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Bjornstad G, Sonthalia S, Rouse B, Freeman L, Hessami N, Dunne JH, Axford N. A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1376. [PMID: 38188230 PMCID: PMC10771715 DOI: 10.1002/cl2.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024]
Abstract
Background Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities. Objectives The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability). Search Methods The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases. Selection Criteria Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included. Data Collection and Analysis Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models. Main Results Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations. Authors' Conclusions At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.
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Affiliation(s)
- Gretchen Bjornstad
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
- Dartington Service Design LabBuckfastleighUK
| | - Shreya Sonthalia
- Dartington Service Design LabBuckfastleighUK
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Benjamin Rouse
- Center for Clinical Evidence and Guidelines, ECRI InstitutePlymouth MeetingPennsylvaniaUSA
| | | | | | - Jo Hickman Dunne
- The Centre for Youth ImpactLondonUK
- University of ManchesterManchesterUK
| | - Nick Axford
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of PlymouthPlymouthUK
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Polo AJ, Solano-Martinez JE, Saldana L, Ramos AD, Herrera M, Ullrich T, DeMario M. The Epidemic of Internalizing Problems Among Latinx Adolescents Before and During the Coronavirus 2019 Pandemic. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:66-82. [PMID: 36998122 DOI: 10.1080/15374416.2023.2169925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
OBJECTIVE Latinx youth exhibit disproportionately higher internalizing symptoms than their peers from other racial/ethnic groups. This study compares depression and anxiety symptoms between referred students of Latinx and non-Latinx backgrounds before and during the COVID-19 pandemic and examines key determinants within the Latinx sample. METHOD Data are analyzed from four academic years - two before and two during the pandemic - from 1220 5th through 8th grade students (Mage = 12.1; 59.6% female; 59.9% Latinx or mixed-Latinx) referred for services across 59 Chicago Public School District (CPS) elementary schools. Using the Children's Depression Inventory (CDI) and the Revised Child Anxiety and Depression Scale (RCADS), mean scores and risk levels for depression, social anxiety, and generalized anxiety are examined. RESULTS Higher internalizing risk and comorbidity rates were found in the second year of the pandemic, compared to pre-pandemic levels. Latinx students reported higher depression, social anxiety, and generalized anxiety symptoms than non-Latinx students. During the pandemic, more Latinx students were classified as having comorbid depression and anxiety, and scored in the clinical range for depression, generalized anxiety, and social anxiety than non-Latinx students. Within the Latinx sample, girls and gender non-conforming students reported the highest maladjustment. CONCLUSIONS Results highlight the pressing need to examine the long-term impact of COVID-19 on the mental health of Latinx children and adolescents, and to address their internalizing problems.
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Alto ME, Bantelman E, Manly JT, Hathaway A, Knight S, Frounfelker RL, Petrenko C. The Development of a Mental Health Program for Unaccompanied Minors in the United States. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2022; 44:164-196. [PMID: 37727220 PMCID: PMC10508890 DOI: 10.1007/s10447-021-09442-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 10/20/2022]
Abstract
The unique needs of unaccompanied children (UC) and unaccompanied refugee minors (URM) often make it challenging for them to engage in traditional mental health services. This paper describes the development and implementation of a mental health program for UC and URM using a collaborative approach with key stakeholders. In the Exploration phase, we conducted an assessment of youths' mental health needs, barriers to, and recommendations for care through discussions with community partners. Next, we describe the Preparation phase in which we designed the program around three major domains: 1) training and consultation, 2) cross-sector collaboration, and 3) direct services. Discussion of the Implementation phase includes a description of youth served and program materials. Finally, the Sustainment phase focuses on recommendations for best practice informed by successes and challenges of program implementation. Findings have implications for future mental health programming for UC/URM.
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Affiliation(s)
- Michelle E. Alto
- Mt. Hope Family Center, University of Rochester, Rochester, NY, USA
| | | | - Jody Todd Manly
- Mt. Hope Family Center, University of Rochester, Rochester, NY, USA
| | - Alisa Hathaway
- Mt. Hope Family Center, University of Rochester, Rochester, NY, USA
| | - Stevie Knight
- Mt. Hope Family Center, University of Rochester, Rochester, NY, USA
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The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) in Portugal: Feasibility Study Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031782. [PMID: 35162806 PMCID: PMC8835210 DOI: 10.3390/ijerph19031782] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 01/27/2023]
Abstract
The Unified Protocol for Children (UP-C) is a transdiagnostic Cognitive-Behavioral Therapy group intervention for children and caregivers targeting the treatment of children’s emotional disorders (EDs). The present study aims to assess the feasibility and acceptability of the UP-C in the Portuguese population using a single-armed design. The participants were 32 children (6–12 years of age) with an ED (anxiety and/or depressive disorder) as a main diagnosis and their parents. All participants received the UP-C intervention and were assessed at pretreatment, midtreatment, posttreatment, and 3 months posttreatment. Children, parents, the clinicians, and an external observer completed questionnaires to assess the feasibility and acceptability of the UP-C (e.g., satisfaction, motivation, and adherence). Children and parents also completed self-report measures assessing the children’s anxiety and depression and its interference and severity. The results of the present study support the feasibility and acceptability of the UP-C in Portugal; low dropout rates, high adherence rates, and high levels of child and parent satisfaction and motivation were observed. Moreover, significant reductions over time in children’s levels of anxiety and/or depression and of its interference and severity were found and were maintained after 3 months of follow-up. These results are promising and warrant a subsequent randomized controlled trial (RCT).
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Hawes MT, Szenczy AK, Olino TM, Nelson BD, Klein DN. Trajectories of depression, anxiety and pandemic experiences; A longitudinal study of youth in New York during the Spring-Summer of 2020. Psychiatry Res 2021; 298:113778. [PMID: 33550176 PMCID: PMC9754702 DOI: 10.1016/j.psychres.2021.113778] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/28/2021] [Indexed: 12/14/2022]
Abstract
Initial reports suggest that mental health problems were elevated early in the COVID-19 pandemic. However, few studies have followed-up participants as the pandemic evolved and examined both between and within person predictors of symptom trajectories. In the current study, adolescents and young adults (N=532) in New York were surveyed monthly between March 27th and July 14th, 2020, a period spanning the first peak and subsequent decline in COVID-19 infection rates in the region. Surveys assessed symptoms of depression and anxiety using the Child Depression Inventory and the Screen for Child Anxiety Related Disorders, as well as experiences related to the pandemic. Multilevel growth modeling indicated that symptoms of depression and anxiety peaked around late April/early May and then decreased through May-July. Some pandemic experiences followed a similar quadratic trajectory, while others decreased linearly across the study. Specific relationships emerged between some types of pandemic experiences and depression and anxiety symptoms. While symptoms of depression and anxiety in youth may have been elevated early in the pandemic, these findings suggest they subsided across Spring-Summer of 2020, with higher levels of both corresponding to a period of peak infection rates and decreases paralleling the decline in pandemic experiences and COVID-19 infection rates.
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Affiliation(s)
- Mariah T. Hawes
- Stony Brook University, USA,Corresponding author at.: 100 Nicolls Rd, Stony Brook, NY 11794, USA
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Bearman SK, Bailin A, Rodriguez E, Bellevue A. Partnering with School Providers to Co-Design Mental Health Interventions: An Open Trial of Act & Adapt in Urban Public Middle Schools. PSYCHOLOGY IN THE SCHOOLS 2020; 57:1689-1709. [PMID: 36590313 PMCID: PMC9799065 DOI: 10.1002/pits.22410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Schools are well positioned to provide access to youth mental health services, but implementing effective programs that promote emotional and behavioral functioning in school settings is complicated by the poor fit of interventions developed in research settings to complex school contexts. The current study formed a research-practice partnership with two urban public schools and mental health providers employed by those schools (N = 6, 100% female, 50% Black/African American, 50% White/Caucasian) in the adaptation of a depression prevention intervention, Act & Adapt. The intervention was modified by decreasing meeting time and streamlining session content, increasing flexibility, making intervention materials more similar to academic curriculum, and increasing the focus on managing disruptive behavior within group sessions. In an open trial, 6th grade students (N = 22; 59% boys, 31% Hispanic, 22% Black/African American, 4% Asian, 30% White/Caucasian) at both schools who were identified as clinically "at risk" reported improvements from baseline to post-intervention and at one-year follow-up on measures of emotional and behavioral difficulties and coping strategies, with parallel results by caregiver report. The providers reported satisfaction with the intervention, and qualitative analyses of provider focus groups suggested both barriers and facilitators to research-practice collaborations to implement mental health interventions in schools.
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Affiliation(s)
| | - Abby Bailin
- Department of Educational Psychology, The University of Texas at Austin
| | - Erin Rodriguez
- Department of Educational Psychology, The University of Texas at Austin
| | - Alison Bellevue
- Ferkauf Graduate School of Professional Psychology, Yeshiva University
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Collard JJ, Fuller-Tyskiewicz M. Positive Irrational Beliefs and Mental Health. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2020. [DOI: 10.1007/s10942-020-00375-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cheron DM, Chiu AAW, Stanick CF, Stern HG, Donaldson AR, Daleiden EL, Chorpita BF. Implementing Evidence Based Practices for Children's Mental Health: A Case Study in Implementing Modular Treatments in Community Mental Health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:391-410. [PMID: 30710173 DOI: 10.1007/s10488-019-00922-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There is strong enthusiasm for utilizing implementation science in the implementation of evidence-based programs in children's community mental health, but there remains work to be done to improve the process. Despite the proliferation of implementation frameworks, there is limited literature providing case examples of overcoming implementation barriers. This article examines whether the use of three implementations strategies, a structured training and coaching program, the use of professional development portfolios for coaching, and a progress monitoring data system, help to overcome barriers to implementation by facilitating four implementation drivers at a community mental health agency. Results suggest that implementation is a process of recognizing and adapting to both predictable and unpredictable barriers. Furthermore, the use of these implementation strategies is important in improving implementation outcomes.
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Affiliation(s)
- Daniel M Cheron
- Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA, 02120, USA.
| | | | | | - H Gemma Stern
- Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA, 02120, USA
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Meta-Analysis: 13-Year Follow-up of Psychotherapy Effects on Youth Depression. J Am Acad Child Adolesc Psychiatry 2020; 59:45-63. [PMID: 31004739 DOI: 10.1016/j.jaac.2019.04.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/25/2019] [Accepted: 04/12/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Youth depression is a debilitating condition that constitutes a major public health concern. A 2006 meta-analysis found modest benefits for psychotherapy versus control. Has 13 more years of research improved that picture? We sought to find out. METHOD We searched PubMed, PsychINFO, and Dissertation Abstracts International for 1960 to 2017, identifying 655 randomized, English-language psychotherapy trials for individuals aged 4 to 18 years. Of these, 55 assessed psychotherapy versus control for youth depression with outcome measures administered to both treatment and control conditions at post (κ = 53) and/or follow-up (κ = 32). Twelve study and outcome characteristics were extracted, and effect sizes were calculated for all psychotherapy versus control comparisons. Using a three-level random-effects model, we obtained an overall estimate of the psychotherapy versus control difference while accounting for the dependency among effect sizes. We then fitted a three-level mixed-effects model to identify moderators that might explain variation in effect size within and between studies. RESULTS The overall effect size (g) was 0.36 at posttreatment and 0.21 at follow-up (averaging 42 weeks after posttreatment). Three moderator effects were identified: effects were significantly larger for interpersonal therapy than for cognitive behavioral therapy, for youth self-reported outcomes than parent-reports, and for comparisons with inactive control conditions (eg, waitlist) than active controls (eg, usual care). Effects showed specificity, with significantly smaller effects for anxiety and externalizing behavior outcomes than for depression measures. CONCLUSION Youth depression psychotherapy effects are modest, with no significant change over the past 13 years. The findings highlight the need for treatment development and research to improve both immediate and longer-term benefits.
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van den Brink G, Stapersma L, Bom AS, Rizopolous D, van der Woude CJ, Stuyt RJL, Hendriks DM, van der Burg JAT, Beukers R, Korpershoek TA, Theuns-Valks SDM, Utens EMWJ, Escher JC. Effect of Cognitive Behavioral Therapy on Clinical Disease Course in Adolescents and Young Adults With Inflammatory Bowel Disease and Subclinical Anxiety and/or Depression: Results of a Randomized Trial. Inflamm Bowel Dis 2019; 25:1945-1956. [PMID: 31050763 PMCID: PMC7006993 DOI: 10.1093/ibd/izz073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anxiety and depressive symptoms are prevalent in patients with inflammatory bowel disease (IBD) and may negatively influence disease course. Disease activity could be affected positively by treatment of psychological symptoms. We investigated the effect of cognitive behavioral therapy (CBT) on clinical disease course in 10-25-year-old IBD patients experiencing subclinical anxiety and/or depression. METHODS In this multicenter parallel group randomized controlled trial, IBD patients were randomized to disease-specific CBT in addition to standard medical care (CBT + care us usual [CAU]) or CAU only. The primary outcome was time to first relapse in the first 12 months. Secondary outcomes were clinical disease activity, fecal calprotectin, and C-reactive protein (CRP). Survival analyses and linear mixed models were performed to compare groups. RESULTS Seventy patients were randomized (CBT+CAU = 37, CAU = 33), with a mean age of 18.3 years (±50% < 18 y, 31.4% male, 51.4% Crohn's disease, 93% in remission). Time to first relapse did not differ between patients in the CBT+CAU group vs the CAU group (n = 65, P = 0.915). Furthermore, clinical disease activity, fecal calprotectin, and CRP did not significantly change over time between/within both groups. Exploratory analyses in 10-18-year-old patients showed a 9% increase per month of fecal calprotectin and a 7% increase per month of serum CRP in the CAU group, which was not seen in the CAU+CBT group. CONCLUSIONS CBT did not influence time to relapse in young IBD patients with subclinical anxiety and/or depression. However, exploratory analyses may suggest a beneficial effect of CBT on inflammatory markers in children.
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Affiliation(s)
- Gertrude van den Brink
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Luuk Stapersma
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Anna Sophia Bom
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | | | | | - Rogier J L Stuyt
- Department of Gastroenterology, Haga Hospital, Den Haag, the Netherlands
| | - Danielle M Hendriks
- Department of Pediatrics, Juliana Children’s Hospital, Den Haag, the Netherlands
| | | | - Ruud Beukers
- Department of Gastroenterology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Thea A Korpershoek
- Department of Gastroenterology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands,Research Institute of Child Development and Education, University of Amsterdam, the Netherlands,Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Johanna C Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands,Address correspondence to: J. C. Escher, MD, PhD, Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, the Netherlands ()
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Schiltz HK, McVey AJ, Dolan BK, Willar KS, Pleiss S, Karst JS, Carson AM, Caiozzo C, Vogt EM, Yund BD, Van Hecke AV. Changes in Depressive Symptoms Among Adolescents with ASD Completing the PEERS ® Social Skills Intervention. J Autism Dev Disord 2019; 48:834-843. [PMID: 29164445 DOI: 10.1007/s10803-017-3396-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Depression is a common concern among people with autism spectrum disorder (ASD) and is often associated with social skills and relationship challenges. The present data, from a randomized controlled trial, examined the effect of PEERS® on self-reported depressive symptoms via the Children's Depression Inventory (CDI) among 49 adolescents with ASD. Findings revealed that many CDI subscale scores declined (p's < 0.05) and were related to direct social contact on the Quality of Socialization Questionnaire at posttest (p's < 0.05). Exploratory analyses uncovered that suicidality was less evident following PEERS®. Findings support the notion that social functioning and depression may be intimately intertwined in ASD; therefore, bolstering social skills in ASD may positively influence other domains of functioning, including mental health.
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Affiliation(s)
- Hillary K Schiltz
- Marquette University, 604 N 16th St. Cramer Hall, Milwaukee, WI, 53233, USA.
| | - Alana J McVey
- Marquette University, 604 N 16th St. Cramer Hall, Milwaukee, WI, 53233, USA
| | - Bridget K Dolan
- Marquette University, 604 N 16th St. Cramer Hall, Milwaukee, WI, 53233, USA
| | - Kirsten S Willar
- Marquette University, 604 N 16th St. Cramer Hall, Milwaukee, WI, 53233, USA
| | - Sheryl Pleiss
- Marquette University, 604 N 16th St. Cramer Hall, Milwaukee, WI, 53233, USA.,Great Lakes Neurobehavioral Center, 7373 France Avenue South, Suite 302, Edina, MN, 55435, USA
| | - Jeffrey S Karst
- Marquette University, 604 N 16th St. Cramer Hall, Milwaukee, WI, 53233, USA.,Children's Hospital of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Audrey M Carson
- Marquette University, 604 N 16th St. Cramer Hall, Milwaukee, WI, 53233, USA.,Texas Children's Hospital, 6621 Fannin St, Houston, TX, 77030, USA
| | - Christina Caiozzo
- Marquette University, 604 N 16th St. Cramer Hall, Milwaukee, WI, 53233, USA
| | - Elisabeth M Vogt
- Marquette University, 604 N 16th St. Cramer Hall, Milwaukee, WI, 53233, USA
| | - Brianna D Yund
- University of Wisconsin, Milwaukee, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA
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Arora PG, Collins TA, Dart EH, Hernández S, Fetterman H, Doll B. Multi-tiered Systems of Support for School-Based Mental Health: A Systematic Review of Depression Interventions. SCHOOL MENTAL HEALTH 2019. [DOI: 10.1007/s12310-019-09314-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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13
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Oud M, de Winter L, Vermeulen-Smit E, Bodden D, Nauta M, Stone L, van den Heuvel M, Taher RA, de Graaf I, Kendall T, Engels R, Stikkelbroek Y. Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis. Eur Psychiatry 2019; 57:33-45. [DOI: 10.1016/j.eurpsy.2018.12.008] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 12/19/2022] Open
Abstract
AbstractBackground:Cognitive-behavioral therapy (CBT) is first choice of treatment for depressive symptoms and disorders in adolescents, however improvements are necessary because overall efficacy is low. Insights on CBT components and contextual and structural characteristics might increase the efficacy. The aim of our approach is to evaluate the efficacy of CBT for youth with depression and investigate the influence of specific components, contextual and structural factors that could improve effects.Methods:A systematic review of randomized controlled trials was conducted, searches were undertaken in CINAHL, CENTRAL, EMBASE, MEDLINE/PubMed and PsycINFO. Outcomes were meta-analyzed and confidence in results was assessed using the GRADE-method. Meta-regression was used to pinpoint components or other factors that were associated with an in- or decrease of effects of CBT.Results:We included 31 trials with 4335 participants. Moderate-quality evidence was found for CBT reducing depressive symptoms at the end of treatment and at follow-up, and CBT as indicated prevention resulted in 63% less risk of being depressed at follow-up. CBT containing a combination of behavioral activation and challenging thoughts component (as part of cognitive restructuring) or the involvement of caregiver(s) in intervention were associated with better outcomes for youth on the long term.Conclusions:There is evidence that CBT is effective for youth with a (subclinical) depression. Our analyses show that effects might improve when CBT contains the components behavioral activation and challenging thoughts and also when the caregiver(s) are involved. However, the influential effects of these three moderators should be further tested in RCTs.
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Abstract
AbstractPeople with epilepsy are significantly more likely to have a mental health disorder than those without a chronic illness. The reasons for this are multiple but may include the mental health difficulties being perceived as complex due to the presence of a chronic illness. In part due to the apparent complexity of the co-occurring physical and mental illness, many are not offered evidence-based treatment (EBT) for the mental health disorder. There is little guidance to inform clinicians about the interventions to use to treat mental health disorders in people with epilepsy. The present paper reports a case of treatment for depression using a standard EBT in a young person with epilepsy. The patient also had clinically significant symptoms of anxiety and an eating disorder and would be considered ‘complex’ according to standard criteria. The intervention, however, was relatively simple and was delivered as guided self-help via 10 weekly telephone calls of approximately 30 minutes duration, and two follow-up calls at one month and three months post-intervention. Self-report and parent-report questionnaire measures were completed before and after the intervention, and at both follow-up time points. A blind-rated online diagnostic interview measure was also completed before and after the intervention. The young person and her family also completed a qualitative interview of their experiences of the intervention. This simple intervention was effective in working towards the client's goals, although pre–post measurement on standard measures was variable. This interesting case raises questions about whether patients with mental and physical comorbidities are complex, or just perceived as complex.
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Hollon SD, Thase ME, Markowitz JC. Treatment and Prevention of Depression. Psychol Sci Public Interest 2017; 3:39-77. [DOI: 10.1111/1529-1006.00008] [Citation(s) in RCA: 292] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depression is one of the most common and debilitating psychiatric disorders and is a leading cause of suicide. Most people who become depressed will have multiple episodes, and some depressions are chronic. Persons with bipolar disorder will also have manic or hypomanic episodes. Given the recurrent nature of the disorder, it is important not just to treat the acute episode, but also to protect against its return and the onset of subsequent episodes. Several types of interventions have been shown to be efficacious in treating depression. The antidepressant medications are relatively safe and work for many patients, but there is no evidence that they reduce risk of recurrence once their use is terminated. The different medication classes are roughly comparable in efficacy, although some are easier to tolerate than are others. About half of all patients will respond to a given medication, and many of those who do not will respond to some other agent or to a combination of medications. Electro-convulsive therapy is particularly effective for the most severe and resistant depressions, but raises concerns about possible deleterious effects on memory and cognition. It is rarely used until a number of different medications have been tried. Although it is still unclear whether traditional psychodynamic approaches are effective in treating depression, interpersonal psychotherapy (IPT) has fared well in controlled comparisons with medications and other types of psychotherapies. It also appears to have a delayed effect that improves the quality of social relationships and interpersonal skills. It has been shown to reduce acute distress and to prevent relapse and recurrence so long as it is continued or maintained. Treatment combining IPT with medication retains the quick results of pharmacotherapy and the greater interpersonal breadth of IPT, as well as boosting response in patients who are otherwise more difficult to treat. The main problem is that IPT has only recently entered clinical practice and is not widely available to those in need. Cognitive behavior therapy (CBT) also appears to be efficacious in treating depression, and recent studies suggest that it can work for even severe depressions in the hands of experienced therapists. Not only can CBT relieve acute distress, but it also appears to reduce risk for the return of symptoms as long as it is continued or maintained. Moreover, it appears to have an enduring effect that reduces risk for relapse or recurrence long after treatment is over. Combined treatment with medication and CBT appears to be as efficacious as treatment with medication alone and to retain the enduring effects of CBT. There also are indications that the same strategies used to reduce risk in psychiatric patients following successful treatment can be used to prevent the initial onset of depression in persons at risk. More purely behavioral interventions have been studied less than the cognitive therapies, but have performed well in recent trials and exhibit many of the benefits of cognitive therapy. Mood stabilizers like lithium or the anticonvulsants form the core treatment for bipolar disorder, but there is a growing recognition that the outcomes produced by modern pharmacology are not sufficient. Both IPT and CBT show promise as adjuncts to medication with such patients. The same is true for family-focused therapy, which is designed to reduce interpersonal conflict in the family. Clearly, more needs to be done with respect to treatment of the bipolar disorders. Good medical management of depression can be hard to find, and the empirically supported psychotherapies are still not widely practiced. As a consequence, many patients do not have access to adequate treatment. Moreover, not everyone responds to the existing interventions, and not enough is known about what to do for people who are not helped by treatment. Although great strides have been made over the past few decades, much remains to be done with respect to the treatment of depression and the bipolar disorders.
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Affiliation(s)
| | - Michael E. Thase
- University of Pittsburgh Medical Center and Western Psychiatric Institute and Clinic
| | - John C. Markowitz
- Weill Medical College of Cornell University and New York State Psychiatric Institute
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16
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Yang L, Zhou X, Zhou C, Zhang Y, Pu J, Liu L, Gong X, Xie P. Efficacy and Acceptability of Cognitive Behavioral Therapy for Depression in Children: A Systematic Review and Meta-analysis. Acad Pediatr 2017; 17:9-16. [PMID: 27989281 DOI: 10.1016/j.acap.2016.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few meta-analyses have focused on the effect of cognitive behavioral therapy (CBT) for depression in children. STUDY SELECTION Randomized controlled trials comparing CBT with control conditions for depression in children (≤13 years old) were included. DATA SOURCES Seven electronic databases (PubMed, Embase, CENTRAL, Web of Science, PsycINFO, CINAHL, and LiLACS) were searched from inception to September 2015. DATA EXTRACTION AND SYNTHESIS The primary efficacy was defined as mean change scores in depressive symptoms, and the second efficacy (remission) was a score below the threshold for a diagnosis of depression, both after treatment and at the end of follow-up. We also measured acceptability by the proportion of participants who discontinued treatment up to posttreatment. RESULTS Nine studies with 306 participants were selected for this analysis. At posttreatment, CBT was significantly more effective than control conditions in terms of primary efficacy (standardized mean difference, -0.41; 95% confidence interval [CI], -0.64 to -0.18) and secondary efficacy (odds ratio [OR], 2.16; 95% CI, 1.24 to 3.78). At follow-up, the results were consistent with those of efficacy outcomes at posttreatment, with a standardized mean difference of -0.34 and an OR of 2.04. CBT had no statistical more all-cause discontinuations than the control group (OR, 0.69; 95% CI, 0.26 to 1.82). However, subgroup analyses found that CBT was only significantly more effective than nontreatment, while it was not better than wait list or psychological placebo. CONCLUSIONS CBT seems to be more beneficial in the treatment of depression in children than nontreatment; however, this finding is limited by the small size of the trials and low literature quality.
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Affiliation(s)
- Lining Yang
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Zhou
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chanjuan Zhou
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuqing Zhang
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juncai Pu
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lanxiang Liu
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xue Gong
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology and Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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17
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Effect of Psychotherapy on Health Care Utilization in Children With Inflammatory Bowel Disease and Depression. J Pediatr Gastroenterol Nutr 2016; 63:658-664. [PMID: 27035372 PMCID: PMC5040612 DOI: 10.1097/mpg.0000000000001207] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Pediatric patients with inflammatory bowel disease (IBD) are at an increased risk of developing depression compared with community controls. Depression often negatively influences illness behaviors such as resource utilization. We sought to investigate the effects of treating depression on utilization of medical resources in depressed pediatric patients with IBD by comparing rates of health care utilization 1 year before and after psychotherapy. METHOD Two hundred seventeen subjects ages 9 to 17 years with IBD and depression received 3 months of psychotherapy for depression as part of a multicenter randomized controlled trial. Of these 217 subjects, 70 had utilization data available 1 year prior and 1 year after receiving 3 months of psychotherapy. Primary outcomes included frequency of hospitalizations, inpatient hospital days, outpatient gastrointestinal visits, and number of emergency room visits, radiological examinations, and endoscopies. Within subject analyses were completed comparing health care utilization 12 months before psychotherapy compared with the 12 months after the conclusion of psychotherapy. RESULTS Fifty-one and 19 patients had CD and UC, respectively. A total of 55.7% of patients had major depression and 44.3% had minor depression. Overall, all study measures of health care utilization were significantly reduced after psychotherapy (P < 0.01)-including gastrointestinal-related (mean values) hospitalization frequency, inpatient days, outpatient visit, emergency room visits, radiological examinations, and endoscopies. CONCLUSIONS Psychotherapy for comorbid depression in pediatric patients with IBD is associated with decreased GI-related health care utilization. The present study highlights the importance of screening for depression in a pediatric population with IBD, and that psychotherapy may be a reasonable adjunctive treatment for pediatric patients with IBD and comorbid depression.
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18
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Schleider JL, Weisz JR. Reducing risk for anxiety and depression in adolescents: Effects of a single-session intervention teaching that personality can change. Behav Res Ther 2016; 87:170-181. [PMID: 27697671 PMCID: PMC5127737 DOI: 10.1016/j.brat.2016.09.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/09/2016] [Accepted: 09/24/2016] [Indexed: 12/11/2022]
Abstract
Efforts to reduce youth mental health problems have advanced greatly but have not lowered overall rates of youth mental illness. Thus, a need exists for disseminable, mechanism-targeted approaches to reducing risk of youth psychopathology. Accordingly, we conducted a randomized-controlled trial testing whether a single-session intervention teaching growth personality mindsets (the belief that personality is malleable) reduced known risk factors for anxiety and depression in adolescents experiencing or at risk for internalizing problems (N = 96, ages 12-15). Compared to a supportive-therapy control, a 30-min computer-guided mindset intervention strengthened adolescents' perceived control; this improvement was associated with increases in growth mindsets. Further, electrodermal activity recovery slopes showed that youths receiving the mindset intervention recovered from a lab-based social stressor over three times as fast as control group youths. Improvements in growth mindsets and perceived control were linked with faster stress recovery. Results suggest a disseminable strategy for reducing internalizing problem risk among adolescents.
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Affiliation(s)
- Jessica L Schleider
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.
| | - John R Weisz
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA
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19
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Kim P, Neuendorf C, Bianco H, Evans GW. Exposure to Childhood Poverty and Mental Health Symptomatology in Adolescence: A Role of Coping Strategies. Stress Health 2016; 32:494-502. [PMID: 26234956 DOI: 10.1002/smi.2646] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 05/26/2015] [Accepted: 07/04/2015] [Indexed: 11/11/2022]
Abstract
Childhood poverty is associated with stress dysregulation which contributes to psychological illness in later ages. The adverse effects of childhood poverty on stress regulation may be mediated in part by the use of disengaging strategies to cope with stress. However, the relations among childhood poverty, coping strategies and psychopathology throughout childhood to adolescence have not been explored. This prospective, longitudinal study included 185 low- and middle-income adolescents at age 17. Chronic exposure to poverty from birth to early adolescence (age 13) was prospectively associated with increases in the use of disengagement versus engagement coping four years later. Increased use of disengagement coping between the ages of 13 and 17 explained the indirect link between poverty exposure since birth and both externalizing and internalizing symptoms at age 17. The findings provide evidence for a coping pathway underlying the link between prolonged exposure to childhood poverty and mental health sequelae. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Cynthia Neuendorf
- Center for Molecular Neurobiology, The Ohio State University, Columbus, OH, USA
| | - Hannah Bianco
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Gary W Evans
- Department of Design and Environmental Analysis and Human Development, Cornell University, Ithaca, NY, USA
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20
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Weersing VR, Jeffreys M, Do MCT, Schwartz KTG, Bolano C. Evidence Base Update of Psychosocial Treatments for Child and Adolescent Depression. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:11-43. [PMID: 27870579 DOI: 10.1080/15374416.2016.1220310] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Depression in youth is prevalent and disabling and tends to presage a chronic and recurrent course of illness and impairment in adulthood. Clinical trial research in youth depression has a 30-year history, and evidence-based treatment reviews appeared in 1998 and 2008. The current review of 42 randomized controlled trials (RCTs) updates these reviews to include RCTs published between 2008 and 2014 (N = 14) and reevaluates previously reviewed literature. Given the growing maturity of the field, this review utilized a stringent set of methodological criteria for trial inclusion, most notable for excluding trials based in subclinical samples of youth that had been included in previous reviews (N = 12) and including well-designed RCTs with null and negative findings (N = 8). Findings from the current review suggest that evidence for child treatments is notably weaker than for adolescent interventions, with no child treatments achieving well-established status and the evidentiary basis of treatments downgraded from previous reports. Cognitive behavioral therapy (CBT) for clinically depressed children appears to be possibly efficacious, with mixed findings across trials. For depressed adolescents, both CBT and interpersonal psychotherapy are well-established interventions, with evidence of efficacy in multiple trials by independent investigative teams. This positive conclusion is tempered by the small size of the interpersonal psychotherapy literature (N = 6) and concern that CBT effects may be attenuated in clinically complicated samples and when compared against active control conditions. Data on predictors, moderators, and mediators are examined and priorities for future research discussed.
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Affiliation(s)
- V Robin Weersing
- a SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology.,b Department of Psychology , San Diego State University
| | - Megan Jeffreys
- a SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
| | - Minh-Chau T Do
- a SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
| | | | - Carl Bolano
- b Department of Psychology , San Diego State University
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21
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Stegall SD, Nangle DW. Successes and Failures in the Implementation of a Manualized Treatment for Childhood Depression in an Outpatient Setting. Clin Case Stud 2016. [DOI: 10.1177/1534650103259718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article describes successes and failures in the implementation of a manualized treatment for childhood depression. The use of treatment manuals is controversial because most have been derived from lab-based treatments and may not be transportable into real-world settings. A manualized cognitive-behavioral treatment was utilized to treat a 9-year-old boy who presented with multifaceted problems (e.g., depressed mood, eating and sleeping difficulties, crying, bedwetting). The outcome was favorable yet underscored the importance of being flexible and using functional analysis. Numerous challenges were encountered, including the lack of a clear-cut diagnosis, difficulties sustaining the pace of treatment, assessing client progress, and motivating both the child and parents. Challenges are discussed with respect to implications for managed care, debates surrounding manualized treatment, and suggestions for utilizing treatment manuals.
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22
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van den Brink G, Stapersma L, El Marroun H, Henrichs J, Szigethy EM, Utens EM, Escher JC. Effectiveness of disease-specific cognitive-behavioural therapy on depression, anxiety, quality of life and the clinical course of disease in adolescents with inflammatory bowel disease: study protocol of a multicentre randomised controlled trial (HAPPY-IBD). BMJ Open Gastroenterol 2016; 3:e000071. [PMID: 26966551 PMCID: PMC4780038 DOI: 10.1136/bmjgast-2015-000071] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/11/2015] [Accepted: 12/21/2015] [Indexed: 01/02/2023] Open
Abstract
Introduction Adolescents with inflammatory bowel disease (IBD) show a higher prevalence of depression and anxiety, compared to youth with other chronic diseases. The inflammation-depression hypothesis might explain this association, and implies that treating depression can decrease intestinal inflammation and improve disease course. The present multicentre randomised controlled trial aims to test the effectiveness of an IBD-specific cognitive–behavioural therapy (CBT) protocol in reducing symptoms of subclinical depression and anxiety, while improving quality of life and disease course in adolescents with IBD. Methods and analysis Adolescents with IBD (10–20 years) from 7 hospitals undergo screening (online questionnaires) for symptoms of depression and anxiety. Those with elevated scores of depression (Child Depression Inventory (CDI) ≥13 or Beck Depression Inventory (BDI) II ≥14) and/or anxiety (Screen for Child Anxiety Related Disorders: boys ≥26, girls ≥30) receive a psychiatric interview. Patients meeting criteria for depressive/anxiety disorders are referred for psychotherapy outside the trial. Patients with elevated (subclinical) symptoms are randomly assigned to medical care-as-usual (CAU; n=50) or CAU plus IBD-specific CBT (n=50). Main outcomes: (1) reduction in depressive and/or anxiety symptoms after 3 months and (2) sustained remission for 12 months. Secondary outcomes: quality of life, psychosocial functioning, treatment adherence. In addition, we will assess inflammatory cytokines in peripheral blood mononuclear cells and whole blood RNA expression profiles. For analysis, multilevel linear models and generalised estimating equations will be used. Ethics and dissemination The Medical Ethics Committee of the Erasmus MC approved this study. If we prove that this CBT improves emotional well-being as well as disease course, implementation is recommended. Trial registration number NCT02265588.
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Affiliation(s)
- Gertrude van den Brink
- Department of Pediatric Gastroenterology , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Luuk Stapersma
- Department of Child and Adolescent Psychiatry/Psychology , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry/Psychology , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Jens Henrichs
- Department of Midwifery Science , AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center , Amsterdam , The Netherlands
| | - Eva M Szigethy
- Department of Psychiatry , University of Pittsburgh , Pittsburgh, Pennsylvania , USA
| | - Elisabeth Mwj Utens
- Department of Child and Adolescent Psychiatry/Psychology , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Johanna C Escher
- Department of Pediatric Gastroenterology , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands
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Eiraldi R, Power TJ, Schwartz BS, Keiffer JN, McCurdy BL, Mathen M, Jawad AF. Examining Effectiveness of Group Cognitive-Behavioral Therapy for Externalizing and Internalizing Disorders in Urban Schools. Behav Modif 2016; 40:611-39. [PMID: 26872957 DOI: 10.1177/0145445516631093] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article presents outcome data of the implementation of three group cognitive-behavioral therapy (GCBT) interventions for children with externalizing behavior problems, anxiety, and depression. School counselors and graduate students co-led the groups in two low-income urban schools. Data were analyzed to assess pre-treatment to post-treatment changes in diagnostic severity level. Results of the exploratory study indicated that all three GCBT protocols were effective at reducing diagnostic severity level for children who had a primary diagnosis of an externalizing disorder, anxiety disorder, or depressive disorder at the clinical or intermediate (at-risk) level. All three GCBT protocols were implemented with relatively high levels of fidelity. Data on the effectiveness of the interventions for reducing diagnostic severity level for externalizing and internalizing spectrum disorders and for specific disorders are presented. A discussion of implementation of mental health evidence-based interventions in urban schools is provided.
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Affiliation(s)
- Ricardo Eiraldi
- The Children's Hospital of Philadelphia, PA, USA University of Pennsylvania, Philadelphia, USA
| | - Thomas J Power
- The Children's Hospital of Philadelphia, PA, USA University of Pennsylvania, Philadelphia, USA
| | | | | | | | - Manju Mathen
- The Children's Hospital of Philadelphia, PA, USA
| | - Abbas F Jawad
- The Children's Hospital of Philadelphia, PA, USA University of Pennsylvania, Philadelphia, USA
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24
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Schleider JL, Weisz JR. Mental Health and Implicit Theories of Thoughts, Feelings, and Behavior in Early Adolescents: Are Girls at Greater Risk? JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2016. [DOI: 10.1521/jscp.2016.35.2.130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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25
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Carpenter AL, Puliafico AC, Kurtz SMS, Pincus DB, Comer JS. Extending parent-child interaction therapy for early childhood internalizing problems: new advances for an overlooked population. Clin Child Fam Psychol Rev 2015; 17:340-56. [PMID: 25212716 DOI: 10.1007/s10567-014-0172-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent-child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent-child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention--such as the PCIT-SM (selective mutism) Program for young children with SM--are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider potential solutions, including modular treatment formats and innovative applications of technology.
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Affiliation(s)
- Aubrey L Carpenter
- Department of Psychology, Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA,
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26
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Straub J, Plener PL, Keller F, Fegert JM, Spröber N, Kölch MG. MICHI–eine Gruppen-Kurzzeitpsychotherapie zur Behandlung von Depressionen bei Jugendlichen. KINDHEIT UND ENTWICKLUNG 2015. [DOI: 10.1026/0942-5403/a000175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Kognitive Verhaltenstherapie (KVT) gilt als Mittel der Wahl bei der Behandlung von Depressionen im Jugendalter wobei bis dato noch kein deutsches Behandlungsmanual in einem randomisierten, kontrollierten Design untersucht wurde. 38 depressive Jugendliche (M=15,86, SD=±1,70 Jahre alt; 78,9 % weiblich) wurden randomisiert entweder der Kontrollgruppe (KG), die Behandlung wie üblich erhielt (TAU), oder Interventionsgruppe (IG), welche an einer ambulanten Gruppen-Kurzzeit-KVT (MICHI-Manual) teilnahm, zugeordnet. Als Effektivitätsmaße dienten die CDRS-R und das BDI-II. Die Interaktion aus Gruppe und Messzeitpunkt war sowohl für die CDRS-R (p=,02), mit einer mittleren Effektstärke (dkorr=,75), als auch für den BDI-II (p=,04), mit einer kleinen Effektstärke (dkorr=,39), signifikant. Die Gruppen-Kurzzeit-KVT entsprechend dem MICHI Manual ist verglichen mit TAU wirksam.
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Affiliation(s)
- Joana Straub
- Klinik für Kinder- und Jugendpsychiatrie/-psychotherapie des Universitätsklinikums Ulm
| | - Paul L. Plener
- Klinik für Kinder- und Jugendpsychiatrie/-psychotherapie des Universitätsklinikums Ulm
| | - Ferdinand Keller
- Klinik für Kinder- und Jugendpsychiatrie/-psychotherapie des Universitätsklinikums Ulm
| | - Jörg M. Fegert
- Klinik für Kinder- und Jugendpsychiatrie/-psychotherapie des Universitätsklinikums Ulm
| | - Nina Spröber
- Klinik für Kinder- und Jugendpsychiatrie/-psychotherapie des Universitätsklinikums Ulm
| | - Michael G. Kölch
- Klinik für Kinder- und Jugendpsychiatrie/-psychotherapie des Universitätsklinikums Ulm
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Zhou X, Hetrick SE, Cuijpers P, Qin B, Barth J, Whittington CJ, Cohen D, Del Giovane C, Liu Y, Michael KD, Zhang Y, Weisz JR, Xie P. Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis. World Psychiatry 2015; 14:207-22. [PMID: 26043339 PMCID: PMC4471978 DOI: 10.1002/wps.20217] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Previous meta-analyses of psychotherapies for child and adolescent depression were limited because of the small number of trials with direct comparisons between two treatments. A network meta-analysis, a novel approach that integrates direct and indirect evidence from randomized controlled studies, was undertaken to investigate the comparative efficacy and acceptability of psychotherapies for depression in children and adolescents. Systematic searches resulted in 52 studies (total N=3805) of nine psychotherapies and four control conditions. We assessed the efficacy at post-treatment and at follow-up, as well as the acceptability (all-cause discontinuation) of psychotherapies and control conditions. At post-treatment, only interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) were significantly more effective than most control conditions (standardized mean differences, SMDs ranged from -0.47 to -0.96). Also, IPT and CBT were more beneficial than play therapy. Only psychodynamic therapy and play therapy were not significantly superior to waitlist. At follow-up, IPT and CBT were significantly more effective than most control conditions (SMDs ranged from -0.26 to -1.05), although only IPT retained this superiority at both short-term and long-term follow-up. In addition, IPT and CBT were more beneficial than problem-solving therapy. Waitlist was significantly inferior to other control conditions. With regard to acceptability, IPT and problem-solving therapy had significantly fewer all-cause discontinuations than cognitive therapy and CBT (ORs ranged from 0.06 to 0.33). These data suggest that IPT and CBT should be considered as the best available psychotherapies for depression in children and adolescents. However, several alternative psychotherapies are understudied in this age group. Waitlist may inflate the effect of psychotherapies, so that psychological placebo or treatment-as-usual may be preferable as a control condition in psychotherapy trials.
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Affiliation(s)
- Xinyu Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Sarah E Hetrick
- Orygen National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Bin Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jürgen Barth
- Institute of Complementary and Integrative Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Craig J Whittington
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpétrière, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Paris, France
| | - Cinzia Del Giovane
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Yiyun Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kurt D Michael
- Department of Psychology, Appalachian State University, Boone, NC, USA
| | - Yuqing Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Dietz LJ, Weinberg RJ, Brent DA, Mufson L. Family-based interpersonal psychotherapy for depressed preadolescents: examining efficacy and potential treatment mechanisms. J Am Acad Child Adolesc Psychiatry 2015; 54:191-9. [PMID: 25721184 PMCID: PMC4347931 DOI: 10.1016/j.jaac.2014.12.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 11/17/2014] [Accepted: 12/24/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To conduct a randomized controlled trial to evaluate the preliminary efficacy of family-based interpersonal psychotherapy (FB-IPT) for treating depression in preadolescents (aged 7-12 years) as compared to child-centered therapy (CCT), a supportive and nondirective treatment that closely approximates the standard of care for pediatric depression in community mental health. METHOD Preadolescents with depression (N = 42) were randomly assigned FB-IPT or CCT. Pre- and posttreatment assessments included clinician-administered measures of depression, parent- and child-reported depression and anxiety symptoms, and parent-child conflict and interpersonal impairment with peers. RESULTS Preadolescents receiving FB-IPT had higher rates of remission (66.0% versus 31%), a greater decrease in depressive symptoms from pre- to posttreatment, and lower depressive symptoms at posttreatment (R(2) = 0.35, ΔR(2) = 0.22; B = -8.15, SE = 2.61, t[37] = -3.13, p = .002, F(2) = 0.28) than did preadolescents with depression receiving CCT. Furthermore, preadolescents in the FB-IPT condition reported significant reductions in anxiety and interpersonal impairment compared with preadolescents in the CCT condition. Changes in social and peer impairment from pre- to posttreatment were associated with preadolescents' posttreatment depressive symptoms. There was a significant indirect effect for decreased social impairment accounting for the association between the FB-IPT and preadolescents' posttreatment depressive symptoms. CONCLUSION Findings indicate FB-IPT is an effective treatment for preadolescent depression and support further investigation of interpersonal mechanisms by which FB-IPT may reduce preadolescent depression. Clinical trial registration information-Phase II Study of Family Based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents; http://clinicaltrials.gov; NCT02054312.
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Affiliation(s)
- Laura J Dietz
- University of Pittsburgh School of Medicine, Pittsburgh.
| | | | - David A Brent
- University of Pittsburgh School of Medicine, Pittsburgh
| | - Laura Mufson
- Columbia University College of Physicians and Surgeons/New York State Psychiatric Institute (NYSPI), New York
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Chu BC, Crocco ST, Arnold CC, Brown R, Southam-Gerow MA, Weisz JR. Sustained Implementation of Cognitive-Behavioral Therapy for Youth Anxiety and Depression: Long-term Effects of Structured Training and Consultation on Therapist Practice in the Field. ACTA ACUST UNITED AC 2015; 46:70-79. [PMID: 26366037 DOI: 10.1037/a0038000] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Identifying factors that promote sustained implementation of evidence-based treatments (EBTs) after therapists receive training is critical for professional psychology. To address the field's minimal knowledge in this area, we interviewed community-based therapists (N = 23) who had completed intensive training in cognitive behavioral therapy (CBT) for either anxiety or depression as part of a randomized effectiveness trial (Southam-Gerow et al., 2010; Weisz et al., 2009). Therapists were interviewed three to five years after completion of the initial trial, representing one of the longest-term follow-ups of therapist practices after training. Therapists viewed each protocol and their individual CBT strategies as effective and appropriate for the majority of their current anxiety and depression caseloads. However, therapists used parts of each protocol much more frequently than the protocol as a whole (i.e., 78.5% used parts of the Coping Cat, and 7.5% used the whole protocol; 58.6% used parts of the PASCET, and 20% used the whole protocol). Therapists reported using problem-solving the most and exposure exercises the least for current anxious cases; they used cognitive restructuring the most and homework the least for current depression cases. Interventions that were more difficult to implement in usual care settings were less likely to be sustained. Future efforts should evaluate the characteristics and structure of EBTs that are most acceptable to therapists and should investigate which kinds of ongoing learning supports will maintain therapist skills in and continued use of EBTs.
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Cox GR, Callahan P, Churchill R, Hunot V, Merry SN, Parker AG, Hetrick SE. Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents. Cochrane Database Syst Rev 2014; 2014:CD008324. [PMID: 25433518 PMCID: PMC8556660 DOI: 10.1002/14651858.cd008324.pub3] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Depressive disorders are common in children and adolescents and, if left untreated, are likely to recur in adulthood. Depression is highly debilitating, affecting psychosocial, family and academic functioning. OBJECTIVES To evaluate the effectiveness of psychological therapies and antidepressant medication, alone and in combination, for the treatment of depressive disorder in children and adolescents. We have examined clinical outcomes including remission, clinician and self reported depression measures, and suicide-related outcomes. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to 11 June 2014. The register contains reports of relevant randomised controlled trials (RCTs) from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). SELECTION CRITERIA RCTs were eligible for inclusion if they compared i) any psychological therapy with any antidepressant medication, or ii) a combination of psychological therapy and antidepressant medication with a psychological therapy alone, or an antidepressant medication alone, or iii) a combination of psychological therapy and antidepressant medication with a placebo or'treatment as usual', or (iv) a combination of psychological therapy and antidepressant medication with a psychological therapy or antidepressant medication plus a placebo.We included studies if they involved participants aged between 6 and 18 years, diagnosed by a clinician as having Major Depressive Disorder (MDD) based on Diagnostic and Statistical Manual (DSM) or International Classification of Diseases (ICD) criteria. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the quality of the studies. We applied a random-effects meta-analysis, using the odds ratio (OR) to describe dichotomous outcomes, mean difference (MD) to describe continuous outcomes when the same measures were used, and standard mean difference (SMD) when outcomes were measured on different scales. MAIN RESULTS We included eleven studies, involving 1307 participants in this review. We also identified one ongoing study, and two additional ongoing studies that may be eligible for inclusion. Studies recruited participants with different severities of disorder and with a variety of comorbid disorders, including anxiety and substance use disorder, therefore limiting the comparability of the results. Regarding the risk of bias in studies, just under half the studies had adequate allocation concealment (there was insufficient information to determine allocation concealment in the remainder), outcome assessors were blind to the participants' intervention in six studies, and in general, studies reported on incomplete data analysis methods, mainly using intention-to-treat (ITT) analyses. For the majority of outcomes there were no statistically significant differences between the interventions compared. There was limited evidence (based on two studies involving 220 participants) that antidepressant medication was more effective than psychotherapy on measures of clinician defined remission immediately post-intervention (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.27 to 0.98), with 67.8% of participants in the medication group and 53.7% in the psychotherapy group rated as being in remission. There was limited evidence (based on three studies involving 378 participants) that combination therapy was more effective than antidepressant medication alone in achieving higher remission from a depressive episode immediately post-intervention (OR 1.56, 95% CI 0.98 to 2.47), with 65.9% of participants treated with combination therapy and 57.8% of participants treated with medication, rated as being in remission. There was no evidence to suggest that combination therapy was more effective than psychological therapy alone, based on clinician rated remission immediately post-intervention (OR 1.82, 95% CI 0.38 to 8.68).Suicide-related Serious Adverse Events (SAEs) were reported in various ways across studies and could not be combined in meta-analyses. However, some trials measured suicidal ideation using standardised assessment tools suitable for meta-analysis. In one study involving 188 participants, rates of suicidal ideation were significantly higher in the antidepressant medication group (18.6%) compared with the psychological therapy group (5.4%) (OR 0.26, 95% CI 0.09 to 0.72) and this effect appeared to remain at six to nine months (OR 0.26, 95% CI 0.07 to 0.98), with 13.6% of participants in the medication group and 3.9% of participants in the psychological therapy group reporting suicidal ideation. It was unclear what the effect of combination therapy was compared with either antidepressant medication alone or psychological therapy alone on rates of suicidal ideation. The impact of any of the assigned treatment packages on drop out was also mostly unclear across the various comparisons in the review.Limited data and conflicting results based on other outcome measures make it difficult to draw conclusions regarding the effectiveness of any specific intervention based on these outcomes. AUTHORS' CONCLUSIONS There is very limited evidence upon which to base conclusions about the relative effectiveness of psychological interventions, antidepressant medication and a combination of these interventions. On the basis of the available evidence, the effectiveness of these interventions for treating depressive disorders in children and adolescents cannot be established. Further appropriately powered RCTs are required.
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Affiliation(s)
- Georgina R Cox
- University of MelbourneOrygen Youth Health Research Centre, Centre for Youth Mental HealthLocked Bag 10, 35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Patch Callahan
- University of MelbourneOrygen Youth Health Research Centre, Centre for Youth Mental HealthLocked Bag 10, 35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Rachel Churchill
- University of BristolCentre for Academic Mental Health, School of Social and Community MedicineOakfield HouseOakfield GroveBristolUKBS8 2BN
| | - Vivien Hunot
- University of BristolCentre for Academic Mental Health, School of Social and Community MedicineOakfield HouseOakfield GroveBristolUKBS8 2BN
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicinePrivate Bag 92019AucklandNew Zealand
| | - Alexandra G Parker
- University of MelbourneOrygen Youth Health Research Centre, Centre for Youth Mental HealthLocked Bag 10, 35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | - Sarah E Hetrick
- University of MelbourneOrygen Youth Health Research Centre, Centre for Youth Mental HealthLocked Bag 10, 35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
- University of Melbourneheadspace Centre of Excellence, Centre for Youth Mental HealthMelbourneVictoriaAustralia
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Szigethy E, Bujoreanu SI, Youk AO, Weisz J, Benhayon D, Fairclough D, Ducharme P, Gonzalez-Heydrich J, Keljo D, Srinath A, Bousvaros A, Kirshner M, Newara M, Kupfer D, DeMaso DR. Randomized efficacy trial of two psychotherapies for depression in youth with inflammatory bowel disease. J Am Acad Child Adolesc Psychiatry 2014; 53:726-35. [PMID: 24954822 PMCID: PMC4104185 DOI: 10.1016/j.jaac.2014.04.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/10/2014] [Accepted: 05/01/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Pediatric inflammatory bowel disease (IBD) is associated with high rates of depression. This study compared the efficacy of cognitive behavioral therapy (CBT) to supportive nondirective therapy (SNDT) in treating youth with comorbid IBD and depression. METHOD Youth (51% female and 49% male; age 9-17 years, mean age 14.3 years) with depression and Crohn's disease (n = 161) or ulcerative colitis (n = 56) were randomly assigned to a 3-month course of CBT or SNDT. The primary outcome was comparative reduction in depressive symptom severity; secondary outcomes were depression remission, increase in depression response, and improved health-related adjustment and IBD activity. RESULTS A total of 178 participants (82%) completed the 3-month intervention. Both psychotherapies resulted in significant reductions in total Children's Depression Rating Scale Revised score (37.3% for CBT and 31.9% for SNDT), but the difference between the 2 treatments was not significant (p = .16). There were large pre-post effect sizes for each treatment (d = 1.31 for CBT and d = 1.30 for SNDT). More than 65% of youth had a complete remission of depression at 3 months, with no difference between CBT and SNDT (67.8% and 63.2%, respectively). Compared to SNDT, CBT was associated with a greater reduction in IBD activity (p = .04) but no greater improvement on the Clinical Global Assessment Scale (p = .06) and health-related quality of life (IMPACT-III scale) (p = .07). CONCLUSION This is the first randomized controlled study to suggest improvements in depression severity, global functioning, quality of life, and disease activity in a physically ill pediatric cohort treated with psychotherapy. Clinical trial registration information-Reducing Depressive Symptoms in Physically Ill Youth; http://clinical trials.gov; NCT00534911.
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Kindt KCM, Kleinjan M, Janssens JMAM, Scholte RHJ. Evaluation of a school-based depression prevention program among adolescents from low-income areas: a randomized controlled effectiveness trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:5273-93. [PMID: 24837666 PMCID: PMC4053916 DOI: 10.3390/ijerph110505273] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/05/2014] [Accepted: 05/05/2014] [Indexed: 01/04/2023]
Abstract
A randomized controlled trial was conducted among a potential high-risk group of 1,343 adolescents from low-income areas in The Netherlands to test the effectiveness of the depression prevention program Op Volle Kracht (OVK) as provided by teachers in a school setting. The results showed no main effect of the program on depressive symptoms at one-year follow-up. A moderation effect was found for parental psychopathology; adolescents who had parents with psychopathology and received the OVK program had less depressive symptoms compared to adolescents with parents with psychopathology in the control condition. No moderating effects on depressive symptoms were found for gender, ethnical background, and level of baseline depressive symptoms. An iatrogenic effect of the intervention was found on the secondary outcome of clinical depressive symptoms. Based on the low level of reported depressive symptoms at baseline, it seems that our sample might not meet the characteristics of a high-risk selective group for depressive symptoms. Therefore, no firm conclusions can be drawn about the selective potential of the OVK depression prevention program. In its current form, the OVK program should not be implemented on a large scale in the natural setting for non-high-risk adolescents. Future research should focus on high-risk participants, such as children of parents with psychopathology.
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Affiliation(s)
- Karlijn C M Kindt
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
| | - Marloes Kleinjan
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
| | - Jan M A M Janssens
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
| | - Ron H J Scholte
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
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Tobin SJ, George MP. Positive affect increases secondary control among causally uncertain individuals. Cogn Emot 2014; 29:401-15. [PMID: 24801280 DOI: 10.1080/02699931.2014.916253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Secondary control (acceptance of and adjustment to negative events) is thought to promote positive affect. We examined the opposite path: could positive affect increase secondary control, particularly among individuals high in causal uncertainty, who stand to benefit from it the most? In two studies, participants completed a causal uncertainty scale, thought about a problem while listening to affect-inducing music or no music, and then completed items that assessed secondary control. In Study 1, the music induced positive or negative affect. In Study 2, the music induced affect that was high or low in activation and positive or negative in valence. In both studies, we found that positive affect-inducing music increased secondary control among high causal uncertainty participants. Furthermore, trait affect did not account for the effects of causal uncertainty, and music did not influence primary control. These findings show that secondary control can fluctuate as a function of state affect.
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Affiliation(s)
- Stephanie J Tobin
- a School of Psychology , University of Queensland , Brisbane , QLD 4072 , Australia
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Riley AR, Gaynor ST. Identifying mechanisms of change: utilizing single-participant methodology to better understand behavior therapy for child depression. Behav Modif 2014; 38:636-64. [PMID: 24742468 DOI: 10.1177/0145445514530756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined therapeutic mechanisms of action at the single-participant level in a behavior therapy (BT) for youth depression. By controlling for non-specific early responses, identifying potential mechanisms of action a priori, taking frequent measures of hypothesized mechanisms and dependent variables, rigorously evaluating internal validity, and using a variety of analytic methods, a unique model for analysis of potential mediators was created. Eleven children (M age = 9.84) meeting criteria on the Children's Depression Rating Scale-Revised (M = 55.36) and Children's Depression Inventory (M = 23.45) received non-directive therapy (NDT), followed by BT for those still displaying significant symptoms. Four participants (36%) had a clinically significant response to NDT. For the remaining seven, statistically significant changes in depressive symptoms and family interactions during the BT interval were found at the group level. At the single-participant level, evidence suggesting that outcome was at least partially mediated by changes in treatment targets was obtained for four of seven (57%). As the field further embraces efforts to learn not only whether treatments work but also how they work, the single-participant approach to evaluating mediators provides a useful framework for evaluating theories of therapeutic change.
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Fabiano GA, Chafouleas SM, Weist MD, Carl Sumi W, Humphrey N. Methodology Considerations in School Mental Health Research. SCHOOL MENTAL HEALTH 2014. [DOI: 10.1007/s12310-013-9117-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Psychotherapeutische Behandlung von depressiven Kindern und Jugendlichen. PSYCHOTHERAPEUT 2013. [DOI: 10.1007/s00278-013-1026-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bearman SK, Weisz JR, Chorpita BF, Hoagwood K, Ward A, Ugueto AM, Bernstein A. More practice, less preach? the role of supervision processes and therapist characteristics in EBP implementation. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 40:518-29. [PMID: 23525895 PMCID: PMC4083565 DOI: 10.1007/s10488-013-0485-5] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Identifying predictors of evidence-based practice (EBP) use, such as supervision processes and therapist characteristics, may support dissemination. Therapists (N = 57) received training and supervision in EBPs to treat community-based youth (N = 136). Supervision involving modeling and role-play predicted higher overall practice use than supervision involving discussion, and modeling predicted practice use in the next therapy session. No therapist characteristics predicted practice use, but therapist sex and age moderated the supervision and practice use relation. Supervision involving discussion predicted practice use for male therapists only, and modeling and role-play in supervision predicted practice use for older, not younger, therapists.
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Affiliation(s)
- Sarah Kate Bearman
- Department of School-Clinical Child Psychology, Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1300 Morris Park Avenue, Bronx, NY, 10461, USA,
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Straub J, Koelch M, Fegert J, Plener P, Gonzalez-Aracil I, Voit A, Sproeber N. Innovations in Practice: MICHI, a brief cognitive-behavioural group therapy for adolescents with depression - a pilot study of feasibility in an inpatient setting. Child Adolesc Ment Health 2013; 18:247-250. [PMID: 32847305 DOI: 10.1111/j.1475-3588.2012.00678.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Group therapy is an economic intervention, allowing for fast access, for the treatment of several depressed adolescents simultaneously; evaluated manualised programs, however, are scarce. METHOD Nine depressive adolescent inpatients (M = 16.33 years; SD = 1.92) participated between October 2009 and March 2010 in a brief manualised group therapy programme (MICHI), which was evaluated with respect to feasibility and trends of efficacy. RESULTS MICHI demonstrated good feasibility, was positively evaluated by the participants by means of an evaluation questionnaire ranging from 1 (very bad) to 10 (very good) (M = 7.22; SD = 1.79), and showed significant reduction of depressive symptoms (z = -2.66, p = .008) assessed by means of a clinical interview. CONCLUSIONS Feasibility of MICHI was demonstrated and larger trials for efficacy will follow.
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Affiliation(s)
- Joana Straub
- Kinder- und Jugendpsychiatrie des Universitätsklinikums Ulm, Steinhövelstraße 5, Ulm, 89075, Germany
| | - Michael Koelch
- Vivantes Klinikum im Friedrichshain, Landsberger Allee, Kinder- und Jugendpsychiatrie, Berlin, Germany
| | - Joerg Fegert
- Kinder- und Jugendpsychiatrie des Universitätsklinikums Ulm, Steinhövelstraße 5, Ulm, 89075, Germany
| | - Paul Plener
- Kinder- und Jugendpsychiatrie des Universitätsklinikums Ulm, Steinhövelstraße 5, Ulm, 89075, Germany
| | - Inma Gonzalez-Aracil
- Kinder- und Jugendpsychiatrie des Universitätsklinikums Ulm, Steinhövelstraße 5, Ulm, 89075, Germany
| | - Anja Voit
- Kinder- und Jugendpsychiatrie des Universitätsklinikums Ulm, Steinhövelstraße 5, Ulm, 89075, Germany
| | - Nina Sproeber
- Kinder- und Jugendpsychiatrie des Universitätsklinikums Ulm, Steinhövelstraße 5, Ulm, 89075, Germany
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Lewandowski RE, Acri MC, Hoagwood KE, Olfson M, Clarke G, Gardner W, Scholle SH, Byron S, Kelleher K, Pincus HA, Frank S, Horwitz SM. Evidence for the management of adolescent depression. Pediatrics 2013; 132:e996-e1009. [PMID: 24043282 PMCID: PMC4074649 DOI: 10.1542/peds.2013-0600] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 12/28/2022] Open
Abstract
Adolescent depression is a prevalent and disabling condition resulting in emotional suffering and social and educational dysfunction. Care for adolescent depression is suboptimal and could be improved through the development and use of quality indicators (QIs). This article reports on the development of a care pathway and QIs for the primary and specialty care management of adolescent depression from case identification through symptom remission. It presents evidence from a review of adolescent clinical practice guidelines and research literature to support QIs at critical nodes in the pathway, and describes implications for practice based on existing evidence. Barriers to measure development are identified, including gaps in empirical evidence, and a research agenda is suggested.
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Affiliation(s)
- R Eric Lewandowski
- MSc, Department of Child and Adolescent Psychiatry, NYU School of Medicine, 1 Park Ave, New York, NY 10016.
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Whiteford HA, Harris MG, McKeon G, Baxter A, Pennell C, Barendregt JJ, Wang J. Estimating remission from untreated major depression: a systematic review and meta-analysis. Psychol Med 2013; 43:1569-1585. [PMID: 22883473 DOI: 10.1017/s0033291712001717] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Few studies have examined spontaneous remission from major depression. This study investigated the proportion of prevalent cases of untreated major depression that will remit without treatment in a year, and whether remission rates vary by disorder severity. METHOD Wait-list controlled trials and observational cohort studies published up to 2010 with data describing remission from untreated depression at ≤ 2-year follow-up were identified. Remission was defined as rescinded diagnoses or below threshold scores on standardized symptom measures. Nineteen studies were included in a regression model predicting the probability of 12-month remission from untreated depression, using logit transformed remission proportion as the dependent variable. Covariates included age, gender, study type and diagnostic measure. RESULTS Wait-listed compared to primary-care samples, studies with longer follow-up duration and older adult compared to adult samples were associated with lower probability of remission. Child and adolescent samples were associated with higher probability of remission. Based on adult samples recruited from primary-care settings, the model estimated that 23% of prevalent cases of untreated depression will remit within 3 months, 32% within 6 months and 53% within 12 months. CONCLUSIONS It is undesirable to expect 100% treatment coverage for depression, given many will remit before access to services is feasible. Data were drawn from consenting wait-list and primary-care samples, which potentially over-represented mild-to-moderate cases of depression. Considering reported rates of spontaneous remission, a short untreated period seems defensible for this subpopulation, where judged appropriate by the clinician. Conclusions may not apply to individuals with more severe depression.
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Affiliation(s)
- H A Whiteford
- Policy and Evaluation Group, Queensland Centre for Mental Health Research, QLD, Australia.
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Wilson CJ, Cottone RR. Using Cognitive Behavior Therapy in Clinical Work With African American Children and Adolescents: A Review of the Literature. JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT 2013. [DOI: 10.1002/j.2161-1912.2013.00032.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Eckshtain D, Gaynor ST. Combined Individual Cognitive Behavior Therapy and Parent Training for Childhood Depression: 2-3-Year Follow-Up. CHILD & FAMILY BEHAVIOR THERAPY 2013; 35:10.1080/07317107.2013.789362. [PMID: 24319316 PMCID: PMC3848053 DOI: 10.1080/07317107.2013.789362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Fourteen children with significant depressive symptoms from an open clinical trial of Primary and Secondary Control Enhancement Training augmented with Caregiver-Child Relationship Enhancement Training, participated in a 2-3-year follow-up assessment. The results suggested that the significant decreases in depressive symptoms observed at post-treatment were maintained at 2-3-year follow-up. Mothers' reports of significant improvement of child psychosocial functioning were also maintained, providing social validation of the effects. Pre-treatment child-rated mother-child relations predicted depressive symptoms at 2-3-year follow-up. These long-term data support the use of the combined intervention and suggest the need for further research on caregiver involvement in treatment.
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Affiliation(s)
- Dikla Eckshtain
- Judge Baker Children's Center and Harvard University, Boston, Massachusetts, USA
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Ward AM, Regan J, Chorpita BF, Starace N, Rodriguez A, Okamura K, Daleiden EL, Bearman SK, Weisz JR, The Research Network on Youth Menta. Tracking Evidence Based Practice with Youth: Validity of the MATCH and Standard Manual Consultation Records. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2013; 42:44-55. [DOI: 10.1080/15374416.2012.700505] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Outcome domains in child mental health research since 1996: have they changed and why does it matter? J Am Acad Child Adolesc Psychiatry 2012; 51. [PMID: 23200282 PMCID: PMC3513697 DOI: 10.1016/j.jaac.2012.09.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Child mental health treatment and services research yields more immediate public health benefit when they focus on outcomes of relevance to a broader group of stakeholders. We reviewed all experimental studies of child and adolescent treatment and service effectiveness published in the last 15 years (1996-2011) and compared the distribution and types of outcome domains to a prior review that focused on studies from the prior 15 years (1980-1995). METHOD Studies were included if they focused on children from birth to 18 years of age with specific or general psychiatric conditions, employed randomized designs, and examined intervention effects with a six-month or longer post-treatment assessment in treatment studies or a 6-month or longer post-baseline assessment for services studies. Two hundred (n=200) studies met criteria. Reported outcome measures were coded into conceptual categories drawn from the 1980-1995 review. RESULTS There was a five-fold increase in the total number of studies (38 versus 200) across the two 15-year time periods, with the largest increase in the number of studies that focused on consumer-oriented outcomes (from eight to 47 studies, an almost sixfold increase); two new domains, parent symptoms and health-related outcomes, were identified. The majority of studies (more than 95%) continued to focus on symptoms and diagnoses as an outcome. Impact ratings were higher among studies examining four or more outcomes versus one to two outcomes in all categories with the exception of Posttraumatic Stress Disorder. CONCLUSIONS Given major shifts in health care policy affecting mental health services, the emergence of health and parent-related outcomes as well as greater attention to consumer perspectives parallels emerging priorities in health care and can enhance the relevance of child outcome studies for implementation in the real world.
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Cox GR, Callahan P, Churchill R, Hunot V, Merry SN, Parker AG, Hetrick SE. Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents. Cochrane Database Syst Rev 2012; 11:CD008324. [PMID: 23152255 DOI: 10.1002/14651858.cd008324.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Depressive disorders are common in children and adolescents and, if left untreated, are likely to recur in adulthood. Depression is highly debilitating, affecting psychosocial, family and academic functioning. OBJECTIVES To evaluate the effectiveness of psychological therapies and antidepressant medication, alone and in combination, for the treatment of depressive disorder in children and adolescents. We have examined clinical outcomes including remission, clinician and self reported depression measures, and suicide-related outcomes. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to 11 November 2011. This register contains reports of relevant randomised controlled trials (RCTs) from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). SELECTION CRITERIA RCTs were eligible for inclusion if they compared i) any psychological therapy with any antidepressant medication, or ii) a combination of psychological therapy and antidepressant medication with a psychological therapy alone, or an antidepressant medication alone, or iii) a combination of psychological therapy and antidepressant medication with a placebo or 'treatment as usual', or (iv) a combination of psychological therapy and antidepressant medication with a psychological therapy or antidepressant medication plus a placebo.We included studies if they involved participants aged between 6 and 18 years, diagnosed by a clinician as having Major Depressive Disorder (MDD) based on Diagnostic and Statistical Manual (DSM) or International Classification of Diseases (ICD) criteria. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed the quality of the studies. We applied a random-effects meta-analysis, using the odds ratio (OR) to describe dichotomous outcomes, mean difference (MD) to describe continuous outcomes when the same measures were used, and standard mean difference (SMD) when outcomes were measured on different scales. MAIN RESULTS We included ten studies, involving 1235 participants in this review. Studies recruited participants with different severities of disorder and with a variety of comorbid disorders, including anxiety and substance use disorder, therefore limiting the comparability of the results. Regarding the risk of bias in studies, half the studies had adequate allocation concealment (there was insufficient information to determine allocation concealment in the remainder), outcome assessors were blind to the participants' intervention in six studies, and in general, studies reported on incomplete data analysis methods, mainly using intention-to-treat (ITT) analyses. For the majority of outcomes there were no statistically significant differences between the interventions compared. There was limited evidence (based on two studies involving 220 participants) that antidepressant medication was more effective than psychotherapy on measures of clinician defined remission immediately post-intervention (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.27 to 0.98), with 67.8% of participants in the medication group and 53.7% in the psychotherapy group rated as being in remission. There was limited evidence (based on three studies involving 378 participants) that combination therapy was more effective than antidepressant medication alone in achieving higher remission from a depressive episode immediately post-intervention (OR 1.56, 95% CI 0.98 to 2.47), with 65.9% of participants treated with combination therapy and 57.8% of participants treated with medication, rated as being in remission. There was no evidence to suggest that combination therapy was more effective than psychological therapy alone, based on clinician rated remission immediately post-intervention (OR 1.82, 95% CI 0.38 to 8.68).Suicide-related Serious Adverse Events (SAEs) were reported in various ways across studies and could not be combined in meta-analyses. However suicidal ideation specifically was generally measured and reported using standardised assessment tools suitable for meta-analysis. In one study involving 188 participants, rates of suicidal ideation were significantly higher in the antidepressant medication group (18.6%) compared with the psychological therapy group (5.4%) (OR 0.26, 95% CI 0.09 to 0.72) and this effect appeared to remain at six to nine months (OR 1.27, 95% CI 0.68 to 2.36), with 13.6% of participants in the medication group and 3.9% of participants in the psychological therapy group reporting suicidal ideation. It was unclear what the effect of combination therapy was compared with either antidepressant medication alone or psychological therapy alone on rates of suicidal ideation. The impact of any of the assigned treatment packages on drop out was also mostly unclear across the various comparisons in the review.Limited data and conflicting results based on other outcome measures make it difficult to draw conclusions regarding the effectiveness of any specific intervention based on these outcomes. AUTHORS' CONCLUSIONS There is very limited evidence upon which to base conclusions about the relative effectiveness of psychological interventions, antidepressant medication and a combination of these interventions. On the basis of the available evidence, the effectiveness of these interventions for treating depressive disorders in children and adolescents cannot be established. Further appropriately powered RCTs are required.
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Affiliation(s)
- Georgina R Cox
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
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Longitudinal Results of Cognitive Behavioral Treatment for Youths with Inflammatory Bowel Disease and Depressive Symptoms. J Clin Psychol Med Settings 2012; 19:329-37. [DOI: 10.1007/s10880-012-9301-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Maalouf FT, Brent DA. Child and adolescent depression intervention overview: what works, for whom and how well? Child Adolesc Psychiatr Clin N Am 2012; 21:299-312, viii. [PMID: 22537728 DOI: 10.1016/j.chc.2012.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors review the currently available evidence-based treatments of child and adolescent major depressive disorder. Medication monotherapy, namely with selective serotonin reuptake inhibitors, is supported by large clinical trials in adolescents. For mild to moderate depression, cognitive behavior therapy (CBT) and interpersonal therapy are reasonable options as monotherapies. There is also evidence that the combination of medication and CBT is superior to medication alone for accelerating the pace of treatment response and remission, despite some negative studies. Response, remission, and recurrence rates after acute treatment and during long-term follow-ups are also presented and discussed.
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Affiliation(s)
- Fadi T Maalouf
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon.
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Eckshtain D, Gaynor ST. Combining individual cognitive behaviour therapy and caregiver-child sessions for childhood depression: an open trial. Clin Child Psychol Psychiatry 2012; 17:266-83. [PMID: 21733933 DOI: 10.1177/1359104511404316] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The objective was to obtain preliminary evidence on the feasibility and efficacy of combining individual cognitive behavior therapy (CBT) with complimentary caregiver-child sessions for depressed youths. Fifteen children participated in an open clinical trial. Treatment included 16 CBT sessions combined with seven caregiver/caregiver-child sessions over 12 weeks. Data were collected at pre-, mid-, and post-treatment and at one- and six-month follow-ups. Significant decreases in depressive symptoms were apparent, with the majority showing clinically meaningful improvement. Benchmarked against the literature, the combination equaled or outperformed CBT in other studies and was superior to control conditions. Mother and teacher reports of child functioning significantly improved, providing social validation of the effects. Mothers reported improved caregiver-child relationships and less parenting stress. Children did not report acute improvements in relations with their caregivers. However, when a father participated, improved father-child relations were reported in the follow-up period. Younger age and lower pretreatment severity predicted greater symptom change. The positive treatment effects provide support for the combined intervention and suggest a further research focus on the effects of caregiver involvement in the treatment of depressed youths.
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Affiliation(s)
- Dikla Eckshtain
- Judge Baker Children's Center and Harvard University, Boston, MA 02120-3225, USA.
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