Keywords: trajectories, latent class analysis, mental health, children and adolescents
Treatment for depression among youth can vary substantially across people and over time. Yet treatment patterns are often assessed using summary measures that obscure the time-varying nature of treatment. For instance, people who abruptly discontinue medication and those who taper off medication are both “off pharmacotherapy”, but experience distinct clinical scenarios. Understanding heterogeneity of treatment for depressed youth may help identify treatment gaps in current practice. We identify distinct classes of youth with similar treatment trajectories in the first year after a diagnosis of depression. Specifically, we fit latent class models to four summary measures of individual trajectories: the number of months (out of 12) with at least one psychotherapy visit and with any antidepressant use, and the number of months from diagnosis to the first antidepressant dispensing and the first psychotherapy visit. We compare baseline characteristics and longer-term measures (hospitalization and attempted suicide). Contrary to accepted guidelines, one-in-twelve received no treatment, and one-in-six received antidepressants without concomitant psychotherapy.