that we look into this
social problem deeper and start to find solutions. Good adolescent health care demands that we
look for depression in young people, diagnose it correctly, and treat it aggressively when it
occurs (Empfield 48). Another problem is the misdiagnosis of depression in adolescents. Many
cases get passed off as seasonal depression or parents may just assume that they have a moody,
reclusive teenager. In actuality, many teenagers endure silent struggles and so long as they are
not vocal about it, the problems get dismissed.
Teenagers that fear being judged for who they are tend to hide their true identities in
order to avoid judgement. In many cases, problems within the family play a big role in the
development of a teenagers depression (Hazen, 94). Unpleasant relationships with parents and
family members is the leading cause of adolescent depression. In many cases, this is caused by
the teenagers sexual orientation or belief that goes against what the parents believe. LGBTQ
teenagers arguably have the most difficult time making it through their adolescent years because
of the stresses brought on by their sexual orientation. There is a lot of stigma and judgement
about the LGBTQ community that are hard enough to handle as a grown adult let alone a
teenager. Adolescent years are a time for sexual development and formulating sexual identities.
Often marginalized, LGBT teens experience harassment, threats of violence, and acts of assault,
rejection, and abuse- even from friends and family members (Gerali, 54). If some teens do not
feel safe around their friends and family, that is setting them up for trust issues in the rest of their
lives. Adolescence is a troubling and confusing time and needs to be handled with the utmost

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fragility and care. Teenagers need support in the form of community and family acceptance and
collaboration.
There is a wide array of reasons for teenagers to feel less than or completely useless.
Outside influences tell teenagers every day that they are not meeting expectations and constantly
comparing them to others. This feeling of pointlessness is enough for teenagers to convince
themselves mentally that their family or even their entire surrounding environment would be
better off if they did not exist. One reason for depression that American society seldom
addresses is the reality that they majority of young people are mediocre or poor students Levine
goes on to explain, Unless they are good at some sport, they are not likely to experience any
sense of competence from school (Levine, 117). Meaning, not only are the smart kids that
generally tend to get bullied feeling depressed, but the adolescents struggling in school are also
feeling depressed. There is not a single type of demographic of teenagers that get bullied.
Bullying knows no boundaries; it is the same all across the board.
Research design:
In the article Collaborative Care for Adolescents with Depression in Primary Care, there
is a randomized trial with blinded outcome assessment conducted between April 2010 and April
2013. Some threats to internal validity could be to trust the participants to give you the full truth
in the screenings. Since the some of the screenings included questionnaires, it was up to the
participant and their integrity to offer the most precise facts. An external threat could be the
sudden change of mind by a participants guardian, therefore needing to adjust the intervention.
The study focuses on delivering and following up on treatment in a primary-care setting.

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The article mentioned that the US Preventive Services Task Force now recommends
depression screening among adolescents. The system that this study decided to use is called the
Reaching Out to Adolescents in Distress (ROAD). ROAD is fundamentally a collaborative care
between providers, patients and family that work together to overcome barriers and offer more
effective, individualized treatment. The care takers in the ROAD system focuses on helping the
patients define their goals, monitor their progress and providing ongoing support over the course
of the study. With the usual care that the adolescents received for their depression, they also
received their depression screening results and could choose to get mental health services at
Group Health. This is important because this study proved that the more involvement there was
in the care for the depression, the better the outcomes will be. The control group represents the
general population in America that gets minimal treatment for depression. To understand the
general adolescent public, we can easily look to the control group for a good idea of what the
average adolescent goes through and why their treatment may or may not be working for them.
Sampling:
The sample size of the study consisted of adolescents aged thirteen through seventeen
who screened positive for depression on two occasions or screened positive for major depression.
The study began by mailing out 10,955 invitations to potential participants. About 10,000
adolescents were eligible for screening and out of those adolescents, 4,010 completed the
screening. The roughly 6,000 adolescents that were rejected were either not fluent in English,
their parents wouldnt give consent, not reachable after initial screening, or parent consented but
the child refused to participate. The participants were then filtered further by completing the
baseline visit, which only 171 did. Out of the 171 participants, only 105 were eligible for trial.
The 66 participants that did not make the cut were either being treated for bipolar disorder, did

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not met depression criteria, had suicidal ideation, or were already receiving psychological care.
The selection of the participants was randomized and four participants refused that idea so they
dropped from the study. With all of the screening complete, the final group of participants
consisted of 101 adolescents.
Measurement:
For this study, it was important for the adolescents to screen positive for depression and
to be between 13-17 years of age. The study would only work on adolescents with depression
significant enough to measure change in. There is a control group of 51 participants and an
intervention group of 50 participants. Both groups had a mean age of 15 years old. The
intervention group consisted of 36 girls and 14 boys while the control group consisted of 37 girls
and 14 boys. The majority of the populations were white. Before beginning the study, the
participants went through many screenings. According to the study, CRAFFT is a behavioral
health screening tool developed to screen adolescents for alcohol and other drug use disorders.
The acronym stands for Car, Relax, Alone, Forget, Friends, Trouble and it ensures that none of
the approved participants used any substances.
Data Collection:
Although The National Institute of Mental Health funded the study, they had no influence
in the actual conduction of the study. The funding was reduced prior to the study so the target
sample size had to be reduced from 160 to 101 participants. The intervention model cost $1,403
per participant. The ROAD system was also very important in the data collection for this study.
All of the data collected had no guidance on the participants since the information wasnt
released or discussed until the conclusion of the study.

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Ethics and Cultural Considerations:
This intervention was effective with my target population because there were significant
results from the study. It is an important study because it could potentially put an end to
adolescent depression, which would virtually eliminate teenage depression leading to suicide.
The study stated, Up to 20% of adolescents experience an episode of major depression by age
18 years yet very few receive evidence-based treatments for their depression. This was an
alarming fact and I made me question why studies like this one that are effective are not being
put to use today. What I found to be the most impressive part of this intervention is that it does
not have limitations in terms of ethnicity, race, or gender. The conductors of the study understand
that depression effects teenagers from an assortment of backgrounds. Even the initial surveys
that sent to the homes were completely randomized and were not looking for any particular
group of adolescents. The study also went through a safety assessment that evaluated both the
intervention and control youth that endorsed suicidal ideation.
The participants and their guardians were well aware of what the study entailed and all
gave consent. The intervention states parents of all adolescents receiving primary care through
the study clinics received a letter describing the study with an opt-out number. In addition, the
research staff subsequently called parents that did not choose to opt-out to obtain consent.
Adolescent consent was also obtained over the phone prior to a brief screening that included
questions from a Patient Health Questionnaire. Research assistants in the primary care clinic
collected baseline data, the outcomes were assessed over the phone at 6 months, and 12 months
by the assistants that were blinded to the intervention status. There were not any ethical issues or
biases in this study since everything was randomized and blind to guarantee the best possible
results. The way the data collection and review was completed, and the conduction of the study

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were done correctly and there was little room for ethical concerns. One occurrence during the
intervention that was a little alarming was that three patients in the intervention and two in the
control group had to undergo psychiatric hospitalization. I understand that this may not have
been a direct result from the study itself, I just think that something could have been done to
prevent it from happening. Other than that, the study seemed like it was conducted with ease and
it was impressive that the researchers kept such close eyes on the study over a 12 month period.
Results and Implications:
The results of this study concluded that the intervention group had greater decreases in
scores on the Child Depression Rating Scale (CDRS). There was a change in depressive
symptoms on the Child Depression Rating Scale from baseline to 12 months. Essentially, the
research done concluded that the CDRS scores decreased from 48.3 to 27.5 for the participants in
the intervention group compared to a decrease from 46.0 to 34.6 for the participants in the
control group. The overall depression decrease at the end of the study was 50.4% for the
intervention participants compared to 20.7% for the participants in the control group. The article
specified that Overall, 86% of the participants in the intervention group received psychotherapy
or medications that met the study quality standards compared with 27% of the control group.
The results are clear prove that collaborative care is the best course of action for adolescents
suffering from depression. There are significant numbers to back the results of this study for
anyone that is interested.
This was a perfect intervention for the topic of adolescent depression because this is a
very serious problem effecting teenagers all over the world. Just as any other social issue that are
constantly being studied to find solutions to, this solidifies that there is a solution to this
devastating problem. I believe that this deserves as much attention as other social problems

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because adolescents are really our future. Raising depressed teenagers that go without treatment
can lead to a terrible future for society in general. This study had the ability to save many people
time and pain because it is finding a solution to their problem. Along with helping teenagers with
their depression, it also gives their parents a peace of mind.
As a social worker, I am limited to what I can do for adolescent clients who suffer from
depression. Therapy certainly does help, but sometimes there needs to be more done to find a
permanent solution to problems. This study included the involvement of different aspect of the
participants lives that I alone cannot substitute. It is important for me to continue to do my
research and find other ways to help clients. For that to happen, studies like this Collaborative
intervention need to remain to be conducted. To conduct this type of research myself, I would
need a better grasp on statistical psychology and to know all that goes into researches. There was
a lot of math and science that went in to this research that I know I will not be able to do by
myself.
In an intervention like this one, it is possible to have barriers or challenges that make it
difficult to implement the intervention. One of the main difficulties is getting every participants
consent. Lack of consent alone minimized the original participation number by a couple
thousand. Another difficulty is the truthfulness of the participants. They might not be feeling as
good or bad as they claim to be during the 6-month assessment. Therefore, you will not know if
there is any actual progress happening. The clients openness can be the reason the study is a
complete success or a complete failure. This study seemed to have the participants full truth and
involvement because the results proved that everyone did their part for the best possible
outcomes. This intervention found a solution to the problem of adolescent depression and it is a
good staple of research.

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References:
Richardson MD, L., Ludman PhD, E., Mc Cauley PhD, E., & Lindenbaum MD, J. (2014).
Collaborative Care for Adolescents with Depression in Primary Care. A Randomized
Clinical Trial.
Empfield, Maureen, and Nick Bakalar. Understanding Teenage Depression: A Guide to
Diagnosis, Treatment, and Management. New York: H. Holt, 2001. Print
Hazen, Eric P., and Mark A. Goldstein. Mental Health Disorders in Adolescents: A Guide for
Parents, Teachers, and Professionals. New Brunswick, NJ: Rutgers UP, 2011. Print.
Levine, Bruce E. Surviving America's Depression Epidemic: How to Find Morale, Energy, and
Community in a World Gone Crazy. White River Junction, VT: Chelsea Green Pub.,
2007. Print.
Rubin, Allen, and Earl R. Babbie. Essential Research Methods for Social Work. Belmont, CA:
Thomson/Brooks/Cole, 2007. Print.
Coleman, L. (2004). The copycat effect: How the media and popular culture trigger the mayhem
in tomorrow's headlines. New York: Paraview Pocket Books.
University of Washington. "Reach Out for Teens Program" ReachOut4Teens. Evidence Based
Treatment, n.d. Web. Apr. 2014.
Gerali, Steve. What Do I Do When-- Teenagers Are Depressed and Contemplate Suicide? El
Cajon, CA: Youth Specialties, 2009. Print.