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Ethnic Response Differences to Individual Treatment of Comorbid Disorders in Adolescents

Ethnic Response Differences to Individual Treatment of Comorbid Disorders in Adolescents. David Salinas University of Colorado Health Sciences Center.

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Ethnic Response Differences to Individual Treatment of Comorbid Disorders in Adolescents

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  1. Ethnic Response Differences to Individual Treatment of Comorbid Disorders in Adolescents David Salinas University of Colorado Health Sciences Center

  2. Substance-dependent Teens: Impact of Treating Depression16 week double-blinded randomized clinical trial of fluoxetine or placebo and Cognitive-Behavioral Therapy Paula Riggs M.D. University of Colorado Health Sciences Center

  3. Statement of Problem: Historically, treatment providers have addressed either substance abuse or mental health problems as the primary disorder rather than addressing both disorders concurrently; for example Major Depression Disorder (MDD), Substance Abuse Disorder (SUD) , and Conduct Disorder (CD).

  4. Secondary Data Analysis: Individual fluoxetine/placebo + Cognitive Behavioral Therapy (CBT) treatment of Hispanic adolescents with MDD, SUD, and CD, ages 13-19. Versus Individual fluoxetine/placebo + CBT treatment of Caucasian adolescents with MDD, SUD, and CD, ages 13-19.

  5. Hypothesis: Caucasian adolescents will have a higher response than Hispanic adolescents to individual fluoxetine/placebo and CBT intervention in a randomized 16-week clinical trial to treat MDD, SUD, and CD in adolescents ages 13-19.

  6. Methods: • Sample selected from subjects admitted to main study. • Main study conducted in Denver, Colorado. • Subjects ages 13-19 y.o. • Ethnicity (Hispanic or Caucasian), was self-reported on the Demographic Information Questionnaire. • Concurrent measurements of MDD, SUD, and CD were taken throughout the study. • Overall improvement response to treatment measured by the Clinical Global Impression Improvement (CGI-I) scale.

  7. Results: Preliminary analysis: 81 subjects with baseline values and 65 subjects with baseline and post-study visit values. Baseline count: Caucasian: 54 Hispanic: 27 Post-study count: Caucasian: 45 Hispanic: 20

  8. Results: For baseline MDD and change scores on Child Depression Rating Scale (CDRS) and CarrollQuestionnaire, there were no differences. • CDRS baseline: p=.21 • CDRS change: p=.31 • Carroll baseline: p=.29 • Carroll change: p=.36

  9. Results (cont.): For baseline SUD and CD and change score, there were no differences. • Days used past 30 days baseline: p=.49 • Days used past 30 days change: p=.99 • Number negative UA’s: p=.22 • Proportion positive UA’s: p=.18 • Baseline CD symptoms (nonparametric): p=.19 • CD symptoms change (nonparametric): p=.11

  10. Results (cont.): For CBT attendance and compliance there were no differences. a. CBT attendance: p=.22 b. CBT compliance: p=.20 OVERALL IMPROVEMENT RESPONSE TO TREATMENT MEASURED BY CGI-I Caucasian adolescents: 67% Hispanic adolescents: 85% p=.127

  11. Conclusion: • Hispanic improvement response to treatment was higher. • However, no significant response differences to treatment between both groups. • Perhaps high acculturation in Hispanics.

  12. Implications: • Comorbid disorders in Hispanic adolescents may be treated simultaneously. • Individual treatment of fluoxetine and CBT may serve as an effective method of treatment for depression and substance use in Hispanic adolescents.

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