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Lindsey MA, Mufson L, Vélez-Grau C, Grogan T, Wilson DM, Reliford AO, Gunlicks-Stoessel M, Jaccard J. Engaging Black youth in depression and suicide prevention treatment within urban schools: study protocol for a randomized controlled pilot. Trials 2024; 25:112. [PMID: 38336803 PMCID: PMC10854091 DOI: 10.1186/s13063-024-07947-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Depression continues to be an ongoing threat to adolescent well-being with Black adolescents being particularly vulnerable to greater burdens of depression as well as lower mental health service utilization. Black adolescents are likely to have untreated depression due to social network influences, varied perceptions of services and providers, or self-stigma associated with experiencing depressive symptoms. Furthermore, if or when treatment is initiated, low engagement and early termination are common. To address this gap, a trial is being conducted to preliminarily test the effectiveness of an engagement intervention targeting Black adolescents with depression in school mental health services in New York City. METHODS A total of 60 Black middle and high school adolescents displaying depressive symptoms are equally randomized (based on school site) to the treatment arms. Both trial arms deliver Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), a time-limited, evidence-based treatment for depression. Additionally, one arm pairs IPT-A with a brief, multi-level engagement intervention, the Making Connections Intervention (MCI), involving adolescents, caregivers, and clinicians. Outcomes of interest are group differences in depression and suicide ideation, adolescent and caregiver engagement, and mental health service use. DISCUSSION This trial will serve as an efficacy assessment of the MCI among a sample of Black adolescent students with depressive symptoms. Clinical and implementation results will be used to inform future research to further test the MCI intervention in a larger sample. TRIAL REGISTRATION Registered by ClinicalTrials.gov on May 3, 2019, identifier: NCT03940508.
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Affiliation(s)
- Michael A Lindsey
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA.
| | - Laura Mufson
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Carolina Vélez-Grau
- School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Tracy Grogan
- McSilver Institute for Poverty Policy and Research, New York University, 708 Broadway, Fifth Floor, New York, NY, 10003, USA
| | - Damali M Wilson
- McSilver Institute for Poverty Policy and Research, New York University, 708 Broadway, Fifth Floor, New York, NY, 10003, USA
| | - Aaron O Reliford
- Child & Adolescent Psychiatry, NYU Langone Health, 1 Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Meredith Gunlicks-Stoessel
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2025 East River Parkway, Minneapolis, MN, 55414, USA
| | - James Jaccard
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
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Hurley D, Swann C, Allen MS, Ferguson HL, Vella SA. A Systematic Review of Parent and Caregiver Mental Health Literacy. Community Ment Health J 2020; 56:2-21. [PMID: 31541315 DOI: 10.1007/s10597-019-00454-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 09/07/2019] [Indexed: 12/14/2022]
Abstract
This study aimed to systematically review the current body of research on parent and caregiver mental health literacy. Electronic databases were searched in January 2018 with 21 studies meeting inclusion criteria. A narrative synthesis of quantitative and qualitative studies was conducted. Findings across studies suggest that parents and caregivers had limited mental health knowledge. Factors associated with help-seeking included cultural and religious beliefs, financial and knowledge barriers, fear and mistrust of treatment services, and stigma. Notable limitations include non-representative samples, cross-sectional research designs, and use of inconsistent and non-validated study measures. Research would benefit from more diverse samples, an increased focus on prevention, and controlled trials of educational programmes targeting mental health literacy.
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Affiliation(s)
- Diarmuid Hurley
- School of Psychology, University of Wollongong, Wollongong, Australia. .,Global Alliance for Mental Health and Sport, School of Psychology, University of Wollongong, Wollongong, Australia.
| | - Christian Swann
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, NSW, Australia.,Centre for Athlete Development, Experience & Performance, Southern Cross University, Coffs Harbour, Australia
| | - Mark S Allen
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Helen L Ferguson
- School of Psychology, University of Wollongong, Wollongong, Australia.,English Institute of Sport, Manchester, England, UK
| | - Stewart A Vella
- School of Psychology, University of Wollongong, Wollongong, Australia.,Global Alliance for Mental Health and Sport, School of Psychology, University of Wollongong, Wollongong, Australia
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Williams SK, Hutto LM. Killing Monsters. Clin Case Stud 2016. [DOI: 10.1177/1534650103261224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The following case study examines a novel treatment strategy used to address one boy's fears, employed in the context of an 8-week psychoeducational counseling experience. As the focus of this article is a specific intervention strategy that occurred during the counseling process, brief information on the theoretical underpinnings, organization, and constituency of the counseling group is provided, although the authors emphasized a single critical incident during which the strategy was implemented. This article emphasizes (a) the flexibility required in conducting this type of group work and the need to adapt group structure to the needs of themembers; (b) the need to sometimes develop novel, and often spontaneous, treatment strategies; (c) the related convergence ofmultiple disciplines (e.g., psychology, religion, medicine); and (d) empathy when working with childhood fears. Related to these factors, specific recommendations for practice and training are outlined.
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Young AS, Meers MR, Vesco AT, Seidenfeld AM, Arnold LE, Fristad MA. Predicting Therapeutic Effects of Psychodiagnostic Assessment Among Children and Adolescents Participating in Randomized Controlled Trials. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 48:S1-S12. [PMID: 27105332 DOI: 10.1080/15374416.2016.1146992] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study explored predictors of improvement after completing a psychodiagnostic screening assessment but before randomization among youth who participated in two pilot randomized controlled trials of omega-3 supplementation and Individual-Family Psychoeducational Psychotherapy (PEP). Ninety-five youth (56.8% male, 61.1% White) ages 7-14 with mood disorders completed screening and baseline assessments (including Clinical Global Impressions-Improvement [CGI-I], Children's Depression Rating Scale-Revised, Young Mania Rating Scale), then were randomized into a 12-week trial of omega-3, PEP, their combination, or placebo. Between screening and randomization, 35.8% minimally improved (CGI-I = 3), 12.6% much improved (CGI-I < 3), totaling 48.4% improved. Caregiver postsecondary education (p = .018), absence of attention-deficit/hyperactivity disorder (p = .027), and lower screen depression severity (p = .034) were associated with CGI-I. Caregiver postsecondary education (p = .020) and absence of a disruptive behavior diagnosis (p = .038) were associated with depression severity improvement. Prerandomization improvement moderated treatment outcomes: Among youth who improved prerandomization, those who received PEP (alone or with omega-3) had more favorable placebo-controlled depression trajectories due to a lack of placebo response. This open-label trial of psychodiagnostic assessment provides suggestive evidence that psychodiagnostic assessment is beneficial, especially for those with depression and without externalizing disorders. Prerandomization improvement is associated with better placebo-controlled treatment response. Future research should test alternative hypotheses for change and determine if less intensive (shorter and/or automated) assessments would provide comparable results.
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Affiliation(s)
- Andrea S Young
- a Department of Psychiatry and Behavioral Health , The Ohio State University
| | - Molly R Meers
- a Department of Psychiatry and Behavioral Health , The Ohio State University
| | - Anthony T Vesco
- a Department of Psychiatry and Behavioral Health , The Ohio State University
| | - Adina M Seidenfeld
- a Department of Psychiatry and Behavioral Health , The Ohio State University
| | - L Eugene Arnold
- a Department of Psychiatry and Behavioral Health , The Ohio State University
| | - Mary A Fristad
- a Department of Psychiatry and Behavioral Health , The Ohio State University
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MacPherson HA, Mackinaw-Koons B, Leffler JM, Fristad MA. Pilot Effectiveness Evaluation of Community-Based Multi-Family Psychoeducational Psychotherapy for Childhood Mood Disorders. ACTA ACUST UNITED AC 2016; 5:43-59. [PMID: 27057423 DOI: 10.1037/cfp0000055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Several psychosocial, family-focused Evidence-Based Treatments (EBTs) for youth with disruptive behavior have proven effective in practice settings. However, limited research has examined community implementation of EBTs for pediatric depression and bipolar disorder. This pilot open trial evaluated Multi-Family Psychoeducational Psychotherapy (MF-PEP) with 41 children ages 7 to 12 (54% male, 92% Caucasian) with mood disorders and their parents in an outpatient setting. MF-PEP is an 8-session, adjunctive EBT with parallel child and parent groups. Fourteen community therapists facilitated six MF-PEP groups at three agencies over two years. Developed checklists were used to evaluate adherence. Clinical outcomes were measured via clinician assessment and self-report questionnaires at pre-treatment, post-treatment, 6-month follow-up, and 12-month follow-up, and analyzed via hierarchical linear modeling. Therapist group adherence ranged from 66.71% to 78.68% (M = 72.14%, SD = 4.85). Children experienced significant improvement in depressive and manic symptoms, and parents reported a significant increase in knowledge of mood disorders. Children with bipolar disorder and families with limited treatment history benefitted most from MF-PEP. Effect sizes (Cohen's d) ranged from small to large for mood outcomes (d = 0.34 to 1.18), knowledge (d = 1.02), and treatment beliefs (d = 0.04 to 0.41). Limitations included small sample, missing data, and open design. Results suggest that MF-PEP may be impactful for families affected by pediatric mood disorders in the community, especially among youth with bipolar disorder and families novice to treatment. Randomized controlled trials are needed to provide more definitive evidence for the effectiveness of MF-PEP in practice settings.
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Affiliation(s)
- Heather A MacPherson
- Departments of Psychology and Psychiatry and Behavioral Health, The Ohio State University
| | | | | | - Mary A Fristad
- Departments of Psychiatry and Behavioral Health, Psychology, and Nutrition, The Ohio State University
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MacPherson HA, Leffler JM, Fristad MA. Implementation of multi-family psychoeducational psychotherapy for childhood mood disorders in an outpatient community setting. JOURNAL OF MARITAL AND FAMILY THERAPY 2014; 40:193-211. [PMID: 24749838 PMCID: PMC4198302 DOI: 10.1111/jmft.12013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Despite advances in evidence-based treatments (EBTs), research suggests these interventions are not utilized in practice settings. This study examined implementation of multi-family psychoeducational psychotherapy (MF-PEP), an EBT for childhood mood disorders, in two outpatient community clinics. Fifteen community therapists facilitated MF-PEP. Twenty community clinicians referred 40 children ages 8-12 with mood disorders and their parents who participated in MF-PEP. Preliminary descriptive findings based on observations and self-report questionnaires demonstrated implementation outcomes of acceptability, adoption, appropriateness, feasibility, implementation cost, penetration, and sustainability of MF-PEP at these clinics. Parents also demonstrated significant improvement in knowledge of mood disorders posttreatment. Preliminary results support implementation of MF-PEP in practice settings and suggest community-based MF-PEP may be associated with improvement in clinical outcomes.
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Eisner LR, Johnson SL. An acceptance-based psychoeducation intervention to reduce expressed emotion in relatives of bipolar patients. Behav Ther 2008; 39:375-85. [PMID: 19027434 PMCID: PMC2847480 DOI: 10.1016/j.beth.2007.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 10/29/2007] [Accepted: 11/01/2007] [Indexed: 01/29/2023]
Abstract
Expressed emotion (EE) is a robust predictor of outcome in bipolar disorder. Despite decades of research, interventions to reduce EE levels have had only modest effects. This study used an expanded model of EE to develop an intervention. Research has demonstrated a strong link between attributions and EE in families of patients with psychiatric disorders. There is also substantial research to suggest that anger can drive blaming attributions. Combining these ideas, this study built on previous psychoeducation interventions through the addition of an acceptance component designed to decrease anger and blaming attributions among family members of those with bipolar disorder. Twenty-eight family members attended a 1-day or 2-evening multifamily group workshop and completed a follow-up assessment 1 week later. At follow-up, participants demonstrated more knowledge about bipolar disorder. Anger, blaming attributions, and number of criticisms remained unchanged. Results of this study are consistent with others in that it is difficult to change EE. Implications for future clinical research in this area are addressed.
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Affiliation(s)
- Lori R Eisner
- Department of Psychology, University of Miami, Coral Gables, FL 33124-2070, USA.
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Psychosocial Family Treatment for a 10-Year-Old with Schizoaffective Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2008. [DOI: 10.1016/j.cbpra.2006.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Abstract
Bipolar disorder (BPD) has received increasing attention from public and professional sources. Although pharmacologic treatments are considered the sine qua non in the treatment of youth with BPD, psychosocial interventions are critical to assist the child and family cope with symptoms that carry with them significant morbidity and mortality. Treatments developed to date are few in number; all are psychoeducationally based, using cognitive-behavioral and family systems interventions within a biopsychosocial framework. This paper reviews possible mediators of outcome, including caregiver concordance, children's social skills, hopelessness, and family stress. The author has developed two family-based psychoeducational interventions for the treatment of youth with BPD: multifamily psychoeducation groups (MFPG) and individual family psychoeducation (IFP). These treatments are both described and the results from a previously published randomized clinical trial (RCT) of MFPG are summarized. Then, new findings from an RCT of IFP are presented, along with preliminary pilot data from an expanded version of IFP. The paper concludes with recommendations for future research.
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Fristad MA, Goldberg-Arnold JS, Gavazzi SM. Multi-family psychoeducation groups in the treatment of children with mood disorders. JOURNAL OF MARITAL AND FAMILY THERAPY 2003; 29:491-504. [PMID: 14593691 DOI: 10.1111/j.1752-0606.2003.tb01691.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study examined the impact of adjunctive multi-family psychoeducation groups (MFPG) on mood-disordered children aged 8 to 11 and their families. Participants were 35 children and 47 parents from families randomly assigned to either immediate MFPG plus treatment as usual (n = 18) or a 6-month wait-list condition plus treatment as usual (n = 17). At the 6 month follow up, immediate treatment families reported: Increased parental knowledge about childhood mood symptoms; increased positive family interactions as reported by the parent; increased perceptions of parental support as reported by children; and increased utilization of appropriate services by families. Expected impact on decreasing negative family interactions was not found. Results are largely consistent with hypothesized findings and support the need to further investigate the adjunctive role of psychoeducation in the treatment of childhood mood disorders.
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Affiliation(s)
- Mary A Fristad
- Departments of Psychiatry and Psychology, Ohio State University, 1670 Upham Drive, Suite 460G, Columbus, Ohio 43210-1250, USA.
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11
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Fristad MA, Goldberg-Arnold JS, Gavazzi SM. Multifamily psychoeducation groups (MFPG) for families of children with bipolar disorder. Bipolar Disord 2002; 4:254-62. [PMID: 12190715 DOI: 10.1034/j.1399-5618.2002.09073.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Multi-family psychoeducation groups (MFPG) have been developed and tested for adults, but not for children with bipolar disorder (BPD). We present data from a pilot study of our manual-driven MFPG treatment for families of children with mood disorders and address two questions: Do families of children with BPD and families of children with major depressive disorder/dysthymic disorder (MDD/DD): 1) differ at treatment entry?; 2) benefit equally from intervention? METHOD A total of 35 children (n=16, BPD; n=19, MDD/DD) aged 8-11 years and their parents were randomized into immediate MFPG plus treatment as usual (TAU) or wait-list + TAU and assessed periodically. RESULTS At baseline, there was a trend toward parents in BPD families being more knowledgeable about mood symptoms than parents in MDD/DD families (p < 0.04). Additionally at baseline, children with BPD evidenced greater mood severity historically and a trend toward more hospitalizations, day treatment, outpatient treatment, medication trials, and placement in special education classrooms than children with MDD/DD. Immediately following and 4 months post-treatment, both BPD and MDD/DD families described having gained knowledge, skills, support, and positive attitudes during treatment. MDD/DD families increased their knowledge of symptoms to the same level as BPD families. CONCLUSIONS While BPD families enter treatment with more impaired children and more extensive treatment histories, both BPD and MDD/DD families benefit from intervention. The clinical issues concerning combining families of children with bipolar and depressive spectrum illnesses in groups are discussed. Clinical impressions suggest that such combinations are clinically feasible and potentially beneficial.
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Affiliation(s)
- Mary A Fristad
- Department of Psychiatry, The Ohio State University, Columbus, OH 43210, USA.
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Livianos-Aldana L, Rojo-Moreno L. Rating and quantification of manic syndromes. Acta Psychiatr Scand Suppl 2002:2-33. [PMID: 11833632 DOI: 10.1034/j.1600-0447.2001.104s409002.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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