Effectiveness of attachment-based family therapy compared to treatment as usual for depressed adolescents in community mental health clinics

Adverse childhood experiences and infidelity: The mediating roles of anxious and avoidant attachment styles

Infidelity is any behavior that breaks the implied agreement of exclusivity within a romantic relationship and is a leading cause of divorce. Previous literature has established a relationship between Adverse Childhood Experiences (ACEs) and infidelity perpetration. As experiencing childhood adversity does not guarantee an individual will engage in infidelity, mechanisms explaining this relationship should be explored. We investigated whether avoidant and anxious attachment styles mediate the relationship between ACEs and cheating frequency. A sample of 584 participants aged 18-82 years (M = 35.31, SD = 11.68, 67.0% female) was recruited and completed online versions of the Childhood Experiences Survey-17, the Relationship Structures Questionnaire, and frequency of cheating behavior in their current or most recent relationship. After dichotomizing gender and testing assumptions, data from 553 participants were available for analysis. A parallel mediation provided support for the first hypothesis, and partial support for the second. Specifically, ACEs were positively associated with anxious and avoidant attachment styles, but only avoidant attachment was significantly and positively associated with cheating frequency. As such, only avoidant attachment acted in a manner consistent with a mediator in the relationship between ACEs and infidelity. This result suggests a potential link between childhood adversity and the development of both avoidant and anxious attachment styles, but that individuals with an avoidant attachment style are more likely to engage in infidelity. These findings provide insight into the role attachment styles play in infidelity post-childhood adversity, and have the potential to guide therapeutic interventions for affected individuals.

Depressive disorders in Chinese left-behind children and adolescents from Yunnan province: prevalence and association with self-harm behaviors

BACKGROUND

The prevalence of clinically diagnosed depressive disorders (DD) in Chinese left-behind children (LBC) remains unknown. We aim to estimate the prevalence of DD, discuss the associations between DD and self-harm (SH) behaviors in a large representative sample of Chinese LBCs chosen from Yunnan province.

METHODS

A total of 5462 LBCs were selected from the most recent datasets of the Mental Health Survey for Children and Adolescents in Yunnan (MHSCAY), a mega population-based two-phase cross-sectional survey. Weighted prevalence rates and designed Logistic regression were adopted to estimate the prevalence of DD and the association between DD and SH.

RESULTS

The weighted prevalence of lifetime and current DD were 4.22% (95% CI: 3.13-6.00%) and 3.84% (95% CI: 2.85-5.00%) in Chinese LBCs. Higher lifetime and current DD prevalence rates were observed in girls and those reported adverse parental marital status and SH behaviors. The absence of DD was associated with significantly decreased odds of SH behavior (OR = 0.06), repetitive SH (OR = 0.09), using multiple SH methods (OR = 0.09), and severe SH (OR = 0.15). Subsequently performed stratified analyses identified prominent effect modification by sex and age, as a stronger association between DD and SH was found in girls (OR = 0.02 versus OR = 0.07 in boys) and younger adolescents (OR = 0.08 versus OR = 0.22 in older adolescents).

CONCLUSION

The prevalence of DD was high in Chinese LBCs. DD was associated with prominently increased risk of SH behaviors in LBCs. Attention and intervention are needed in this vulnerable population.

Effectiveness of Psychotherapy for Internalising Symptoms in Children and Adolescents When Delivered in Routine Settings: A Systematic Review and Meta-analysis

This systematic review and meta-analysis aimed to examine the effectiveness of psychological interventions for internalising disorders in youth when delivered in routine settings. Secondary aims were to examine the effectiveness of cognitive behavioural therapy and determine moderators of treatment response. The study was pre-registered (PROSPERO 2020 CRD42020202776). Databases were systematically searched (PsycINFO, Medline, Embase, PubMed, ERIC) in December 2022 and screened according to the PRISMA 2020 statement. Inclusion: School aged participants (4-18 years) with a primary internalising disorder; psychotherapy delivered in a routine setting (e.g. outpatient clinic, school) by setting staff; compared psychotherapy to any control in a randomised controlled trial; reported pre-to-post or pre-to-follow-up comparisons on the primary disorder according to child, parent or independent evaluator report; and was published in English. Risk of bias was assessed using the ROB 2.0 Cochrane tool. Results were synthesised using random effects to pool estimates. Risk ratios were used to analyse dichotomous data and standardised mean differences (SMD) for continuous data. Forty-five studies were included (N = 4901 participants; M = 13 years; range 8-16; SD = 2.5). Nine used waitlist control, 17 treatment as usual, 4 placebo; 15 compared psychotherapy to active control. Psychotherapy was associated with small significant effects pre- to post-treatment compared to non-active controls for anxiety (SMD =  - 0.24 to 0.50) and depression (SMD =  - 0.19 to 0.34) with effects differing by informant. Psychotherapy led to small significant pre-to-post-benefits in youth internalising disorders in routine settings. Results are limited by reporter type and follow-up.

Review: Adverse event monitoring and reporting in studies of pediatric psychosocial interventions: a systematic review

BACKGROUND

Adverse event monitoring in studies of psychotherapy is crucial to clinical decision-making, particularly for weighing of benefits and harms of treatment approaches. In this systematic review, we identified how adverse events are defined, measured, and reported in studies of psychosocial interventions for children with mental disorders.

METHOD

Medline, PsycINFO, Embase, ProQuest Dissertations and Theses Global, and the Cochrane Library were searched from January 2011-January 2023, and Google Scholar from January 2011-February 2023. English language experimental and quasi-experimental studies that evaluated the efficacy or effectiveness of psychosocial interventions for childhood mental disorders were included. Information on the definition, assessment, and report of adverse events was extracted using a checklist based on Good Clinical Practice guidelines.

RESULTS

In this review, 117 studies were included. Studies most commonly involved treating anxiety disorders or obsessive-compulsive disorder (32/117; 27%); 44% of the experimental interventions tested (52/117) were cognitive behavioral therapies. Adverse events were monitored in 36 studies (36/117; 31%) with a protocol used in 19 of these studies to guide monitoring (19/36; 53%). Twenty-seven different events were monitored across the studies with hospitalization the most frequently monitored (3/36; 8%). Event severity was fully assessed in 6 studies (17%) and partially assessed in 12 studies (33%). Only 4/36 studies (11%) included assessing events for cause.

CONCLUSIONS

To date, adverse events have been inconsistently defined, measured and reported in psychosocial intervention studies of childhood mental health disorders. Information on adverse events is an essential knowledge component for understanding the potential impacts and risks of therapeutic interventions.

Influence of on emotions and behavior of adolescents with major depressive disorder

Background

Major depressive disorder in adolescents is characterized by high prevalence rate, high recurrence rate, high suicide rate and high disability rate. However, the recognition rate and cure rate are low, and the disease has a very bad influence on the family and society. The lack of psychiatrists and psychotherapists in villages and small towns makes it difficult to get timely and professional intervention and treatment for adolescent with major depressive disorder.

Methods

A total of 84 adolescents with major depressive disorder who received treatment in the department of psychosomatic medicine of the Second Affiliated Hospital of Nanchang University participated in this survey, and they were divided into the control group and the intervention group by random number table. Adolescent Non-suicidal Self-injury Assessment Questionnaire (ANSSIAQ), Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU), Screen for Child Anxiety Related Emotional Disorders (SCARED) and Depression Self-Rating Scale for Childhood (DSRS) were used to investigate the negative emotions and behavior of adolescents with major depressive disorder at baseline and intervention for 12 weeks.

Results

There were no significant differences in the baseline information of adolescents (sex ratio, age, education level), including the total score of SCARED, DSRS and SQAPMPU, the total mean score of ANSSIAQ between the two groups (P > 0.05). After 12-week intervention, the score of SCARED, DSRS and SQAPMPU, the total mean score of ANSSIAQ in both groups were lower than that of the baseline, and the score of the intervention group showed a more obvious downward trend (P < 0.05).

Conclusions

In-person and remote Satir family therapy not only effectively reduced the anxiety and depression level among participants, but also validly reduced their non-suicidal self-injury behavior and mobile phone use behavior. The results verified that the model we adopted can be well applied for the out-patient management of adolescents with major depressive disorder, especially in villages and small towns.

Family therapy for adolescents with depression and suicidal ideation: A systematic review and meta-analysis

OBJECTIVE

To systematically review and meta-analyze the effectiveness of family therapy compared to other active treatments for adolescents with depressive disorders or suicidal ideation.

METHOD

We conducted a systematic search of The Cochrane Central Register of Controlled Trials, Medline, Embase, PsycINFO, AMED, CINAHL and Web of Science and performed two meta-analyses of outcomes for depressive symptoms and suicidal ideation.

RESULTS

We screened 5,940 records and identified 10 randomized controlled studies of family therapy for depressive disorder or suicidal ideation in adolescents with an active treatment comparison group. Nine studies reported outcome measures of depressive symptoms and four reported outcome measures of suicidal ideation. The meta-analysis showed no significant difference between family therapy and active comparison treatments for end-of-treatment levels of depression. For suicidal ideation our meta-analysis showed a significant effect in favour of family therapy over comparison treatments for suicidal ideation.

CONCLUSIONS

Based on the current body of research, we found that family therapy is not superior to other psychotherapies in the treatment of depressive disorder. However, family therapy leads to significantly improved outcomes for suicidal ideation, compared to other psychotherapies. The evidence for the treatment of depression is of low quality needs more research.

Implementing Evidence-Based Suicide Prevention Strategies for Greatest Impact

Suicide remains a leading cause of death in the United States and globally. In this review, epidemiological trends in mortality and suicide risk are presented, with consideration given to the impact of the COVID-19 pandemic. A public health model of suicide prevention with a community and clinical framework, along with advances in scientific discovery, offer new solutions that await widespread implementation. Actionable interventions with evidence for reducing risk for suicidal behavior are presented, including universal and targeted strategies at community, public policy, and clinical levels. Clinical interventions include screening and risk assessment; brief interventions (e.g., safety planning, education, and lethal means counseling) that can be done in primary care, emergency, and behavioral health settings; psychotherapies (cognitive-behavioral, dialectical behavior, mentalization therapy); pharmacotherapy; and systemwide procedures for health care organizations (training, policies, workflow, surveillance of suicide indicators, use of health records for screening, care steps). Suicide prevention strategies must be prioritized and implemented at scale for greatest impact.

Associations between insecure attachment styles to parents and suicidal ideation in adolescents with depression

Objective

Suicidal ideation and depressive symptoms are often interrelated in clinical settings. Insecure attachment may be a risk factor for suicidal ideation in depressed adolescents. To our knowledge, this study is the first to examine the association between self-reported insecure attachment styles to both parents and suicidal ideation in a clinical sample of adolescents with depression.

Methods

Fifty clinically depressed adolescents (13-17 years, 84% girls) completed self-reported measures of suicidal ideation, depressive symptoms, and attachment style to parents.

Results

There was a statistically significant bivariate association between higher levels of attachment anxiety in relation to mothers and fathers and higher levels of suicidal ideation. When attachments to both parents were included in the same multivariate model, only attachment anxiety to the mother was significantly associated with the level of suicidal ideation. Self-reported depressive symptoms remained significantly associated with the level of suicidal ideation in all analyses. Younger adolescents with attachment anxiety reported higher levels of suicidal ideation than older adolescents.

Conclusion

Conclusions about directionality and causality of associations between insecure attachment and suicidal ideation are limited due to the cross-sectional design. Our findings suggest that attachment anxiety in relation to the mother and father is associated with increased levels of suicidal ideation. Implication of these findings for treatment selection is discussed.

Efficacy of attachment-based family therapy compared to treatment as usual for suicidal ideation in adolescents with MDD

Attachment-Based Family Therapy (ABFT) is the only empirically supported family therapy model designed to treat adolescent depression, including those at risk for suicide, and their families. ABFT aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. To study the effectiveness of ABFT compared with Treatment as Usual (TAU) in reducing suicidal ideation in clinically depressed adolescents. Sixty adolescents (86.7% girls), aged 13 to 18 years (M = 14.9), with major depressive disorder referred to two CAMHS were randomized to receive 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions according to the treatment manual. Suicidal ideation was measured with the Suicidal Ideation Questionnaire-Junior at 4, 6, 8, 10, 12, 14, and 16 weeks. Linear mixed models were fitted to test our hypothesis, time was the only factor to have a significant effect on suicidal ideation t(31.05) = -3.32, p < .01. Participants in both treatment groups reported significantly reduced suicidal ideation, but the majority were still in the clinical range after 16 weeks of treatment. ABFT was not associated with more favorable outcomes than TAU. Findings must be interpreted with caution given the study limitations.