Semester

Spring

Date of Graduation

2009

Document Type

Dissertation

Degree Type

PhD

College

School of Pharmacy

Department

Pharmaceutical Systems and Policy

Committee Chair

Virginia (Ginger) Scott

Abstract

Major depressive disorder is a serious public health problem and impacts approximately 2% of children and 4-8% of the adolescents in the United States (Birmaher et al., 1996). There are risks associated with untreated major depressive disorder and no sound epidemiological basis for treating children and adolescents with this disorder (Brent, 2005). The purpose of this study was to examine physician treatment preferences for children and adolescents with major depressive disorder and to examine the factors which impact these choices.;The study was conducted in two phases. Phase I involved identifying pediatricians who treat child and adolescents for major depressive disorder and who were willing to participate in the larger Phase II survey, regarding specific treatment practices. Survey methodology was utilized in both phases and a national random sample of pediatricians (n=2,000) and child psychiatrists (n=2,250) was employed.;Approximately 40.00% of the pediatricians who returned surveys indicated they treat children and/or adolescents. Of those 163 pediatricians who treat children and/or adolescents, only 67.48% (n=110) were willing to participate in the Phase II survey. Phase II of this study determined the majority of the child psychiatrists indicated they utilize a combination of antidepressants and counseling to treat children (52.19%) and adolescents (76.95%) with major depressive disorder. A preponderance of pediatricians also use a combination of antidepressants and counseling to treat children (63.46%) and adolescents (87.72%) with major depressive disorder. In the event physicians utilize an antidepressant medication for the first-line of treatment for children or adolescents, they indicated they most commonly prescribe medication was either ProzacRTM or ZoloftRTM.;It was found that child psychiatrists and pediatricians monitor both children and adolescents significantly less (p=0.000) than the U.S. FDA recommendations during the first and second months of antidepressant therapy. During month three, pediatricians still monitor children and adolescents significantly less (p=0.000) than the U.S. FDA recommendations. However, the frequency with which child psychiatrists monitor children (p=0.098) and adolescents (p=0.101), who are on antidepressant treatment, during the third month of treatment, does not differ significantly from the U.S. FDA recommendations.;It was found the type of physician, age of the physician, and geographic region in which the physician practiced was associated with prescribing antidepressant medication for a child with major depressive disorder. Exploratory factor analysis revealed four underlying factors; socio-economic status of patient, disease severity, medication cost, and drug profile. Based on this analysis, it was concluded that these four factors influence child psychiatrists' decision of whether or not to prescribe antidepressant medication to a child or adolescent who had been newly diagnosed with major depressive disorder.;In the absence of empirical research to guide the selection of treatment of children and adolescents with major depressive disorder this study determined physicians prefer to treat children and/or adolescents with a combination of antidepressants and counseling. Physicians reported an adequate course of treatment to help prevent relapse of depressive symptoms. However, physicians need to increase the amount of monitoring to be in line with U.S. FDA monitoring recommendations. Limitations to the study are those inherent with any research utilizing survey methodology. The rationales behind physician preferences for treatment and monitoring choices for children and adolescents with major depressive disorder were not studied and are subject to future research. Further investigation is also warranted to better understand the associations between physician characteristics (specialty, age, and geographic location) and the treatment prescribed.

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