(PS7-D94) Psychological Intervention Outcomes in Primary Care for Depressed and Anxious Youth: A Meta-analysis

Background: Despite ongoing efforts to identify and remediate symptoms of depression and anxiety among youth, rates of internalizing disorders are at a historic high. Estimates predict that 20% of youth experience clinically elevated anxiety symptoms and 25% experience symptoms of depression – yet only 40% receive treatment (Racine et al., 2021; Reinert et al., 2022). To address this ongoing surge in youth internalizing disorders, innovative initiatives aimed at expanding efficacious psychological interventions are needed. Primary care can serve as an ideal setting to identify and provide early intervention to depressed and anxious youth. Because most families are familiar with primary care providers and routinely participate in health screening in these settings, providing psychological interventions in primary care can improve access to mental health services. Meta-analyses show that implementing psychological interventions in primary care improves youth outcomes compared to usual care (e.g., Asarnow et al., 2015). However, little is known about the effectiveness of primary care-based psychological interventions that target youth depression and anxiety. Moreover, there is a paucity of evidence identifying which interventions to use and for whom. The primary aim of this meta-analysis is to estimate the mean effect of psychological interventions delivered in primary care on post-intervention symptoms of depression and anxiety in youth. The secondary aim is to evaluate candidate moderators of treatment outcomes, including characteristics of (a) interventions (e.g., type, duration, cultural adaptation), (b) implementation (e.g., medication enhancement, integration model, provider), and (c) participants (e.g., mean age, percentage of each race/ethnicity).    

Methods: We searched four bibliographic databases (Medline Ovid, PsycINFO, Embase, Cinahl) to identify studies evaluating psychological interventions in primary care for depressed and anxious youth (ages 2 to 21 years old). Published studies or dissertations/theses that were written in English between 1970 and 2022, and reported pre-post outcome data, were included (e.g., RCTs, single-group designs).

Results: A total of 4596 studies were identified across five decades of literature. Pre-screening and full-text review are currently underway. Pre- and post-intervention means, standard deviations, and other data will be extracted from included studies to compute both standardized mean differences between intervention and control groups, and standardized mean gains to reflect pre-post change (Hedges’ g). In addition, candidate moderators of intervention outcomes will be assessed.

Conclusion: Findings from this study will inform best practices for healthcare providers, hospitals, and researchers aiming to provide psychological interventions for depressed and anxious youth in primary care. Moreover, identified moderators could guide decision making on the selection and implementation of psychological interventions for youth in primary care. Lastly, study results could shed light on future directions on ways to improve psychological services for depressed and anxious youth via primary care.