HMN 2025: What are the disparities in mental health care for youth from lower-income households

Young patients from lower-income households in Texas may not be getting the most effective treatment for severe depression and suicidal thoughts, based on findings from researchers at UT Southwestern Medical Center.

According to the study conducted as part of the Texas Youth Depression and Suicide Research Network (TX-YDSRN) initiative, these patients are much less likely to receive a combination of psychotherapy and medication, which prior research has shown to be more effective than either treatment alone in improving outcomes for youth with moderate to severe depression. The findings were published in Psychiatric Research and Clinical Practice.

“Combination treatment is the recommended option for moderate to severe depression in youth, as it targets both biological and psychological aspects of the disorder,” said senior author Madhukar Trivedi, M.D., Professor of Psychiatry, Chief of the Mood Disorders Division, and founding Director of the Center for Depression Research and Clinical Care (CDRC) at UT Southwestern.

“When youth cannot access this treatment, often due to financial or geographic barriers, they may receive care that is less effective, increasing the risk for persistent depression and suicidal behavior.”

The researchers studied patient data collected by the TX-YDSRN for 646 depressed youth ages 8 to 20 from clinical sites across the state, including Children’s Health. Patients were grouped by the treatment they received during their first month of care: no treatment; therapy only; medication only; or a combination of therapy and medication. Sociodemographic and clinical features were compared across these treatment types.

The most common treatment was combination therapy (52.8%), followed by medication only (34.8%). However, young patients who received medication only were more than three times as likely to come from households earning $25,000 or less annually than those from households earning $200,000 or more (20.5% vs. 6.2%). Young patients from higher-earning households were more likely to receive combination therapy (18.3% vs. 9.3%).

“These findings reinforce the importance of integrating both psychotherapy and pharmacotherapy into the treatment of depression in youth based on youth and caregiver preferences. They also highlight the need to remove financial barriers to accessing combination treatment, which could lead to better patient outcomes and reduced suicide risk,” Dr. Trivedi said.

E. Rabia Ayvaci, M.D., Assistant Professor of Psychiatry at UT Southwestern and the study’s first author, said that there were no significant differences in treatment by race or sex and that youth with more severe symptoms were more likely to receive combination treatment.

“The goal is to continue examining treatment access and outcomes longitudinally, which will allow for future evaluation of the effectiveness of different treatment approaches over time,” Dr. Ayvaci said.

Dr. Trivedi said a recent initiative from the CDRC and TX-YDSRN, called Activ8, could play a role in improving access to care across Texas.

“Activ8 is a behavioral activation telehealth program for teens that reduces time, financial, and geographic/transportation barriers to care,” he said.

“The initiative aims to improve access to empirically based interventions for teens with depression and increase the number of providers in Texas communities. Activ8 is an example of how we are working to improve youth mental health outcomes by identifying barriers to care and using that knowledge to inform and guide future efforts.”