Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What are the comparative side effects of antidepressant medication side effects on low socio-economic ethnic/racial minority adolescents versus white low socio-economic adolescents?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

no

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

This question applies specifically to white adolescents (12-17), ethnic minority adolescents, both groups are low socio-economic adolescents (based on whether they qualify for the Department of Agriculture's free school lunch program), both male and female, diagnosed with depression, prescribed psychotroic medications, and complies with medication and therapy services.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Ethnic groups are minority versus white, low socio-economic, depression diagnosed in adolescence.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Understanding that there are distinctions/differences in potential side-effects based on ethnicity is material in how future trial populations are involved in testing as well as how medication prescribing will take place.

Describe any health-related risks, side effects, or harms that you are concerned about.

A one size fits dispensing of psychotropic medication is a serious risk to the populations that are supposed to receive the benefit of the medication. Without a clear scientific analysis of various ethnic backgrounds involved in trials as well as scientific inquiry into the various chemistry differences among ethnic populations is unethical and can cause permanent physical and emotional damage to an adolescent if they are not informed of the side effects pertinent to them.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Depression and other mental health disorders

AHRQ Priority Populations

• Low income groups
• Minority groups
• Children

Federal Health Care Program

• Medicaid
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

As I study FDA approval of psychotropic medications and ready the clinical trials, I am disturbed by the lack of representation of various ethic groups in the study. After some time, I then read the unintended consequences of some medications and recognize that those side effects may not be complete because the side effects are provided based on the clinical trial study group. Various groups are not included and therefore have nothing to provide a comparative analysis.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

I have an MSW which required a great deal of reading and when a topic jumps out at me, I study it until I find an answer to all of my questions. I have yet to locate clinical studies that are ethnic minority inclusive.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

no

If yes, please explain:

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

It will have global impact on the methodology of all medicinal longitudinal studies.

Describe the timeframe in which an answer to your question is needed.

There is no specific time frame. For the various groups that have not be used in clinical studies and are currently on psychotropic medication, time is of the essence.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

All minority groups deal with inequities in health care. Not being valued as a necessary component of any clinical trial is merely one example. Poverty creates vulnerability in health care decision making. There are therapists that will not see a patient unless they are on medication. Undereducated and immigrant families many times do not have the emotional strength, capacity, resources or time to research and question the medical community.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

It will have global impact on the methodology of all medicinal longitudinal studies.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program