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Mansueto S, Kumar R, Raitman MR, Jahagirdar A, Chen S, Wang W, Krause KR, Monga S, Szatmari P, Courtney DB. Discriminative validity and interpretability of the mood and feelings questionnaire. J Affect Disord 2024; 363:552-562. [PMID: 39029698 DOI: 10.1016/j.jad.2024.07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/12/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Using the Mood and Feelings Questionnaire (MFQ) to differentiate between depression severity levels remains unexplored. We explored the discriminative validity of the MFQ to identify an optimal cut-off MFQ score to distinguish between subthreshold-to-mild and moderate-to-severe depression severity levels. METHODS An observational cross-sectional design was used in a sample (N = 67) of help-seeking youth (ages 13 to 18, inclusive) experiencing depressive symptoms. The MFQ was administered verbatim to youth by a research analyst over the phone. Youth were then grouped into subthreshold-to-mild or moderate-to-severe depression severity categories based on scores received on the Kiddie Schedule for Affective Disorders and Schizophrenia-Depression Rating Scale. Receiver Operating Characteristic curve analyses were conducted, with area under the curve (AUC) and Youden Index (J) as primary indices. We hypothesized that the lower limit of the 95 % confidence interval for the area under the curve would be ≥0.70. RESULTS The primary analysis yielded an AUC of 0.85 (95 % CI: 0.763-0.947) and an optimal cut-off of ≥43 (J = 0.60, positive predictive value = 91.4 %, negative predictive value = 62.5 %, sensitivity = 72.7 %, specificity = 87.0 %). LIMITATIONS Our study collected a small sample, and as such cannot identify how subgroup classification (e.g., based on race or gender) may moderate outcomes. Further, unknown measurement error of the predictor and reference variable measures can bias the estimates. CONCLUSIONS Our preliminary findings highlight the potential for the MFQ to support clinical decision-making relevant to adolescents experiencing varying severities of depressive symptoms in secondary care settings.
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Affiliation(s)
| | | | | | | | - Sheng Chen
- Centre for Addiction and Mental Health, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Canada
| | | | - Suneeta Monga
- Hospital for Sick Children, University of Toronto, Department of Psychiatry, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Canada; Hospital for Sick Children, University of Toronto, Department of Psychiatry, Canada
| | - Darren B Courtney
- Centre for Addiction and Mental Health, Canada; University of Toronto, Department of Psychiatry, Canada.
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2
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Chokroverty L. Depression Part 2: Treatment. Pediatr Rev 2024; 45:494-504. [PMID: 39217118 DOI: 10.1542/pir.2024-006479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 09/04/2024]
Abstract
Depression treatment strategies are within the scope of pediatric practice and among the competencies recommended by the Academy of Pediatrics and The American Board of Pediatrics. Treatments that may be provided through collaborative care include nonpharmacologic therapies such as psychosocial treatments and evidence-based psychotherapies, and pharmacotherapy and monitoring processes for depression. Abundant support and guidance are available to pediatricians in depression care, including mental health consultation and online materials.
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Affiliation(s)
- Linda Chokroverty
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Montefiore Health Systems/Albert Einstein College of Medicine, Bronx, NY
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3
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Chokroverty L. Depression Part 1: Evaluation. Pediatr Rev 2024; 45:483-493. [PMID: 39217122 DOI: 10.1542/pir.2022-005688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 09/04/2024]
Abstract
By young adulthood, 1 in 5 teens will experience an episode of major depression. The second leading cause of death among youths aged 15 to 24 years is suicide, most of which will have been caused by untreated or undiagnosed depression. Depression is a highly heritable condition: depressed children often have depressed parents. Support to caregivers is important because depressed parents can have negative effects on children's development and future mental health. Groups more vulnerable to mental health disorders such as depression include Black, Indigenous, and persons of color and lesbian, gay, bisexual, transgender, or queer/questioning, who in recent years have the highest rate of suicide attempts (Black teens, sexual minority youth), the highest increases in suicide rates (Black children and youths), and the highest suicide rates (American Indian/Alaskan native). They frequently experience more adverse childhood events, which increases the risk of depression and suicide attempts. Pediatricians are most likely to care for these vulnerable youths, who often are less engaged in specialty mental health care for a variety of reasons, including stigma and barriers to access. By offering behavioral and mental health care to vulnerable populations in primary care, mental health equity may be achieved. Screening for depression and assessment for suicide are within the scope of pediatric practice and among the competencies recommended by the American Academy of Pediatrics and The American Board of Pediatrics.
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Affiliation(s)
- Linda Chokroverty
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Montefiore Health Systems/Albert Einstein College of Medicine, Bronx, NY
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4
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Menculini G, Cinesi G, Scopetta F, Cardelli M, Caramanico G, Balducci PM, De Giorgi F, Moretti P, Tortorella A. Major challenges in youth psychopathology: treatment-resistant depression. A narrative review. Front Psychiatry 2024; 15:1417977. [PMID: 39056019 PMCID: PMC11269237 DOI: 10.3389/fpsyt.2024.1417977] [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] [Received: 04/15/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
Major depressive disorder (MDD) represents a major health issue in adolescents and young adults, leading to high levels of disability and profoundly impacting overall functioning. The clinical presentation of MDD in this vulnerable age group may slightly differ from what can be observed in adult populations, and psychopharmacological strategies do not always lead to optimal response. Resistance to antidepressant treatment has a prevalence estimated around 40% in youths suffering from MDD and is associated with higher comorbidity rates and suicidality. Several factors, encompassing biological, environmental, and clinical features, may contribute to the emergence of treatment-resistant depression (TRD) in adolescents and young adults. Furthermore, TRD may underpin the presence of an unrecognized bipolar diathesis, increasing the overall complexity of the clinical picture and posing major differential diagnosis challenges in the clinical practice. After summarizing current evidence on epidemiological and clinical correlates of TRD in adolescents and young adults, the present review also provides an overview of possible treatment strategies, including novel fast-acting antidepressants. Despite these pharmacological agents are promising in this population, their usage is expected to rely on risk-benefit ratio and to be considered in the context of integrated models of care.
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Affiliation(s)
- Giulia Menculini
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gianmarco Cinesi
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Francesca Scopetta
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Matteo Cardelli
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Guido Caramanico
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Pierfrancesco Maria Balducci
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Community Mental Health Center “CSM Terni”, Department of Psychiatry, Local Health Unit USL Umbria 2, Terni, Italy
| | - Filippo De Giorgi
- Division of Psychiatry, Clinical Psychology and Rehabilitation, General Hospital of Perugia, Perugia, Italy
| | - Patrizia Moretti
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alfonso Tortorella
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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5
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Chang JC, Hai-Ti-Lin, Wang YC, Gau SSF. Treatment-resistant depression in children and adolescents. PROGRESS IN BRAIN RESEARCH 2023; 281:1-24. [PMID: 37806711 DOI: 10.1016/bs.pbr.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Major depressive disorder (MDD) in children and adolescents is a significant health problem, causing profound impairments in social, academic, and family functioning and substantial morbidity and mortality. Up to 15% of children and adolescents suffer from MDD, and a proportion, around 30 to 40% of them, failed to respond to initial selective serotonin reuptake inhibitor (SSRI) treatment. The only evidence-based recommendation is medication switching to another SSRI and augmentation with cognitive behavioral therapy. Newly developing treatment, including ketamine, transcranial magnetic stimulation, psychotherapy other than cognitive behavioral therapy, and combined pharmacotherapy with other interventions, requires further longitudinal controlled trials regarding efficacy and safety in this vulnerable population.
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Affiliation(s)
- Jung-Chi Chang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Ti-Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Ching Wang
- Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Abstract
Major depressive disorder is a substantial public health challenge impacting at least 3 million adolescents annually in the United States. Depressive symptoms do not improve in approximately 30% of adolescents who receive evidence-based treatments. Treatment-resistant depression in adolescents is broadly defined as a depressive disorder that does not respond to a 2-month course of an antidepressant medication at a dose equivalent of 40 mg of fluoxetine daily or 8 to 16 sessions of a cognitive behavioral or interpersonal therapy. This article reviews historical work, recent literature on classification, current evidence-based approaches, and emerging interventional research.
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Affiliation(s)
- Emine Rabia Ayvaci
- Department of Psychiatry, UT Southwestern Medical Center, 6300 Harry Hines Boulevard, Dallas, TX 75235, USA. https://twitter.com/AyvaciRabia
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Vortioxetine for Major Depressive Disorder in Adolescents: 12-Week Randomized, Placebo-Controlled, Fluoxetine-Referenced, Fixed-Dose Study. J Am Acad Child Adolesc Psychiatry 2022; 61:1106-1118.e2. [PMID: 35033635 DOI: 10.1016/j.jaac.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 11/23/2021] [Accepted: 01/06/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of vortioxetine in adolescents with major depressive disorder (MDD). METHOD After 4 weeks of single-blind lead-in treatment with a Brief Psychosocial Intervention (BPI) plus placebo, patients (aged 12-17 years) with MDD (DSM-5) who did not meet response criteria (Children's Depression Rating Scale-Revised [CDRS-R]; total score ≥40 plus <40% reduction and a Parent Global Assessment score >2) were randomized 1:1:1:1 to 8 weeks of BPI plus double-blind treatment with vortioxetine 10 mg, vortioxetine 20 mg, fluoxetine 20 mg, or placebo. The primary endpoint was change from randomization in CDRS-R total score at week 8; the primary comparison was the average effect of 2 vortioxetine doses vs placebo. RESULTS Of 784 patients enrolled in the lead-in, 616 were randomized. At week 8, the mean change in CDRS-R total score averaged for vortioxetine doses was -18.01 (SE = 0.98) and the mean difference vs placebo was 0.21 (P = .878; not significant). For fluoxetine, the mean change in CDRS-R total score was -21.95 and the mean difference vs placebo was -3.73 (P = .015). Treatment-emergent adverse events occurring in ≥5% of patients in either vortioxetine arm and at least twice more frequently than placebo were nausea, headache, vomiting, and dizziness. CONCLUSION Patients in all groups showed reduction in CDRS-R scores by the end of the study, with no difference between combined doses of vortioxetine and placebo. The primary endpoint was not met, thereby rendering the study negative. The overall favorable safety profile of vortioxetine in an adolescent patient population was consistent with that seen in adults. CLINICAL TRIAL REGISTRATION INFORMATION Active Reference (Fluoxetine) Fixed-Dose Study of Vortioxetine in Paediatric Patients Aged 12 to 17 Years With Major Depressive Disorder (MDD); http://clinicaltrials.gov; NCT02709746.
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Amitai M, Kaffman S, Kroizer E, Lebow M, Magen I, Benaroya-Milshtein N, Fennig S, Weizman A, Apter A, Chen A. Neutrophil to-lymphocyte and platelet-to-lymphocyte ratios as biomarkers for suicidal behavior in children and adolescents with depression or anxiety treated with selective serotonin reuptake inhibitors. Brain Behav Immun 2022; 104:31-38. [PMID: 35470013 DOI: 10.1016/j.bbi.2022.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Both the neutrophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR) have been proposed as biomarkers of suicidal risk in adults with depression. We examined whether these ratios may be considered biomarkers for suicidal behavior in young patients with major depressive or anxiety disorders before treatment with selective serotonin reuptake inhibitors (SSRIs), or as biomarkers for the adverse event of SSRI-associated suicidality. METHODS Children and adolescents meeting criteria for major depressive or anxiety disorder were recruited. Serum levels of three pro-inflammatory cytokines (TNF-α, IL-6, IL-1β) were assessed; and NLR and PLR calculated, from blood samples collected at baseline and after 8 weeks treatment with SSRI. A Mann-Whitney test was performed to evaluate differences in NLR and PLR between children with and without a history of a suicide attempt prior to treatment. We compared hematological parameters before and after treatment, and between children who developed SSRI-associated suicidality versus children without treatment emergent suicidality. RESULTS Among 91 children and adolescents (aged 13.9 ± 2.4 years), baseline NLR and PLR were significantly higher among those with a history of a suicide attempt versus those without such history. Statistically significant correlations were found for the suicide ideation subscale in the Columbia suicide severity rating scale with both baseline NLR and PLR. Baseline NLR and PLR were similar in children who did and did not develop SSRI-associated suicidality after 8 weeks. In the final logistic regression model (χ2 = 18.504, df = 4, p value = 0.001), after controlling for sex, depression severity and IL-6 levels, NLR was significantly associated with a past suicide attempt (β = 1.247, p = 0.019; OR [95% CI] = 3.478 [1.230-9.841]), with a NLR cut-off value of = 1.76 (area under the curve = 0.75 (95% CI = 0.63-0.88, sensitivity = 73%, and specificity = 71%, p value = 0.003). CONCLUSIONS High NLR and PLR values may be associated with suicidal behavior in depressed and anxious children and adolescents. NLR appears as a better predictor of suicide attempt than PLR, and thus may be a useful biomarker of suicidality in young patients with depression or anxiety.
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Affiliation(s)
- Maya Amitai
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel; Department of Stress Neurobiology and Neurogenetics, Max-Planck Institute of Psychiatry, Munich, Germany; Department of Psychiatry, Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petach Tikva, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shaked Kaffman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Kroizer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Lebow
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel; Department of Stress Neurobiology and Neurogenetics, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Iddo Magen
- Department of Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Noa Benaroya-Milshtein
- Department of Psychiatry, Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petach Tikva, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silvana Fennig
- Department of Psychiatry, Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petach Tikva, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Petach Tikva, Israel; Research Unit, Geha Mental Health Center, Petach Tikva, Israel
| | - Alan Apter
- Department of Psychiatry, Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petach Tikva, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Chen
- Department of Brain Sciences, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel; Department of Stress Neurobiology and Neurogenetics, Max-Planck Institute of Psychiatry, Munich, Germany
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Dubicka B, Marwedel S, Banares S, McCulloch A, Tahoun T, Hearn J, Kroll L. Feasibility study of a new behavioural activation programme for young people with depressed mood. Child Adolesc Ment Health 2022; 27:131-137. [PMID: 34028154 DOI: 10.1111/camh.12474] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Behavioural activation (BA) is effective in adults with depression but the evidence for young people (YP) is less clear. We therefore developed and tested a new coproduced BA programme. METHOD In phase one (2014 to 2015 inclusive), we codeveloped with young people attending specialist child and adolescent mental health service (CAMHS) an 8-session BA workbook. In Phase two (2019 to 2020 inclusive), we ran an uncontrolled feasibility study in two specialist CAMHS, with BA being offered to YP by less specialised staff. RESULTS In phase one, we tested the workbook with 15 YP with depression and other comorbidities. Satisfaction was good from both YP and staff, and 9 YP reported improvement in mood. In phase two, 51 YP were offered BA; 15 declined to take part. 36 consented with three dropping out after consent. 33 YP (mean age 14.6, 12 males, 24 females) continued treatment attending a mean of 6.6 sessions. At the end of treatment, youth-rated Mood and Feeling Questionnaire (MFQ) mean score decreased from 43.2 to 27.6, difference 14.6 (95% CI 8.7 to 20.2; n = 28), and Clinician Global Assessment Score (CGAS) mean score increased from 52.3 to 69.8, difference 18.0 (95% CI 11.9 to 24.2; n = 29). Of the 33 YP who participated in therapy, 12 (36%) recovered and were discharged. CONCLUSIONS This programme demonstrated preliminary evidence for effectiveness and utility. Less specialised staff were able to use BA, and this may reduce secondary waits for more specialist therapy. More research is needed about the role of BA in specialist CAMHS.
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Affiliation(s)
- Bernadka Dubicka
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust Headquarters, Ashton-under-Lyne, UK.,Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | | | - Amy McCulloch
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust Headquarters, Ashton-under-Lyne, UK
| | - Taghrid Tahoun
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Leo Kroll
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust Headquarters, Ashton-under-Lyne, UK
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Xiang Y, Cuijpers P, Teng T, Li X, Fan L, Liu X, Jiang Y, Du K, Lin J, Zhou X, Xie P. Comparative short-term efficacy and acceptability of a combination of pharmacotherapy and psychotherapy for depressive disorder in children and adolescents: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:139. [PMID: 35193522 PMCID: PMC8862472 DOI: 10.1186/s12888-022-03760-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/03/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Although the clinical efficacy and safety of combination of pharmacotherapy and psychotherapy in the treatment of depressive disorders in children and adolescents have been studied, the results remain controversial. This meta-analysis aimed to study the short-term efficacy and acceptability of combined therapy for children and adolescents with depressive disorders. METHODS We conducted a systematic search in multiple databases for randomised controlled trials (RCTs), up to 31 December 2020, that assessed the combination of pharmacotherapy and psychotherapy against other active treatment options (pharmacotherapy, psychotherapy and placebo combined psychotherapy) in children and adolescents ( ≤ 18 years old) with depressive disorder. This study was registered with PROSPERO (CRD42020196701). RESULTS A total of 14 RCTs involving 1,325 patients were included. For the primary and secondary outcomes, there were no statistically significant differences between the compared interventions in terms of remission (odds ratios [OR] = 1.37; 95% confidence interval [CI]: 0.93 to 2.04), acceptability (OR = 0.99; 95% CI: 0.72 to 1.38), efficacy (standardised mean differences = -0.07; 95% CI: -0.32 to 0.19), and suicidality (OR = 1.17; 95% CI: 0.67 to 2.06). Limited evidence showed that the combination of fluoxetine (OR = 1.90, 95% CI: 1.10 to 3.29) or non-selective serotonin reuptake inhibitors (non-SSRI) (OR = 2.46, 95% CI: 1.06 to 5.72) with cognitive-behavioural therapy (CBT) was superior to other active treatment options. Most included trials were rated as 'some concerns' in terms of risk of bias assessment. CONCLUSION There is no evidence from the limited available data that all combined therapies are superior to other active treatment options for the acute treatment of depressive disorder in children and adolescents. However, it showed that fluoxetine or non-SSRI pharmacotherapies combined with CBT might be superior to other therapies in short-term. Mixed characteristics (e.g. age) and small sample size of non-SSRI combined therapy may influence the generalisability of the results.
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Affiliation(s)
- Yajie Xiang
- grid.452206.70000 0004 1758 417XDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China ,grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Pim Cuijpers
- grid.16872.3a0000 0004 0435 165XDepartment of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Teng Teng
- grid.452206.70000 0004 1758 417XDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China ,grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Xuemei Li
- grid.452206.70000 0004 1758 417XDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China ,grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Li Fan
- grid.452206.70000 0004 1758 417XDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China ,grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Xueer Liu
- grid.452206.70000 0004 1758 417XDepartment of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016 China ,grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Yuanliang Jiang
- grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China ,grid.263488.30000 0001 0472 9649School of Psychology, Shenzhen University, Shenzhen, China
| | - Kang Du
- grid.452206.70000 0004 1758 417XNHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China ,grid.203458.80000 0000 8653 0555Chongqing Key Laboratory of Neurobiology, Chongqing, China ,grid.263488.30000 0001 0472 9649School of Psychology, Shenzhen University, Shenzhen, China
| | - Jingyuan Lin
- grid.16872.3a0000 0004 0435 165XDepartment of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands ,grid.263488.30000 0001 0472 9649School of Psychology, Shenzhen University, Shenzhen, China
| | - Xinyu Zhou
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China. .,Chongqing Key Laboratory of Neurobiology, Chongqing, China. .,Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Peng Xie
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China. .,NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China. .,Chongqing Key Laboratory of Neurobiology, Chongqing, China.
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Courtney DB, Watson P, Krause KR, Chan BWC, Bennett K, Gunlicks-Stoessel M, Rodak T, Neprily K, Zentner T, Szatmari P. Predictors, Moderators, and Mediators Associated With Treatment Outcome in Randomized Clinical Trials Among Adolescents With Depression: A Scoping Review. JAMA Netw Open 2022; 5:e2146331. [PMID: 35103789 PMCID: PMC8808324 DOI: 10.1001/jamanetworkopen.2021.46331] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/08/2021] [Indexed: 12/26/2022] Open
Abstract
Importance The application of precision medicine principles for the treatment of depressive disorders in adolescents requires an examination of the variables associated with depression outcomes in randomized clinical trials (RCTs). Objective To describe predictors, moderators, and mediators associated with outcomes in RCTs for the treatment of depressive disorders in adolescents. Evidence Review A scoping review of RCTs for the treatment of depression in adolescents was conducted. Databases searched included MEDLINE, Embase, APA PsycInfo, and CINAHL. Included publications tested predictors, moderators, and/or mediators associated with depression symptom outcomes (eg, symptom reduction, response, remission) in RCTs pertaining to the treatment of adolescents, ages 13 to 17 years. Predictors were defined as variables that were associated with depression outcomes, independent of treatment group. Moderators were defined as baseline variables that were associated with differential outcomes between treatment groups. Mediators were defined by a formal mediation analysis. In duplicate, variables were extracted and coded with respect to analysis type (univariable or multivariable), statistical significance, direction of effect size, reporting of a priori hypotheses, and adjustment for multiple comparisons. Aggregated results were summarized by variable domain and RCT sample. Findings Eighty-one articles reporting on variables associated with outcomes across 33 RCTs were identified, including studies of biological (10 RCTs), psychosocial (18 RCTs), and combined (4 RCTs) treatments as well as a service delivery model (1 RCT). Fifty-three variable domains were tested as baseline predictors of depression outcome, 41 as moderators, 19 as postbaseline predictors, and 5 as mediators. Variable domains that were reported as significant in at least 3 RCTs included age, sex/gender, baseline depression severity, early response to treatment, sleep changes, parent-child conflict, overall psychopathology, suicidal ideation, hopelessness, functional impairment, attendance at therapy sessions, and history of trauma. Two publications reported a priori hypotheses and adjustment for multiple comparisons, both finding that baseline depression severity and family conflict were associated with poorer outcomes. Conclusions and Relevance This review identified commonly researched variables requiring more scrutiny as well as underresearched variables to inform future study designs. Further efforts to discover predictors, moderators, and mediators associated with treatment response have great potential to optimize care for adolescents with depression.
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Affiliation(s)
- Darren B. Courtney
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Priya Watson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Kathryn Bennett
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | - Terri Rodak
- Centre for Addiction and Mental Health Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kirsten Neprily
- School and Applied Child Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Tabitha Zentner
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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12
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Liu W, Li G, Wang C, Yu M, Zhu M, Yang L. Can Fluoxetine Combined with Cognitive Behavioral Therapy Reduce the Suicide and Non-Suicidal Self-Injury Incidence and Recurrence Rate in Depressed Adolescents Compared with Fluoxetine Alone? A Meta-Analysis. Neuropsychiatr Dis Treat 2022; 18:2543-2557. [PMID: 36349346 PMCID: PMC9637350 DOI: 10.2147/ndt.s367931] [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] [Received: 03/28/2022] [Accepted: 10/22/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE The efficacy of medication and psychotherapy for adolescent depression is controversial, so we conducted a meta-analysis to evaluate the efficacy of combination therapy. METHODS We followed the PRISMA checklist in completing the meta-analysis. Relevant literature was searched in PubMed, Web of Science and Embase, Chinese databases CNKI and WanFang Data. We included the literature on the comparison of the fluoxetine plus psychotherapy or cognitive-behavioral therapy (CBT) and each treatment alone for adolescent depression published in 1980-2021. All statistical analyses were performed using Stata software. RESULTS After careful review, a total of 489 relevant articles were retrieved, and 13 studies were finally included. In comparison with the control group (fluoxetine alone), fluoxetine plus CBT achieved higher response rate (RR=1.12, 95% CI: 1.04, 1.21), lower incidence of adverse Reactions (RR=0.62,95% CI:0.40,0.96), lower proportion of suicide or self-injury (RR=0.94,95% CI:0.74,1.20), and lower one-year recurrence rate (RR=0.27, 95% CI: 0.16, 0.45). Before treatment, there were no significant differences in Hamilton Depression Scale score (HAMD), Children's Depression Rating Scale Revised (CDRS-R) score, and Clinical Global Impression (CGI) Severity score. After treatment, HAMD score (SMD=-1.01, 95% CI:-1.39,-0.63), CDRS-R score (SMD= -0.10,95% CI:-0.26,-0.07), and CGI score (SMD = -0.22, 95% CI: -0.54, -0.10) were significantly lower in the combined treatment group than in the control group. CONCLUSION Adolescents simultaneously treated with fluoxetine and CBT had significantly reduced incidence of depressive symptoms, suicide or NSSI, adverse reactions, and one-year recurrence of symptoms, than adolescents treated with fluoxetine alone. This indicates fluoxetine plus CBT may be superior to fluoxetine alone for the clinical treatment of adolescent depression.
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Affiliation(s)
- Wenliang Liu
- Department of Psychological, Huai'an No.3 People's Hospital, Huaian, People's Republic of China
| | - Gongying Li
- Department of Psychological, Huai'an No.3 People's Hospital, Huaian, People's Republic of China
| | - Congjie Wang
- Department of Psychological, Huai'an No.3 People's Hospital, Huaian, People's Republic of China
| | - Mingchao Yu
- Department of Psychological, Huai'an No.3 People's Hospital, Huaian, People's Republic of China
| | - MengYa Zhu
- Department of Psychological, Huai'an No.3 People's Hospital, Huaian, People's Republic of China
| | - Lin Yang
- Department of Psychological, Huai'an No.3 People's Hospital, Huaian, People's Republic of China
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13
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Murphy SE, Capitão LP, Giles SLC, Cowen PJ, Stringaris A, Harmer CJ. The knowns and unknowns of SSRI treatment in young people with depression and anxiety: efficacy, predictors, and mechanisms of action. Lancet Psychiatry 2021; 8:824-835. [PMID: 34419187 DOI: 10.1016/s2215-0366(21)00154-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/15/2021] [Accepted: 04/01/2021] [Indexed: 01/12/2023]
Abstract
The use of SSRIs for the treatment of depression and anxiety in young people is increasing. However, the effects of SSRIs in adolescence, a time when there are substantial changes in neural, cognitive, and social functioning, are not well understood. Here, we review evidence from clinical trials about the benefits and risks of SSRIs in young people and consider their mechanisms of action, as shown through human experimental work and animal models. We emphasise key outstanding questions about the effects of SSRIs in youth, identified through gaps in the literature and in consultation with young people with lived experience. It is crucial to characterise the mechanisms underpinning risks and benefits of SSRIs in this age group to progress the field, and to narrow the chasm between the widespread use of SSRIs in youth and the science on which this use is based.
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Affiliation(s)
- Susannah E Murphy
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Liliana P Capitão
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Sophie L C Giles
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Philip J Cowen
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Argyris Stringaris
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Catherine J Harmer
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
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14
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Aitken M, Andrade BF. Attention Problems and Restlessness as Transdiagnostic Markers of Severity and Treatment Response in Youth with Internalizing Problems. Res Child Adolesc Psychopathol 2021; 49:1069-1082. [PMID: 33755870 DOI: 10.1007/s10802-021-00797-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 11/25/2022]
Abstract
Transdiagnostic models of psychopathology suggest that disorders may share common features that could influence their severity. Attention problems and psychomotor restlessness are included in the diagnostic criteria for several disorders, including disorders on the internalizing spectrum, but their transdiagnostic significance has received little attention. The present study identifies patterns of attention problems and restlessness among youth with internalizing problems, in order to understand their clinical significance in terms of internalizing symptom severity and response to cognitive behavioral therapy (CBT). Participants were 142 adolescents age 11-18 clinically referred for mood and/or anxiety problems. Latent class analysis was used to identify patterns of self-reported attention problems and psychomotor restlessness, and classes were compared on internalizing, depression, and anxiety severity. Differences in treatment response were examined in a subset of youth (n = 82; age 14-18) who participated in group CBT. Youth in the Attention Problems class (42% of sample) and youth in the Restless class (15% of sample) endorsed significantly more internalizing, depression, and anxiety problems than youth with Low Symptoms of attention problems or psychomotor restlessness (43% of sample). Youth in the Restless class responded significantly better to CBT than youth in the Low Symptoms of attention problems or psychomotor restlessness class in terms of decrease in overall internalizing problems. Attention problems and psychomotor restlessness appear to be important transdiagnostic markers of severity across the internalizing spectrum; however, they do not limit the effectiveness of CBT and, in the case of psychomotor restlessness, may forecast a good treatment response.
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Affiliation(s)
- Madison Aitken
- Department of Psychiatry, University of Toronto, Toronto, Canada. .,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Canada. .,Margaret and Wallace McCain Centre for Child and Youth Mental Health, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Brendan F Andrade
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Canada.,Margaret and Wallace McCain Centre for Child and Youth Mental Health, Centre for Addiction and Mental Health, Toronto, Canada
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15
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Mew EJ, Monsour A, Saeed L, Santos L, Patel S, Courtney DB, Watson PN, Szatmari P, Offringa M, Monga S, Butcher NJ. Systematic scoping review identifies heterogeneity in outcomes measured in adolescent depression clinical trials. J Clin Epidemiol 2020; 126:71-79. [DOI: 10.1016/j.jclinepi.2020.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/15/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022]
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16
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Courtney D, Watson P, Chan BWC, Bennett KJ, Neprily K, Zentner T, Rodak T, Narrandes R, Szatmari P. How have predictors, moderators, mediators, treatment response, remission and resistance been defined and measured in randomised controlled trials for adolescent depression? A scoping review protocol. BMJ Open 2020; 10:e036171. [PMID: 32571862 PMCID: PMC7311009 DOI: 10.1136/bmjopen-2019-036171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Among randomised controlled trials for depressed adolescents, the extent of variation in how depressive symptom outcomes are defined is unknown. The variability in which potential predictors of these outcomes are tested is also unclear. This paper is a protocol describing the methods of a planned scoping review. The scoping review will examine and summarise how change in depressive symptoms have been described in RCT treatment studies to date. This review will report the measures used to describe change in depressive symptoms and whether the measure was used as a continuous or binary outcome or both. This review will describe how dichotomous outcome terms are defined to describe change in depression severity. This review will also examine predictors, moderators and mediators of change in depressive symptoms within RCTs. METHODS AND ANALYSIS In this paper, we describe the protocol for our scoping review. Following the format outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, a research librarian will develop an operationalised search strategy, which we will apply to the MEDLINE, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature databases. We will search for papers from inception to 6 February 2020. A hand search for key citations will also be conducted. Investigator-raters will screen articles, first via the titles and abstracts and then through full-text reviews. We will include articles with randomised control design which assess the treatment of adolescents with major depressive disorder. We will systematically extract and synthesise prespecified data which includes: definition of depression used for participant inclusion, measures used to evaluate changes in depression, type of outcome used (continuous, binary or both), definitions of dichotomous terms to denote change in depression (eg, response, remission, recovery, etc) and reported predictors/moderators/mediators of change. ETHICS AND DISSEMINATION Ethics approval is not required. Findings will be presented in journal publications and at conferences.
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Affiliation(s)
- Darren Courtney
- Child, Youth and Family Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Priya Watson
- Child, Youth and Family Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Kathryn J Bennett
- Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | - Tabitha Zentner
- Child, Youth and Family Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Renira Narrandes
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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17
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Simplicio MD, Appiah-Kusi E, Wilkinson P, Watson P, Meiser-Stedman C, Kavanagh DJ, Holmes EA. Imaginator: A Proof-of-Concept Feasibility Trial of a Brief Imagery-Based Psychological Intervention for Young People Who Self-Harm. Suicide Life Threat Behav 2020; 50:724-740. [PMID: 32057131 PMCID: PMC7613067 DOI: 10.1111/sltb.12620] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/18/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The Imaginator study tested the feasibility of a short mental imagery-based psychological intervention for young people who self-harm and used a stepped-wedge design to investigate effects on self-harm frequency reduction at 3 and 6 months. METHOD A total of 38 participants aged 16-25 were recruited via community self-referral and mental health services. Participants were randomized to immediate delivery of Functional Imagery Training (FIT) or usual care followed by delayed delivery after 3 months. FIT comprised two face-to-face sessions, five phone sessions, and use of a smartphone app. Outcomes' assessment was blind to allocation. RESULTS Three quarters of those who began treatment completed face-to-face sessions, and 57% completed five or more sessions in total. Self-harm frequency data were obtained on 76% of the sample at 3 months (primary outcome) and 63% at 6 months. FIT produced moderate reductions in self-harm frequency at 3 months after immediate (d = 0.65) and delayed delivery (d = 0.75). The Immediate FIT group maintained improvements from 3 to 6 months (d = 0.05). Participants receiving usual care also reduced self-harm (d = 0.47). CONCLUSIONS A brief mental imagery-based psychological intervention targeting self-harm in young people is feasible and may comprise a novel transdiagnostic treatment for self-harm.
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Affiliation(s)
- Martina Di Simplicio
- Centre for Psychiatry, Brain Sciences Division, Imperial College London, London, UK,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Elizabeth Appiah-Kusi
- King’s College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, UK
| | - Paul Wilkinson
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Peter Watson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | | | - David J. Kavanagh
- Centre for Children’s Health Research, Institute of Health & Biomedical Innovation, and School of Psychology & Counselling, Queensland University of Technology, Brisbane, Australia
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18
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Asarnow JR, Tompson MC, Klomhaus AM, Babeva K, Langer DA, Sugar CA. Randomized controlled trial of family-focused treatment for child depression compared to individual psychotherapy: one-year outcomes. J Child Psychol Psychiatry 2020; 61:662-671. [PMID: 31840263 PMCID: PMC7242159 DOI: 10.1111/jcpp.13162] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Childhood-onset depression is associated with increased risk of recurrent depression and high morbidity extending into adolescence and adulthood. This multisite randomized controlled trial evaluated two active psychosocial treatments for childhood depression: family-focused treatment for childhood depression (FFT-CD) and individual supportive psychotherapy (IP). Aims were to describe effects through 52 weeks postrandomization on measures of depression, functioning, nondepressive symptoms, and harm events. METHODS Children meeting criteria for depressive disorders (N = 134) were randomly assigned to 15 sessions of FFT-CD or IP and evaluated at mid-treatment for depressive symptoms and fully at roughly 16 weeks (after acute treatment), 32 weeks, and 52 weeks/one year. See clinicaltrials.gov: NCT01159041. RESULTS Analyses using generalized linear mixed models confirmed the previously reported FFT-CD advantage on rates of acute depression response (≥50% Children's Depression Rating Scale reduction). Improvements in depression and other outcomes were most rapid during the acute treatment period, and leveled off between weeks 16 and 52, with a corresponding attenuation of observed group differences, although both groups showed improved depression and functioning over 52 weeks. Survival analyses indicated that most children recovered from their index depressive episodes by week 52: estimated 76% FFT-CD, 77% IP. However, by the week 52 assessment, one FFT-CD child and six IP children had suffered recurrent depressive episodes. Four children attempted suicide, all in the IP group. Other indicators of possible harm were relatively evenly distributed across groups. CONCLUSIONS Results indicate a quicker depression response in FFT-CD and hint at greater protection from recurrence and suicide attempts. However, outcomes were similar for both active treatments by week 52/one year. Although community care received after acute treatment may have influenced results, findings suggest the value of a more extended/chronic disease model that includes monitoring and guidance regarding optimal interventions when signs of depression-risk emerge.
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Affiliation(s)
| | | | | | - Kalina Babeva
- University of California, Los Angeles, Los Angeles, CA, USA
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19
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Monsour A, Mew EJ, Patel S, Chee-A-Tow A, Saeed L, Santos L, Courtney DB, Watson PN, Monga S, Szatmari P, Offringa M, Butcher NJ. Primary outcome reporting in adolescent depression clinical trials needs standardization. BMC Med Res Methodol 2020; 20:129. [PMID: 32450810 PMCID: PMC7247139 DOI: 10.1186/s12874-020-01019-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence-based health care is informed by results of randomized clinical trials (RCTs) and their syntheses in meta-analyses. When the trial outcomes measured are not clearly described in trial publications, knowledge synthesis, translation, and decision-making may be impeded. While heterogeneity in outcomes measured in adolescent major depressive disorder (MDD) RCTs has been described, the comprehensiveness of outcome reporting is unknown. This study aimed to assess the reporting of primary outcomes in RCTs evaluating treatments for adolescent MDD. METHODS RCTs evaluating treatment interventions in adolescents with a diagnosis of MDD published between 2008 and 2017 specifying a single primary outcome were eligible for outcome reporting assessment. Outcome reporting assessment was done independently in duplicate using a comprehensive checklist of 58 reporting items. Primary outcome information provided in each RCT publication was scored as "fully reported", "partially reported", or "not reported" for each checklist item, as applicable. RESULTS Eighteen of 42 identified articles were found to have a discernable single primary outcome and were included for outcome reporting assessment. Most trials (72%) did not fully report on over half of the 58 checklist items. Items describing masking of outcome assessors, timing and frequency of outcome assessment, and outcome analyses were fully reported in over 70% of trials. Items less frequently reported included outcome measurement instrument properties (ranging from 6 to 17%), justification of timing and frequency of outcome assessment (6%), and justification of criteria used for clinically significant differences (17%). The overall comprehensiveness of reporting appeared stable over time. CONCLUSIONS Heterogeneous reporting exists in published adolescent MDD RCTs, with frequent omissions of key details about their primary outcomes. These omissions may impair interpretability, replicability, and synthesis of RCTs that inform clinical guidelines and decision-making in this field. Consensus on the minimal criteria for outcome reporting in adolescent MDD RCTs is needed.
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Affiliation(s)
- Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Emma J Mew
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Sagar Patel
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Alyssandra Chee-A-Tow
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Leena Saeed
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Lucia Santos
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
| | - Darren B Courtney
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Priya N Watson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Suneeta Monga
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9712, Toronto, Ontario, M5G 0A4, Canada
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20
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Davies SE, Neufeld SA, van Sprang E, Schweren L, Keivit R, Fonagy P, Dubicka B, Kelvin R, Midgley N, Reynolds S, Target M, Wilkinson P, van Harmelen AL, Goodyer IM. Trajectories of depression symptom change during and following treatment in adolescents with unipolar major depression. J Child Psychol Psychiatry 2020; 61:565-574. [PMID: 31647124 PMCID: PMC7216986 DOI: 10.1111/jcpp.13145] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/10/2019] [Accepted: 09/24/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To classify a cohort of depressed adolescents recruited to the UK IMPACT trial, according to trajectories of symptom change. We examined for predictors and compared the data-driven categories of patients with a priori operational definitions of treatment response. METHOD Secondary data analysis using growth mixture modelling (GMM). Missing data were imputed. Trajectories of self-reported depressive symptoms were plotted using scores taken at six nominal time points over 86 weeks from randomisation in all 465 patients. RESULTS A piecewise GMM categorised patients into two classes with initially similar and subsequently distinct trajectories. Both groups had a significant decline in depressive symptoms over the first 18 weeks. Eighty-four per cent (84.1%, n = 391) of patients were classed as 'continued-improvers' with symptoms reducing over the duration of the study. A further class of 15.9% (n = 74) of patients were termed 'halted-improvers' with higher baseline depression scores, faster early recovery but no further improvement after 18 weeks. Presence of baseline comorbidity somewhat increased membership to the halted-improvers class (OR = 1.40, CI: 1.00-1.96). By end of study, compared with classes, a clinical remission cut-off score (≤27) and a symptom reduction score (≥50%) indexing treatment response misclassified 15% and 31% of cases, respectively. CONCLUSIONS A fast reduction in depressive symptoms in the first few weeks of treatment may not indicate a good prognosis. Halted improvement is only seen after 18 weeks of treatment. Longitudinal modelling may improve the precision of revealing differential responses to treatment. Improvement in depressive symptoms may be somewhat better in the year after treatment than previously considered.
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Affiliation(s)
| | | | | | - Lizanne Schweren
- Department of PsychiatryUniversity Medical Center GroningenGroningenThe Netherlands
| | - Rogier Keivit
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health PsychologyDivision of Psychology and Language SciencesUniversity College LondonLondonUK
| | | | - Raphael Kelvin
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Nick Midgley
- Research Department of Clinical, Educational and Health PsychologyDivision of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Shirley Reynolds
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Mary Target
- Research Department of Clinical, Educational and Health PsychologyDivision of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Paul Wilkinson
- Department of PsychiatryUniversity of CambridgeCambridgeUK
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21
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Boylan K, MacQueen G, Kirkpatrick R, Lee J, Santaguida PL. A systematic review of interventions for treatment resistant major depressive disorder in adolescents. Eur Child Adolesc Psychiatry 2020; 29:433-443. [PMID: 31165921 DOI: 10.1007/s00787-019-01341-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/19/2019] [Indexed: 12/24/2022]
Abstract
To update a comparative effectiveness review (1980-2011) of treatments for adolescents whose depressive episode or disorder (MDE/MDD) did not respond to one or more trials of SSRI antidepressants. MEDLINE, Cochrane Central, PsychINFO, Cochrane Database of Systematic Reviews, EMBASE, CINAHL, and AMED were searched in addition to the grey literature. We spanned May 2011 to September 1, 2017 and included only articles in English. 11 new studies were reviewed based on the criteria of having tested a comparative treatment in adolescents with MDD or MDE who were confirmed to have failed one or more SSRI trials. Data were extracted using standardized forms and a reference guide in DistillerSR; a second reviewer verified the accuracy of the data fields and discrepancies were resolved by consensus. One trial (N = 29) found a small benefit of escalating doses of fluoxetine and the treatment of adolescent depression study (TORDIA, N = 334) found significant benefits of combined SSRI or venlafaxine treatment with CBT for most outcomes. No new studies were identified since the previous review (2012). One trial is currently registered that will be a cross over trial of rTMS; other registered trials are open label. Multiple secondary data analyses of TORDIA have identified important predictors of treatment response and relapse. No new comparative studies were identified since the original review. Trials are desperately needed to identify new treatments for youth with SSRI resistant MDD. These youth should not be deemed as treatment resistant until completing one or two failed trials of SSRI combined with evidence-based psychotherapy.
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Affiliation(s)
- Khrista Boylan
- McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
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22
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Dwyer JB, Stringaris A, Brent DA, Bloch MH. Annual Research Review: Defining and treating pediatric treatment-resistant depression. J Child Psychol Psychiatry 2020; 61:312-332. [PMID: 32020643 PMCID: PMC8314167 DOI: 10.1111/jcpp.13202] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Adolescent major depressive disorder (MDD) is a significant health problem, associated with substantial morbidity, cost, and mortality. Depression is a significant risk factor for suicide, which is now the second leading cause of death in young people. Up to twenty per cent of adolescents will experience MDD before adulthood, and while a substantial proportion will improve with standard-of-care treatments (psychotherapy and medication), roughly one third will not. METHODS Here, we have reviewed the literature in order to discuss the concept of treatment-resistant depression (TRD) in adolescence, examine risk factors, diagnostic difficulties, and challenges in evaluating symptom improvement, and providing guidance on how to define adequate medication and psychotherapy treatment trials. RESULTS We propose a staging model for adolescent TRD and review the treatment literature. The evidence base for first- and second-line treatments primarily derives from four large pediatric clinical trials (TADS, TORDIA, ADAPT, and IMPACT). After two medications and a trial of evidence-based psychotherapy have failed to alleviate depressive symptoms, the evidence becomes quite thin for subsequent treatments. Here, we review the evidence for the effectiveness of medication switches, medication augmentation, psychotherapy augmentation, and interventional treatments (i.e., transcranial magnetic stimulation, electroconvulsive therapy, and ketamine) for adolescent TRD. Comparisons are drawn to the adult TRD literature, and areas for future pediatric depression research are highlighted. CONCLUSIONS As evidence is limited for treatments in this population, a careful consideration of the known risks and side effects of escalated treatments (e.g., mood stabilizers and atypical antipsychotics) is warranted and weighed against potential, but often untested, benefits.
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Affiliation(s)
- Jennifer B. Dwyer
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA,Yale Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Argyris Stringaris
- Mood Brain and Development Unit, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - Michael H. Bloch
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA,Yale Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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23
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Dhanak D, Thackeray L, Dubicka B, Kelvin R, Goodyer IM, Midgley N. Adolescents' experiences of brief psychosocial intervention for depression: An interpretative phenomenological analysis of good-outcome cases. Clin Child Psychol Psychiatry 2020; 25:106-118. [PMID: 31216867 DOI: 10.1177/1359104519857222] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Brief psychosocial intervention (BPI) is a treatment for adolescent depression that has recently demonstrated clinical effectiveness in a controlled trial. The aim of this study is to explore experiences of adolescents with major depression receiving BPI treatment in the context of good treatment outcomes. METHOD A subsample of five interviews from a larger study of adolescents' experiences of BPI was purposively selected, focusing on good-outcome cases. Interviews were analysed using interpretative phenomenological analysis to provide a richer understanding of participants' experiences of overcoming depression in the BPI group. RESULTS Four central themes were identified: 'Being heard and feeling safe', 'Collaborative working enhancing therapy', 'Gaining a different perspective on one's self and relationships' and 'A positive therapeutic relationship'. CONCLUSION BPI is a novel approach with promising clinical effectiveness. Utilising adolescents' experiences has revealed potential psychological mechanisms of good treatment response to BPI. Overall implications for clinical practice with depressed adolescents are discussed.
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Affiliation(s)
- Darshita Dhanak
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Lisa Thackeray
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, UK
| | - Bernadka Dubicka
- Institute of Brain and Behaviour and Mental Health, The University of Manchester, UK
| | - Raphael Kelvin
- Developmental Psychiatry Section, University of Cambridge, UK
| | - Ian M Goodyer
- Developmental Psychiatry Section, University of Cambridge, UK
| | - Nick Midgley
- Research Department of Clinical, Educational and Health Psychology, University College London, UK.,Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, UK
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24
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John-Baptiste AA, Li L, Isaranuwatchai W, Osuch E, Anderson KK. Healthcare utilization costs of emerging adults with mood and anxiety disorders in an early intervention treatment program compared to a matched cohort. Early Interv Psychiatry 2019; 13:1439-1446. [PMID: 30688032 DOI: 10.1111/eip.12790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/06/2018] [Accepted: 12/26/2018] [Indexed: 11/26/2022]
Abstract
AIM The First Episode Mood and Anxiety Disorder Program (FEMAP) provides treatment to emerging adults with mood and anxiety disorders in an accessible, youth-friendly environment. We sought to investigate FEMAP's impact on the costs of care. METHODS We conducted a retrospective observational study of one-year health service costs using linked administrative datasets to compare emerging adults treated at FEMAP (FEMAP users) to propensity-score matched controls (non-users). Costs from the perspective of the Ontario Ministry of Health and Long-Term Care, included drug benefit claims, inpatient, physician and ambulatory care services. We used bootstrapping to perform unadjusted comparisons between FEMAP users and non-users, by cost category and overall. We performed risk-adjusted comparison of overall costs using generalized estimating equations. RESULTS FEMAP users (n = 366) incurred significantly lower costs compared to non-users (n = 660), for inpatient services (-$784, 95% confidence interval [CI] -$1765, -$28), ambulatory care services (-$90, 95% CI -$175, -$14) and drug benefit claims (-$47, 95% CI -$115,-$4) and significantly higher physician services costs ($435, 95% CI $276, $581) over 1 year. The unadjusted difference in overall costs was not significant (-$853, 95% CI -$2048, $142). Following adjustment for age, sex and age at first mental health diagnosis, the difference of -$914 (95% CI (-$2747, $919)) was also not significant. CONCLUSIONS FEMAP was associated with significantly lower costs of inpatient and ambulatory care services, and higher costs of physician services, however we are unable to conclude that FEMAP is cost-saving overall.
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Affiliation(s)
- Ava A John-Baptiste
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Interfaculty Program in Public Health, Western University, London, Ontario, Canada.,Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI Centre), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Lihua Li
- Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research (CLEAR), St. Michael's Hospital, Toronto, Ontario, Canada.,Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Elizabeth Osuch
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, London, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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25
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Srinivasan R, Walker S, Wakefield J. Cognitive behavioural therapy, short-term psychoanalytical psychotherapy and brief psychosocial intervention are all effective in the treatment of depression in adolescents. Arch Dis Child Educ Pract Ed 2019; 104:56. [PMID: 30076158 DOI: 10.1136/archdischild-2018-315259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ramya Srinivasan
- Division of Psychiatry, University College London, London, UK.,UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Susan Walker
- Division of Psychiatry, University College London, London, UK.,UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Justin Wakefield
- Child and Adolescent Mental Health Service (CAMHS), East London NHS Foundation Trust, London, London, UK
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26
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Hides L, Dingle G, Quinn C, Stoyanov SR, Zelenko O, Tjondronegoro D, Johnson D, Cockshaw W, Kavanagh DJ. Efficacy and Outcomes of a Music-Based Emotion Regulation Mobile App in Distressed Young People: Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e11482. [PMID: 30664457 PMCID: PMC6352004 DOI: 10.2196/11482] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/20/2018] [Accepted: 09/29/2018] [Indexed: 12/11/2022] Open
Abstract
Background Emotion dysregulation increases the risk of depression, anxiety, and substance use disorders. Music can help regulate emotions, and mobile phones provide constant access to it. The Music eScape mobile app teaches young people how to identify and manage emotions using music. Objective This study aimed to examine the effects of using Music eScape on emotion regulation, distress, and well-being at 1, 2, 3, and 6 months. Moderators of outcomes and user ratings of app quality were also examined. Methods A randomized controlled trial compared immediate versus 1-month delayed access to Music eScape in 169 young people (aged 16 to 25 years) with at least mild levels of mental distress (Kessler 10 score>17). Results No significant differences between immediate and delayed groups on emotion regulation, distress, or well-being were found at 1 month. Both groups achieved significant improvements in 5 of the 6 emotion regulation skills, mental distress, and well-being at 2, 3, and 6 months. Unhealthy music use moderated improvements on 3 emotion regulation skills. Users gave the app a high mean quality rating (mean 3.8 [SD 0.6]) out of 5. Conclusions Music eScape has the potential to provide a highly accessible way of improving young people’s emotion regulation skills, but further testing is required to determine its efficacy. Targeting unhealthy music use in distressed young people may improve their emotion regulation skills. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12615000051549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365974
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Affiliation(s)
- Leanne Hides
- School of Psychology, The University of Queensland, Brisbane, Australia.,School of Psychology & Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
| | - Genevieve Dingle
- School of Psychology & Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Catherine Quinn
- School of Psychology & Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Stoyan R Stoyanov
- School of Psychology, The University of Queensland, Brisbane, Australia.,School of Psychology & Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
| | - Oksana Zelenko
- Creative Industries Faculty, Queensland University of Technology, Brisbane, Australia
| | - Dian Tjondronegoro
- School of Business and Tourism, Southern Cross University, Gold Coast, Australia
| | - Daniel Johnson
- School of Business and Tourism, Southern Cross University, Gold Coast, Australia
| | - Wendell Cockshaw
- School of Psychology & Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
| | - David J Kavanagh
- School of Psychology & Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
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27
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Monsour A, Mew EJ, Szatmari P, Patel S, Saeed L, Offringa M, Butcher NJ. Outcomes reported in randomised clinical trials of major depressive disorder treatments in adolescents: a systematic scoping review protocol. BMJ Open 2019; 9:e024191. [PMID: 30782729 PMCID: PMC6340428 DOI: 10.1136/bmjopen-2018-024191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/19/2018] [Accepted: 11/22/2018] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) is a common mental health condition in adolescents. Randomised clinical trials (RCTs) are the gold standard for assessing the safety and efficacy of interventions in this population. Heterogeneity in the outcomes measured and reported between RCTs limits the ability to compare, contrast, and combine trial results in a clinically meaningful way. There is currently no core outcome set (COS) available for use in RCTs evaluating interventions in adolescents with MDD. We will conduct a systematic scoping review of outcomes reported in adolescent depression RCTs to assess the variability of trial outcomes and to inform the development of a COS for adolescent MDD. METHODS AND ANALYSIS We will apply methods based on the Joanna Briggs Institute scoping review methods manual. RCTs evaluating any treatment intervention for adolescent MDD published in the last 10 years will be located using an electronic bibliographic database search (MEDLINE, PsycINFO and Cochrane Central Register of Controlled Trials). Title and abstract screening, full-text screening, and data charting of eligible studies will be performed in duplicate. Outcomes identified will be mapped to an outcome-domain framework. Data analysis will include summary statistics of the characteristics of the included trials and outcomes. ETHICS AND DISSEMINATION The results of this review will inform the development of a COS for adolescent MDD. The development and implementation of a COS for RCTs evaluating interventions in adolescents with MDD promise to help reduce variability in trial outcome selection, definition, measurement and reporting, ultimately facilitating evidence synthesis that will help to identify the best treatment practices for adolescents with MDD.
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Affiliation(s)
- Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Emma J Mew
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression at the Centre for Addiction and Mental Health, and Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sagar Patel
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Leena Saeed
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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28
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Holtmann M, Mokros L, Kirschbaum-Lesch I, Kölch M, Plener PL, Ruckes C, Schulte-Markwort M, Legenbauer T. Adolescent depression: Study protocol for a randomized, controlled, double-blind multicenter parallel group trial of Bright Light Therapy in a naturalistic inpatient setting (DeLight). Trials 2018; 19:568. [PMID: 30340625 PMCID: PMC6194631 DOI: 10.1186/s13063-018-2949-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depressive disorders are among the most prominent health problems in youth. Even with the best available pharmacological and non-pharmacological treatments, remission rates are low. Without early treatment, depression in youth is associated with a high risk of symptom progression, chronicity, co-morbidity, and suicidal behavior. Thus, adolescent depression is a prime candidate for innovation in treatment. In depressive adults, meta-analytic evidence has proven that bright light therapy (BLT) is a potent low-threshold intervention, promising due to easy application, low side effects, and optimized compliance. In adolescents, studies with small samples show promising effects. This randomized controlled trial will examine the effectiveness of BLT in youth inpatients. METHODS/DESIGN In this randomized, controlled, double-blind multicenter parallel group trial, morning BLT is applied for four weeks in addition to treatment as usual (TAU) for depressed youth inpatients (daily morning exposure to bright light via light-emitting glasses, 10,000 lx, for 30 min) and will be compared to a control condition (placebo light treatment, red light, identical light glasses). The primary objective is to assess whether BLT reduces symptoms of depression in youth with greater effect compared to placebo light therapy. Secondary objectives are to examine the impact of BLT on responder status, application of antidepressant medication, and further depression-related symptoms (sleep, activity, quality of life, satisfaction with health, general psychopathology, alertness, and circadian function). N = 224 patients will be recruited in a naturalistic inpatient setting. A follow-up will be carried out after three and six months. DISCUSSION The study aims to discuss and evaluate BLT as an additive method supporting standardized clinical procedures dealing with severe to moderate depressive symptoms in youth. TRIAL REGISTRATION German Clinical Trials Register, DRKS00013188 . Registered on November 30, 2017.
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Affiliation(s)
- Martin Holtmann
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
| | - Laura Mokros
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
| | - Inken Kirschbaum-Lesch
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
| | - Michael Kölch
- Department Child and Adolescent Psychiatry and Psychotherapy, Brandenburg Medical School, Neuruppin, Germany
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Trials, Mainz University, Mainz, Germany
| | | | - Tanja Legenbauer
- Clinic for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
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29
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McPherson S, Rost F, Town J, Abbass A. Epistemological flaws in NICE review methodology and its impact on recommendations for psychodynamic psychotherapies for complex and persistent depression. PSYCHOANALYTIC PSYCHOTHERAPY 2018. [DOI: 10.1080/02668734.2018.1458331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Felicitas Rost
- Portman Clinic, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Joel Town
- Faculty of Medicine, Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Allan Abbass
- Faculty of Medicine, Centre for Emotions and Health, Dalhousie University, Halifax, Canada
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30
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Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, Holland F, Kelvin R, Midgley N, Roberts C, Senior R, Target M, Widmer B, Wilkinson P, Fonagy P. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial. Health Technol Assess 2018; 21:1-94. [PMID: 28394249 DOI: 10.3310/hta21120] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years. OBJECTIVE To determine whether or not either of two specialist psychological treatments, cognitive-behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief psychosocial intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment. DESIGN Observer-blind, parallel-group, pragmatic superiority randomised controlled trial. SETTING A total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London. PARTICIPANTS Adolescents aged 11-17 years with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses. INTERVENTIONS In total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up. MAIN OUTCOME MEASURES Mean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation. RESULTS There were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = -0.578, 95% confidence interval (CI) -2.948 to 4.104; p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = -1.898, 95% CI -4.922 to 1.126; p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49-52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome. CONCLUSIONS The three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings. LIMITATIONS Neither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data. TRIAL REGISTRATION Current Controlled Trials ISRCTN83033550. FUNDING This project was funded by the National Institute for Heath Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 12. See the National Institute for Heath Research Journals Library website for further project information. Funding was also provided by the Department of Health. The funders had no role in the study design, patient recruitment, data collection, analysis or writing of the study, any aspect pertinent to the study or the decision to submit to The Lancet.
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Affiliation(s)
- Ian M Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | - Sarah Byford
- David Goldberg Centre, King's College London, London, UK
| | - Bernadka Dubicka
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Jonathan Hill
- Child and Adolescent Psychiatry, University of Manchester, Manchester, UK.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Fiona Holland
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Raphael Kelvin
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Nick Midgley
- Anna Freud National Centre for Children and Families, London, UK.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chris Roberts
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Rob Senior
- Tavistock and Portman NHS Foundation Trust, London, UK
| | - Mary Target
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Barry Widmer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paul Wilkinson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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31
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Coşkunlu A, Tanıl E, Coffey A, Büyüktaşkın D, Mulligan A. The Vasarhelyi method of child art psychotherapy: an adjunctive treatment in childhood depression. PSYCHOANALYTIC PSYCHOTHERAPY 2018. [DOI: 10.1080/02668734.2017.1334150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Aynur Coşkunlu
- Department of Child and Adolescent Psychiatry, University College Dublin, Dublin, Ireland
- Department of Psychology, Fatih Sultan Mehmet Vakıf University, Istanbul, Turkey
| | - Ezgi Tanıl
- Department of Child and Adolescent Psychiatry, University College Dublin, Dublin, Ireland
- Department of Psychology, Fatih Sultan Mehmet Vakıf University, Istanbul, Turkey
| | - Anne Coffey
- Department of Child and Adolescent Psychiatry, University College Dublin, Dublin, Ireland
- Department of Child Art Psychotherapy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Dicle Büyüktaşkın
- Department of Child and Adolescent Psychiatry, University College Dublin, Dublin, Ireland
- Department of Child and Adolescent Psychiatry, Gazi University School of Medicine, Ankara, Turkey
| | - Aisling Mulligan
- Department of Child and Adolescent Psychiatry, University College Dublin, Dublin, Ireland
- Dublin North City and County Child and Adolescent Mental Health Service, Health Services Executive, Ireland
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32
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Hussain H, Dubicka B, Wilkinson P. Newer generation antidepressants for young people: Real-life evidence needed. BJPSYCH ADVANCES 2017. [DOI: 10.1192/apt.bp.116.016717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryMajor depressive disorder in children and adolescents is common and associated with significant morbidity and mortality. This 2012 meta-analysis by Hetrick et al shows statistically significant, but small, improvements in depressive symptom scores and probability of remission with second-generation antidepressants (SGAs) compared with placebo. SGAs lead to a small, but significant, increase in risk of suicidal thoughts/attempts compared with placebo. Patients included in the primary studies had milder depression, less psychiatric comorbidity and less suicidality than those normally seen in clinical practice in the UK's National Health Service. However, primary studies had significant methodological shortcomings. Therefore, caution is needed when trying to generalise results to clinical practice.
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Strawn JR, Dobson ET, Giles LL. Primary Pediatric Care Psychopharmacology: Focus on Medications for ADHD, Depression, and Anxiety. Curr Probl Pediatr Adolesc Health Care 2017; 47:3-14. [PMID: 28043839 PMCID: PMC5340601 DOI: 10.1016/j.cppeds.2016.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The evidence base for psychopharmacologic interventions in youth with depressive and anxiety disorders as well as attention/deficit hyperactivity disorder (ADHD) has dramatically increased over the past two decades. Psychopharmacologic interventions commonly utilized in the pediatric primary care setting-selective serotonin (norepinephrine) reuptake inhibitors (SSRIs/SSNRIs), stimulants and α2 agonists-are reviewed. General pharmacologic principles are summarized along with class-related side effects and tolerability concerns (e.g., suicidality and activation in antidepressant-treated youth as well as insomnia, irritability, anorexia in stimulant-treated pediatric patients). Selected landmark trials of antidepressant medications in youth with depressive disorders [Treatment of Adolescent Depression Study (TADS) and the Treatment of SSRI-Resistant Depression Study (TADS)] and anxiety disorders [Child/Adolescent Anxiety Multimodal Study (CAMS) and Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS)] are described in addition to the Multimodal Treatment of ADHD Study. Finally, available data are presented that are related to prediction of treatment outcomes in youth with depressive disorders, anxiety disorders, and ADHD.
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Affiliation(s)
| | - Eric T Dobson
- University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Lisa L Giles
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT; Department of Psychiatry and Behavioral Health, Primary Children׳s Hospital, Salt Lake City, UT
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Saba L, Byrne A, Mulligan A. Child art psychotherapy in CAMHS: Which cases are referred and which cases drop out? SPRINGERPLUS 2016; 5:1816. [PMID: 27812453 PMCID: PMC5069233 DOI: 10.1186/s40064-016-3509-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/11/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Vasarhelyi method of child art psychotherapy (CAP) is offered at certain Child and Adolescent Mental Health Services. Children attend three introductory sessions, and then choose to continue weekly CAP or conclude the sessions. AIMS This study aims to identify the clinical disorders and characteristics of patients referred to CAP, and to determine who engages with the therapy. METHODS A retrospective review of the clinical records of 67 children who attended CAP in DNCC/Mater CAMHS over 13 years was performed. The data was analysed using Microsoft Excel 12.0 and SPSS version 20. RESULTS 67 children (57 % male and 43 % female) aged 5-17 years participated in CAP with an average age of 10.6 years. Children attended an average of 14 sessions of CAP, with a range of 1-61 sessions (mean of 13.8 ± 12.9 sessions). Anxiety disorder (28 %), behaviour disorder/ODD (25 %), and ADHD (21 %) are the most common diagnoses referred. These diagnoses along with autism spectrum disorder (ASD) had the highest overall engagement, while those with depression engaged the least. Children with ADHD and with ASD attended high numbers of sessions (with a mean of 23 and 19 respectively). Those who experienced acute life events or difficulties in the home engaged well (60 and 40 % respectively). There was no significant difference found in the percentage of appointments attended by males in comparison to females. CONCLUSION CAP is generally acceptable to children, with a high average attendance rate. It was noted that children with ADHD and with ASD engaged well with the therapy for prolonged periods, whereas children with depression did not engage so well. We suggest that CAMHS clinics should consider referring children diagnosed with ADHD and children diagnosed with ASD to CAP as an adjunct to other therapies. We suggest that individuals with depression should be referred initially to other therapeutic services as the engagement with CAP was relatively poor.
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Affiliation(s)
- Leslie Saba
- Department of Child and Adolescent Psychiatry, University College Dublin, Belfield, Dublin 4, Ireland
| | - Alison Byrne
- Department of Child Art Psychotherapy, Mater Miserircordiae University Hospital, Dublin 7, Ireland
| | - Aisling Mulligan
- Department of Child and Adolescent Psychiatry, University College Dublin, Belfield, Dublin 4, Ireland
- HSE Dublin North City and County Child and Adolescent Mental Health Service, James Joyce St., Dublin 1, Ireland
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Stevens JR, Rodgers JJ, Stern TA. Idiosyncratic Adverse Reactions to Psychotropic Medications. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160622-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Devenish B, Berk L, Lewis AJ. The treatment of suicidality in adolescents by psychosocial interventions for depression: A systematic literature review. Aust N Z J Psychiatry 2016; 50:726-40. [PMID: 26896044 DOI: 10.1177/0004867415627374] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Given depression is a significant risk factor for suicidal behaviour, it is possible that interventions for depression may also reduce the risk of suicide in adolescents. The purpose of this literature review is to determine whether psychological interventions aimed to prevent and/or treat depression in adolescents can also reduce suicidality. METHODS We conducted a systematic review of psychological interventions aimed to prevent and/or treat depression in adolescents in which outcomes for suicidality were reported, using five databases: PsycINFO, Embase, Medline, CINAHL and Scopus. Study quality was assessed using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS A total of 35 articles pertaining to 12 treatment trials, two selective prevention trials and two universal prevention trials met inclusion criteria. No studies were identified that used a no-treatment control. In both intervention and active control groups, suicidality decreased over time; however, most structured psychological depression treatment interventions did not outperform pharmaceutical or treatment as usual control groups. Depression prevention studies demonstrated small but statistically significant reductions in suicidality. LIMITATIONS Analysis of study quality suggested that at least 10 of the 16 studies have a high risk of bias. Conclusive comparisons across studies are problematic due to differences in measures, interventions, population differences and control groups used. CONCLUSIONS It is unclear whether psychological treatments are more effective than no treatment since no study has used a no-treatment control group. There is evidence to suggest that Cognitive Behavioural Therapy interventions produce pre-post reductions in suicidality with moderate effect sizes and are at least as efficacious as pharmacotherapy in reducing suicidality; however, it is unclear whether these effects are sustained. There are several trials showing promising evidence for family-based and interpersonal therapies, with large pre-post effect sizes, and further evaluation with improved methodology is required. Depression prevention interventions show promising short-term effects.
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Affiliation(s)
- Bethany Devenish
- Faculty of Health, School of Psychology, Deakin University, Burwood, Australia
| | - Lesley Berk
- Faculty of Health, School of Psychology, Deakin University, Burwood, Australia Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, Deakin University, Burwood, Australia
| | - Andrew J Lewis
- Faculty of Health, School of Psychology, Deakin University, Burwood, Australia School of Psychology and Exercise Science, Murdoch University, Murdoch WA, Australia
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Almirall D, Chronis-Tuscano A. Adaptive Interventions in Child and Adolescent Mental Health. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 45:383-95. [PMID: 27310565 DOI: 10.1080/15374416.2016.1152555] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The treatment or prevention of child and adolescent mental health (CAMH) disorders often requires an individualized, sequential approach to intervention, whereby treatments (or prevention efforts) are adapted over time based on the youth's evolving status (e.g., early response, adherence). Adaptive interventions are intended to provide a replicable guide for the provision of individualized sequences of interventions in actual clinical practice. Recently, there has been great interest in the development of adaptive intervenions by investigators working in CAMH. The development of such replicable, real-world, individualized sequences of decision rules to guide the treatment or prevention of CAMH disorders represents an important "next step" in interventions research. The primary purpose of this special issue is to showcase some recent work on the science of adaptive interventions in CAMH. In this overview article, we review why individualized sequences of interventions are needed in CAMH, provide an introduction to adaptive interventions, briefly describe each of the articles included in this special issue, and describe some exciting areas of ongoing and future research. A hopeful outcome of this special issue is that it encourages other researchers in CAMH to pursue creative and significant research on adaptive interventions.
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Affiliation(s)
- Daniel Almirall
- a Survey Research Center, Institute for Social Research , University of Michigan
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Clarke G, DeBar LL, Pearson JA, Dickerson JF, Lynch FL, Gullion CM, Leo MC. Cognitive Behavioral Therapy in Primary Care for Youth Declining Antidepressants: A Randomized Trial. Pediatrics 2016; 137:e20151851. [PMID: 27244782 PMCID: PMC4845864 DOI: 10.1542/peds.2015-1851] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Health care providers have few alternatives for youth depression other than antidepressants. We examined whether brief cognitive behavioral therapy (CBT) is a viable alternative in primary care. METHODS A total of 212 adolescents aged 12 to 18 with major depression who had recently declined or quickly discontinued new antidepressant treatment were randomized to self-selected treatment as usual (TAU) control condition or TAU plus brief individual CBT. Blinded evaluators followed youth for 2 years. The primary outcome was time to major depression diagnostic recovery. RESULTS CBT was superior to the control condition on the primary outcome of time to diagnostic recovery from major depression, with number needed to treat from 4 to 10 across follow-up. A similar CBT advantage was found for time to depression diagnosis response, with number needed to treat of 5 to 50 across time points. We observed a significant advantage for CBT on many secondary outcomes over the first year of follow-up but not the second year. Cohen's d effect sizes for significant continuous measures ranged from 0.28 to 0.44, in the small to medium effect range. Most TAU health care services did not differ across conditions, except for psychiatric hospitalizations, which occurred at a significantly higher rate in the control condition through the first year of follow-up. CONCLUSIONS Observed results were consistent with recent meta-analyses of CBT for youth depression. The initial year of CBT superiority imparted an important clinical benefit and may reduce the risk of future recurrent depression episodes.
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Affiliation(s)
- Gregory Clarke
- Kaiser Permanente Center for Health Research, Portland Oregon
| | - Lynn L DeBar
- Kaiser Permanente Center for Health Research, Portland Oregon
| | - John A Pearson
- Kaiser Permanente Center for Health Research, Portland Oregon
| | | | - Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland Oregon
| | | | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland Oregon
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Pataki C, Carlson GA. Major Depressive Disorder Among Children and Adolescents. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2015; 14:10-14. [PMID: 31975788 DOI: 10.1176/appi.focus.20150037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depression among youths remains a public health concern, particularly because only a fraction of affected youths receive treatment. To obtain treatment, youths with depression must first be identified so that early intervention can occur. Furthermore, investigation of both more effective pharmacological agents and more widespread accessibility of cognitive-behavioral interventions are necessary. To address unmet needs in the identification and treatment of depression among youths, clinical counseling programs are being developed in primary care clinics and in schools to identify and treat depressive symptoms or milder major depressive disorder and have shown promising outcomes thus far in reducing depression and increasing quality of life.
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Affiliation(s)
- Caroly Pataki
- Dr. Pataki is health science clinical professor of Psychiatry and Biobehavioral Science, David Geffen School of Medicine at University of California, Los Angeles. Dr. Carlson is professor of Psychiatry and Pediatrics and director emerita in the Division of Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York (e-mail: gabrielle. )
| | - Gabrielle A Carlson
- Dr. Pataki is health science clinical professor of Psychiatry and Biobehavioral Science, David Geffen School of Medicine at University of California, Los Angeles. Dr. Carlson is professor of Psychiatry and Pediatrics and director emerita in the Division of Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York (e-mail: gabrielle. )
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Emslie GJ, Kennard BD, Mayes TL, Nakonezny PA, Moore J, Jones JM, Foxwell AA, King J. Continued Effectiveness of Relapse Prevention Cognitive-Behavioral Therapy Following Fluoxetine Treatment in Youth With Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry 2015; 54:991-8. [PMID: 26598474 PMCID: PMC9597885 DOI: 10.1016/j.jaac.2015.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the continued effect of a sequential treatment strategy (fluoxetine followed by continued medication plus relapse prevention cognitive-behavioral therapy [RP-CBT]) on relapse prevention beyond the treatment phase. METHOD Youth (aged 8-17 years) with major depressive disorder (MDD) were treated with fluoxetine for 6 weeks. Responders (≥50% reduction on the Children's Depression Rating Scale-Revised [CDRS-R]) were randomized to continued medication management alone (MM) or continued medication management plus RP-CBT (MM+CBT) for an additional 6 months. Long-term follow-up assessments were conducted at weeks 52 and 78. RESULTS Of 144 youth randomized to MM (n = 69) or MM+CBT (n = 75), 67% had at least 1 follow-up assessment, with equal rates in the 2 groups. Remission rates were high, although most had remitted during the 30-week treatment period. Only 6 additional participants remitted during long-term follow-up, and there were no differences on time to remission between MM+CBT and MM. The MM+CBT group had a significantly lower risk of relapse than the MM group throughout the 78-week follow-up period (hazard ratio = 0.467, 95% CI = 0.264 to 0.823; χ(2) = 6.852, p = .009). The estimated probability of relapse during the 78-week period was lower with MM+CBT than MM only (36% versus 62%). Mean time to relapse was also significantly longer with MM+CBT compared to MM alone by approximately 3 months (p = .007). CONCLUSION The addition of RP-CBT after acute response to medication management had a continued effect on reducing risk of relapse even after the end of treatment. Clinical trial registration information-Sequential Treatment of Pediatric MDD to Increase Remission and Prevent Relapse; http://clinicaltrials.gov/; NCT00612313.
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Affiliation(s)
- Graham J. Emslie
- University of Texas Southwestern Medical Center and Children’s Health Children’s Medical Center, Dallas
| | - Betsy D. Kennard
- University of Texas Southwestern Medical Center and Children’s Health Children’s Medical Center, Dallas
| | - Taryn L. Mayes
- University of Texas Southwestern Medical Center and Children’s Health Children’s Medical Center, Dallas
| | - Paul A. Nakonezny
- Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas
| | - Jarrette Moore
- University of Texas Southwestern Medical Center and Children’s Health Children’s Medical Center, Dallas
| | - Jessica M. Jones
- University of Texas Southwestern Medical Center and Children’s Health Children’s Medical Center, Dallas
| | - Aleksandra A. Foxwell
- University of Texas Southwestern Medical Center and Children’s Health Children’s Medical Center, Dallas
| | - Jessica King
- University of Texas Southwestern Medical Center and Children’s Health Children’s Medical Center, Dallas
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Kwan B, Rickwood DJ. A systematic review of mental health outcome measures for young people aged 12 to 25 years. BMC Psychiatry 2015; 15:279. [PMID: 26573269 PMCID: PMC4647516 DOI: 10.1186/s12888-015-0664-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/27/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mental health outcome measures are used to monitor the quality and effectiveness of mental health services. There is also a growing expectation for implementation of routine measurement and measures being used by clinicians as a feedback monitoring system to improve client outcomes. The recent focus in Australia and elsewhere targeting mental health services to young people aged 12-25 years has meant that outcome measures relevant to this age range are now needed. This is a shift from the traditional divide of child and adolescent services versus adult services with a transitioning age at 18 years. This systematic review is the first to examine mental health outcome measures that are appropriate for the 12 to 25 year age range. METHODS MEDLINE and PsychINFO databases were systematically searched to identify studies using mental health outcome measures with young people aged 12 to 25 years. The search strategy complied with the relevant sections of the PRISMA statement. RESULTS A total of 184 published articles were identified, covering 29 different outcome measures. The measures were organised into domains that consisted of eight measures of cognition and emotion, nine functioning measures, six quality of life measures, and six multidimensional mental health measures. No measures were designed specifically for young people aged 12 to 25 years and only two had been used by clinicians as a feedback monitoring system. Five measures had been used across the whole 12 to 25 year age range, in a range of mental health settings and were deemed most appropriate for this age group. CONCLUSIONS With changes to mental health service systems that increasingly focus on early intervention in adolescence and young adulthood, there is a need for outcome measures designed specifically for those aged 12 to 25 years. In particular, multidimensional measures that are clinically meaningful need to be developed to ensure quality and effectiveness in youth mental health. Additionally, outcome measures can be clinically useful when designed to be used within routine feedback monitoring systems.
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Affiliation(s)
- Benjamin Kwan
- Faculty of Health, University of Canberra, Kirinari Street, Bruce, ACT, 2601, Australia.
| | - Debra J Rickwood
- Faculty of Health, University of Canberra, Kirinari Street, Bruce, ACT, 2601, Australia.
- Headspace National Youth Mental Health Foundation National Office, 485 La Trobe Street, Melbourne, VIC, 3000, Australia.
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Brown R, James A. Practical pharmacotherapy in child psychiatry: an update. BJPSYCH ADVANCES 2015. [DOI: 10.1192/apt.bp.114.013193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryPsychopharmacology is an increasingly important aspect of child and adolescent psychiatry. The evidence base for the psychopharmacological treatment of depression, anxiety, schizophrenia, bipolar disorder, obsessive—compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) is increasing. This article presents a synthesis of the information from randomised controlled trials, meta-analyses and the UK NICE guidelines as an aid to practical psychopharmacology.
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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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Loades ME. Evidence-Based Practice in the Face of Complexity and Comorbidity: A Case Study of an Adolescent With Asperger's Syndrome, Anxiety, Depression, and Chronic Pain. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2015; 28:73-83. [PMID: 25865961 DOI: 10.1111/jcap.12108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PROBLEM Working with clients who present with multiple conditions and comorbidities, including mental health difficulties, neurodevelopmental disorders, and physical health conditions, requires the therapist to go beyond the existing evidence base to make decisions about which specific cognitive behavior therapy (CBT) models and resultant treatment approaches to draw on in therapy. Routine outcome monitoring across a number of parameters, including goal progress, symptom improvement, and changes in functioning, are core to maintaining accountability through monitoring the ongoing impact of idiosyncratic interventions. METHOD The case of a young person (age 17 years) who presented with mixed anxiety and depression in the context of autism spectrum disorder (ASD) and chronic pain are presented. In addition to evidence-based adaptations to CBT for clients with ASDs, the therapist selected a cognitive model of low self-esteem as a means of collaboratively conceptualizing the client's difficulties. FINDINGS AND CONCLUSION Routine outcome measurement demonstrated the effectiveness of the intervention.
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Affiliation(s)
- Maria E Loades
- Clinical Psychology Doctorate Programme, University of Bath, Bath, UK
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45
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Dalgleish T, Goodall B, Chadwick I, Werner-Seidler A, McKinnon A, Morant N, Schweizer S, Panesar I, Humphrey A, Watson P, Lafortune L, Smith P, Meiser-Stedman R. Trauma-focused cognitive behaviour therapy versus treatment as usual for post traumatic stress disorder (PTSD) in young children aged 3 to 8 years: study protocol for a randomised controlled trial. Trials 2015; 16:116. [PMID: 25872653 PMCID: PMC4417274 DOI: 10.1186/s13063-015-0632-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/04/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Following horrific or life-threatening events approximately 10 to 15% of young children develop post traumatic stress disorder (PTSD). The symptoms of this disorder are distressing - nightmares, flashbacks, anger outbursts and disturbed play. These symptoms cause major disruption to a child's functioning and, if left untreated, can persist for many years. As yet, there are no established empirically-validated treatments for PTSD in young children. Trauma-focused cognitive behaviour therapy (TF-CBT) is a psychological intervention that is effective in treating the disorder in older children (8 to 12 years), adolescents and adults. This study examines TF-CBT adapted for children aged between 3 and 8 years. METHODS/DESIGN This protocol describes a two-arm exploratory randomised controlled trial comparing TF-CBT to treatment as usual (TAU) in children aged 3 to 8 years with a principal diagnosis of PTSD following a single-event discrete trauma. Using a half-crossover design, 44 participants will be randomly allocated to receive the intervention or to receive TAU. Those allocated to TAU will be offered TF-CBT at the end of the 'treatment' period (approximately 12 weeks) if still indicated. The primary outcome is PTSD diagnosis according to DSM-5 criteria for children 6 years and younger at post-treatment. Secondary outcomes include effects on co-morbid diagnoses and changes in emotion and trauma symptoms at each of the follow-up points (post-treatment, 3-months, 12-months). Additionally, broader efficacy will be considered with regard to treatment feasibility, acceptability and service utilisation. The key targets of the intervention are trauma memory, the interpretation of the meaning of the event, and the management of symptoms. DISCUSSION This is the first European trial to examine the efficacy of TF-CBT in alleviating PTSD in very young children. As well as providing much-needed data on the utility of the intervention, this exploratory trial will also allow us to gather important information about the feasibility of delivering the treatment in UK National Health Service (NHS) settings, and its acceptability to the children and their families. This study will highlight aspects of the intervention that need improvement or modification in preparation for a full-scale evaluation in a larger sample. TRIAL REGISTRATION ISRCTN35018680 , registered on 18 November 2013.
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Affiliation(s)
- Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
| | - Benjamin Goodall
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
| | - Isobel Chadwick
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
| | - Aliza Werner-Seidler
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
| | - Anna McKinnon
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
| | - Nicola Morant
- Department of Psychology, University of Cambridge, Cambridge, UK.
| | - Susanne Schweizer
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
| | - Inderpal Panesar
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
| | - Ayla Humphrey
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
| | - Peter Watson
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
| | - Louise Lafortune
- Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Patrick Smith
- Institute of Psychiatry, Kings College London, London, UK.
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Iftene F, Predescu E, Stefan S, David D. Rational-emotive and cognitive-behavior therapy (REBT/CBT) versus pharmacotherapy versus REBT/CBT plus pharmacotherapy in the treatment of major depressive disorder in youth; a randomized clinical trial. Psychiatry Res 2015; 225:687-94. [PMID: 25500320 DOI: 10.1016/j.psychres.2014.11.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/27/2014] [Accepted: 11/12/2014] [Indexed: 01/22/2023]
Abstract
Major depressive disorder is a highly prevalent and debilitating condition in youth, so developing efficient treatments is a priority for mental health professionals. Psychotherapy (i.e., cognitive behavioral therapy/CBT), pharmacotherapy (i.e., SSRI medication), and their combination have been shown to be effective in treating youth depression; however, the results are still mixed and there are few studies engaging multi-level analyses (i.e., subjective, cognitive, and biological). Therefore, the aims of this randomized control study (RCT) were both theoretical - integrating psychological and biological markers of depression in a multi-level outcome analysis - and practical - testing the generalizability of previous results on depressed Romanian youth population. Eighty-eight (N=88) depressed Romanian youths were randomly allocated to one of the three treatment arms: group Rational Emotive Behavior Therapy (REBT)/CBT (i.e., a form of CBT), pharmacotherapy (i.e., sertraline), and group REBT/CBT plus pharmacotherapy. The results showed that all outcomes (i.e., subjective, cognitive, and biological) significantly change from pre to post-treatment under all treatment conditions at a similar rate and there were no significant differences among conditions at post-test. In case of categorical analysis of the clinical response rate, we found a non-significant trend favoring group REBT/CBT therapy. Results of analyses concerning outcome interrelations are discussed.
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Affiliation(s)
- Felicia Iftene
- Department of Psychiatry, Queens University, C/o Providence Care Mental Health Services, 752 King Street West, Kingston, Ontario, Canada K7L 4X3.
| | - Elena Predescu
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
| | - Simona Stefan
- Department of Clinical Psychology and Psychotherapy/International Institute for the Advanced Study of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, No 37 Republici Street, 400015 Cluj-Napoca, Romania.
| | - Daniel David
- Department of Clinical Psychology and Psychotherapy/International Institute for the Advanced Study of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, No 37 Republici Street, 400015 Cluj-Napoca, Romania.
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Furber G, Segal L. The validity of the Child Health Utility instrument (CHU9D) as a routine outcome measure for use in child and adolescent mental health services. Health Qual Life Outcomes 2015; 13:22. [PMID: 25890377 PMCID: PMC4340862 DOI: 10.1186/s12955-015-0218-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few cost-utility studies of child and adolescent mental health services (CAMHS) use quality adjusted life years (a combination of utility weights and time in health state) as the outcome to enable comparison across disparate programs and modalities. Part of the solution to this problem involves embedding preference-based health-related quality of life (PBHRQOL) utility instruments, which generate utility weights, in clinical practice and research. The Child Health Utility (CHU9D) is a generic PBHRQOL instrument developed specifically for use in young people. The purpose of this study was to assess the suitability of the CHU9D as a routine outcome measure in CAMHS clinical practice. METHODS Two hundred caregivers of children receiving community mental health services completed the CHU9D alongside a standardised child and adolescent mental health measure (the Strengths and Difficulties Questionnaire - SDQ) during a telephone interview. We investigated face validity, practicality, internal consistency, and convergent validity of the CHU9D. In addition, we compared the utility weights obtained in this group with utility weights from other studies of child and adolescent mental health populations. RESULTS Participants found the CHU9D easy and quick to complete. It demonstrated acceptable internal consistency, and correlated moderately with the SDQ. It was able to discriminate between children in the abnormal range and those in the non-clinical/borderline range as measured by the SDQ. Three CHU9D items without corollaries in the SDQ (sleep, schoolwork, daily routine) were found to be significant predictors of the SDQ total score and may be useful clinical metrics. The mean utility weight of this sample was comparable with clinical subsamples from other CHU9D studies, but was significantly higher than mean utility weights noted in other child and adolescent mental health samples. CONCLUSIONS Initial validation suggests further investigation of the CHU9D as a routine outcome measure in CAMHS is warranted. Further investigation should explore test-retest reliability, sensitivity to change, concordance between caregiver and child-completed forms, and the calibration of the utility weights. Differences between utility weights generated by the CHU9D and other utility instruments in this population should be further examined by administering a range of PBHRQOL instruments concurrently in a mental health group.
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Affiliation(s)
- Gareth Furber
- Health Economics and Social Policy Group, School of Population Health, University of South Australia, Adelaide, Australia.
| | - Leonie Segal
- Health Economics and Social Policy Group, School of Population Health, University of South Australia, Adelaide, Australia.
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Hagan CC, Graham JM, Tait R, Widmer B, van Nieuwenhuizen AO, Ooi C, Whitaker KJ, Simas T, Bullmore ET, Lennox BR, Sahakian BJ, Goodyer IM, Suckling J. Adolescents with current major depressive disorder show dissimilar patterns of age-related differences in ACC and thalamus. Neuroimage Clin 2015; 7:391-9. [PMID: 25685707 PMCID: PMC4309951 DOI: 10.1016/j.nicl.2014.12.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/25/2014] [Accepted: 12/27/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is little understanding of the neural system abnormalities subserving adolescent major depressive disorder (MDD). In a cross-sectional study we compare currently unipolar depressed with healthy adolescents to determine if group differences in grey matter volume (GMV) were influenced by age and illness severity. METHOD Structural neuroimaging was performed on 109 adolescents with current MDD and 36 healthy controls, matched for age, gender, and handedness. GMV differences were examined within the anterior cingulate cortex (ACC) and across the whole-brain. The effects of age and self-reported depressive symptoms were also examined in regions showing significant main or interaction effects. RESULTS Whole-brain voxel based morphometry revealed no significant group differences. At the whole-brain level, both groups showed a main effect of age on GMV, although this effect was more pronounced in controls. Significant group-by-age interactions were noted: A significant regional group-by-age interaction was observed in the ACC. GMV in the ACC showed patterns of age-related differences that were dissimilar between adolescents with MDD and healthy controls. GMV in the thalamus showed an opposite pattern of age-related differences in adolescent patients compared to healthy controls. In patients, GMV in the thalamus, but not the ACC, was inversely related with self-reported depressive symptoms. CONCLUSIONS The depressed adolescent brain shows dissimilar age-related and symptom-sensitive patterns of GMV differences compared with controls. The thalamus and ACC may comprise neural markers for detecting these effects in youth. Further investigations therefore need to take both age and level of current symptoms into account when disaggregating antecedent neural vulnerabilities for MDD from the effects of MDD on the developing brain.
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Affiliation(s)
- Cindy C. Hagan
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychology, Columbia University, New York, NY, USA
| | | | - Roger Tait
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Barry Widmer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Cinly Ooi
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Tiago Simas
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Edward T. Bullmore
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Belinda R. Lennox
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Oxford, Medical Sciences Division, Oxford, UK
| | - Barbara J. Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Ian M. Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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Abstract
Depression is a relatively common diagnosis in children and adolescents, and is associated with significant morbidity and suicidality in this population. Evidence-based treatment of the acute illness is imperative to try to prevent the development of treatment-resistant depression or other complications. In situations where response to acute treatment is inadequate, clinicians should first consider factors that may influence outcome, such as psychiatric or medical comorbidities, psychosocial stressors, and treatment noncompliance. Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for depression in children and adolescents. For treatment-resistant depression, a switch to an alternate SSRI is recommended before trials of other antidepressants. Psychotherapy, such as cognitive behavioral therapy or interpersonal therapy, may improve treatment response. More research is needed examining medication augmentation strategies for treatment-resistant depression in children and adolescents.
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Affiliation(s)
- Melissa DeFilippis
- Department of Child and Adolescent Psychiatry, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0188, USA,
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Blackmon JE, Liptak C, Recklitis CJ. Development and preliminary validation of a short form of the Beck Depression Inventory for Youth (BDI-Y) in a sample of adolescent cancer survivors. J Cancer Surviv 2014; 9:107-14. [PMID: 25164512 DOI: 10.1007/s11764-014-0394-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/05/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of this study was to analyze adolescent cancer survivors' responses to the Beck Depression Inventory for Youth (BDI-Y) to determine if a short form of the measure could be developed that would accurately identify survivors with clinically significant levels of depressive symptoms. METHODS Two hundred two adolescent survivors (mean age = 15.39 years, SD = 1.93) completed the BDI-Y at a single time point and were divided into two groups: a derivation sample (n = 105) and a replication sample (n = 97). Based on correlations with the total BDI-Y score in the derivation sample, items were selected for inclusion in three potential short forms, with 6, 8, and 11 items, respectively. These short forms were then evaluated against the full BDI-Y scale first in the derivation sample and subsequently in the replication sample (n = 97). RESULTS Each of the three short forms had high correlations with the total BDI-Y scale (r > 0.95), good internal consistency (α > 0.80), and good overall discrimination compared to a standard BDI-Y cutoff score (AUC > 0.90). The eight-item short form demonstrated notable consistency across the derivation and replication samples, with high sensitivity and specificity using a cutoff score of ≥5, making it a promising tool for clinical screening. CONCLUSIONS Abbreviated versions of the BDI-Y can accurately detect depression in adolescent cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS An eight-item short form demonstrates strong psychometric properties and potential for use as a screening measure in this population, while the 6- and 11-item short forms may be suited to other applications.
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Affiliation(s)
- Jaime E Blackmon
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
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