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National Study Reveals Gaps in Antidepressant Treatment Quality for Youth

National Study Reveals Gaps in Antidepressant Treatment Quality for Youth 1024 683 Pam Georgiana

Findings highlight critical disparities and opportunities to improve care.

A national study led by Cynthia A. Fontanella, PhD, principal investigator in the Center for Suicide Prevention and Research in the Abigail Wexner Research Institute at Nationwide Children’s Hospital and professor of Psychiatry and Behavioral Health at the Ohio State University, finds that many young people prescribed antidepressants for major depression are not receiving care that meets established quality standards.

Published in The Journal of the American Academy of Child & Adolescent Psychiatry, the study analyzes Medicaid claims data from nearly 200,000 youth aged 9 to 24 who began antidepressant treatment between 2016 and 2019.

The research team evaluated adherence to three Healthcare Effectiveness Data and Information Set (HEDIS) measures:

  • Acute Phase Treatment: Continued antidepressant use for at least 3 months.
  • Continuation Phase Treatment: Continued use for at least 6 months
  • Follow-up Care: At least three follow-up visits during the Acute Phase.

The results showed concerning results, including:

  • 6% of youth remained on medication through the acute phase.
  • 2% received the recommended follow-up visits.
  • 5% stayed on their treatment through the continuation phase.

“These are well-established indicators of quality of care,” says Dr. Fontanella. “The low rates of follow-up visits and continuation of antidepressant use highlight the urgent need for clinicians to prioritize early and ongoing monitoring, particularly during the high-risk acute treatment phase, to ensure adherence, evaluate treatment response, and manage potential side effects.”

She continues, “Failure to follow treatment guidelines can increase the risk of persistent symptoms, relapse and adverse outcomes, including suicidal thoughts and behaviors. Our findings underscore both the critical importance of structured care plans and educating patients and families about the necessity of consistent, guideline-concordant treatment.”

This study is one of the very few large-scale national evaluations of antidepressant treatment quality in youth.

“There has not been much research in this area,” Dr. Fontanella notes. “Prior studies showed poor quality of care and racial disparities, but they were regional and dated. Ours provides a current, national perspective.”

The research did identify clear disparities. Adolescents and young adults (ages 12 and older), Black and Hispanic youth, those with co-occurring substance use disorders, and those living in socially vulnerable areas with limited access to providers were significantly less likely to meet care benchmarks.

“These gaps likely reflect both cultural preferences and systemic barriers,” Dr. Fontanella explains. “Some families may prefer non-medication approaches such as counseling, while others face limited access to follow-up care or lack trust in health care providers.”

In contrast, youth with prior mental health care, chronic medical conditions, prior psychotropic use or those in foster care had higher rates of care standard adherence. This is likely due to closer monitoring and more structured treatment environments.

Dr. Fontanella notes that the findings also stress the importance of focused quality improvement initiatives.

“Primary care and behavioral health providers play a vital role in overcoming these barriers to quality treatment,” she says. “For example, I have seen some very promising interventions in family education, structured monitoring protocols and new behavioral strategies like reward systems and reminders.”

Dr. Fontanella’s team is conducting follow-up studies using Medicaid data to examine whether adherence to care standards leads to improved outcomes, including decreased deliberate self-harm, suicide and recurrence of depression. .

“We need to ensure all youth, regardless of age, race or geography, have access to consistent, evidence-based depression care,” Dr. Fontanella concludes. “That means addressing both the clinical and structural barriers that hinder access to quality treatment.”

Reference:

Fontanella CA, Hyer JM, Steelesmith DL, Campo JV, Fristad MA, Bridge JA, dosReis S, Brock GN, Olfson M. Antidepressant Treatment Quality of Depressed Youth: A National Evaluation of Medicaid Patients. Journal of the American Academy of Child and Adolescent Psychiatry. 2025 May 27:S0890-8567(25)00257-6.

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.