Importance Depression during childhood and adolescence is heterogeneous. Treatment patterns are often examined in aggregate, yet there is substantial variability across individual treatment trajectories. Understanding this variability can help identify treatment gaps among youths with depression. Objective To characterize heterogeneity in 12-month trajectories of psychotherapy and antidepressant treatment in youths with depression. Design, Setting, and Participants This is a longitudinal-cohort study of youths 18 years or younger with a new diagnosis of depression and at least 12 months of follow-up following diagnosis, as determined from commercial insurance claims filed from 2007 to 2014. Latent class models were fit to summary measures of psychotherapy and antidepressant use in the 12 months following the index diagnosis. We examined variation in baseline health, health care utilization, and health outcomes across classes with similar patterns of psychotherapy and antidepressant use. Data analysis took place between June 2016 and March 2017. Main Outcomes and Measures Psychotherapy and antidepressant use. Results The cohort included 84 909 individuals with a mean (SD) age at index diagnosis of 15.0 (2.6) years, of whom 49 995 (59%) were female. Attention-deficit/hyperactivity disorder (n = 14 625; 17%) and anxiety (n = 12 358; 15%) were the most common comorbid diagnoses. During the assessment period, 59 023 individuals (70%) received psychotherapy at any point, and 33 997 individuals (40%) were dispensed antidepressants at any point. Eight classes with distinct treatment trajectories were identified, which we classified into 4 broad groups: 3 classes that received dual therapy (n = 18 710; 22%), 2 classes that received antidepressant monotherapy (n = 15 287; 18%), 2 classes that received psychotherapy monotherapy (n = 40 313; 48%) and 1 class that received no treatment (n = 10 599; 13%). The most common class received psychotherapy monotherapy (n = 35 243; 42%) and had the lowest incidence of attempted suicide (0.8 per 100 person-years [PY]) and inpatient hospitalization (3.5 per 100 PY) during the assessment period and postassessment period (0.5 per 100 PY and 1.3 per 100 PY, respectively). The group receiving dual therapy had the highest incidence of attempted suicide during the assessment period (4.7-7.1 per 100 PY, depending on the class) and postassessment period (1.5-1.7 per 100 PY). Conclusions and Relevance In our sample, 13% of youths received no treatment, and 18% received antidepressants without concomitant psychotherapy. Summary measures of treatment can mask informative patterns of psychotherapy and antidepressant use. Latent class analysis can be used to identify subgroups of individuals with similar treatment trajectories and help identify treatment gaps under current practice patterns.

中文翻译：

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儿童和青少年抑郁症诊断后 12 个月治疗轨迹的变化

童年和青春期的重要性抑郁症是异质的。治疗模式通常是综合检查的，但个体治疗轨迹之间存在很大差异。了解这种可变性有助于确定青少年抑郁症的治疗差距。目的 表征青少年抑郁症 12 个月心理治疗和抗抑郁治疗轨迹的异质性。设计、设置和参与者 这是一项纵向队列研究，对象为 18 岁或以下新诊断为抑郁症并在诊断后至少进行 12 个月的随访，根据 2007 年至 2014 年提交的商业保险索赔确定。类模型适合于在指标诊断后的 12 个月内对心理治疗和抗抑郁药使用的汇总测量。我们检查了具有相似心理治疗和抗抑郁药使用模式的班级之间基线健康、医疗保健利用和健康结果的变化。数据分析发生在 2016 年 6 月至 2017 年 3 月之间。主要结果和措施心理治疗和抗抑郁药的使用。结果 该队列包括 84 909 名个体，其指数诊断的平均 (SD) 年龄为 15.0 (2.6) 岁，其中 49 995 (59%) 名是女性。注意缺陷/多动障碍（n = 14 625；17%）和焦虑（n = 12 358；15%）是最常见的共病诊断。在评估期间，59 023 人（70%）在任何时间点接受了心理治疗，33 997 人（40%）在任何时间点接受了抗抑郁药。确定了具有不同治疗轨迹的 8 个类别，我们将其分为 4 个大组：接受双重治疗的 3 个班级（n = 18 710；22%），接受抗抑郁药单药治疗的 2 个班级（n = 15 287；18%），接受心理治疗单药治疗的 2 个班级（n = 40 313；48%）和 1 个班级未接受治疗的患者（n = 10 599；13%）。最常见的类别接受心理治疗单药治疗（n = 35 243；42%），在评估期间和评估后自杀未遂（0.8/100 人年 [PY]）和住院住院（3.5/100 PY）的发生率最低期间（分别为每 100 PY 0.5 和每 100 PY 1.3）。接受双重治疗的组在评估期间（每 100 PY 4.7-7.1，取决于类别）和评估后期间（每 100 PY 1.5-1.7）的自杀未遂发生率最高。结论和相关性 在我们的样本中，13% 的青少年未接受治疗，18% 的患者接受了抗抑郁药，但没有同时进行心理治疗。治疗的总结措施可以掩盖心理治疗和抗抑郁药使用的信息模式。潜在类别分析可用于识别具有相似治疗轨迹的个体亚组，并帮助识别当前实践模式下的治疗差距。