O’Mareen Spence, MPH
Early Symptom Improvement as a Predictor of Antidepressant Response in Youth Diagnosed with Depression: Translating Evidence from Randomized Controlled Trials to Community Practice
Summary
Over half of children and adolescents diagnosed with depression do not respond to an antidepressant. A critical barrier to improving treatment response is that the translation of clinical trial evidence into population outcomes is lacking. Rich data from pediatric antidepressant randomized clinical trials (RCT) are underutilized to predict response in pediatric outpatient settings. This research applies a Bayesian approach to pediatric antidepressant RCT data to investigate symptom changes early in treatment that predict initial and sustained response among children and adolescents diagnosed with depression. Combined-sample multiple imputation is implemented to impute symptom change measures in outpatient data. The prediction model from the RCT data is then applied to community outpatient data for a pediatric cohort with depression. In the outpatient data, this project will test whether a youth with a high probability of response is less likely to augment the antidepressant with another psychotropic. Here, treatment augmentation is a proxy for treatment non- response. The ultimate goal is to translate response prediction from RCTs to community practice for more effective depression management in pediatric populations. This project will answer the question, “Who would benefit, and when, from antidepressant treatment?” The scientific impact will be advancing translational research of clinical efficacy data to population outcomes.
I am extremely grateful to the PhRMA Foundation for making its Predoctoral Fellowship in Health Outcomes available to international students, like myself, to obtain funding for their dissertation research. The support I have received as a Predoctoral Fellow has allowed me to hone my skills as an independent researcher by giving me the opportunity to focus my time on my dissertation research. The goal of which is to translate evidence obtained from randomized controlled trials to real world data in order to improve the health outcomes of youth diagnosed with depression.
