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Gutierrez-Colina AM, Aichele S, Lavender JM, Sanchez N, Thorstad I, Gulley LD, Emerick JE, Schrag R, Thomas V, Spinner H, Arnold T, Heroy A, Haigney MC, Tanofsky-Kraff M, Shomaker LB. Associations of social and cognitive-behavioral variables with disinhibited eating and anxiety: An ecological momentary assessment study. Int J Eat Disord 2024. [PMID: 38415929 DOI: 10.1002/eat.24177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Among adolescents, disinhibited eating and anxiety commonly co-occur. Precision intervention approaches targeting unique mechanistic vulnerabilities that contribute to disinhibited eating and anxiety may therefore be helpful. However, the effectiveness of such interventions hinges on knowledge of between- and within-person associations related to disinhibited eating, anxiety, and related processes. METHOD A sample of 39 adolescent females (12-17 years) with elevated anxiety and above-average weight (BMI %ile ≥ 75th) completed measures of theoretically driven social and cognitive-behavioral variables, disinhibited eating, and anxiety via ecological momentary assessment over 7 days. Data were analyzed using mixed-effects models. RESULTS Between-person differences in social stressors were linked to emotional eating, eating in the absence of hunger, and anxiety, whereas between-person differences in negative thoughts were associated with all disinhibited eating variables and anxiety. Between-person differences in avoidance were not related to any outcome. Additionally, between-person differences in social stressors and negative thoughts-as well as within-person deviations (from person-average levels) of social stressors, negative thoughts, and avoidance-were associated with anxiety. In turn, between-person differences in anxiety predicted eating in the absence of hunger and emotional eating, and within-person deviations in anxiety were associated with emotional eating at any given time point. DISCUSSION Findings support elements of both the interpersonal and cognitive-behavioral models of disinhibited eating. Differential trigger effects on anxiety, both at the between- and within-person levels, and significant associations between anxiety and all eating-related outcomes, highlight the potential utility of interventions targeting individual differences in sensitivity to anxiety triggers. PUBLIC SIGNIFICANCE Findings provide support for the interpersonal and cognitive-behavioral models of disinhibited eating, highlighting anxiety as a salient vulnerability and potential mechanistic factor underlying disinhibited eating. Social, cognitive, and behavioral variables were differentially related to anxiety across participants, suggesting potential for future intervention tailoring and intervention selection based on adolescents' sensitivity to anxiety as a trigger for disinhibited eating behavior.
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Affiliation(s)
- Ana M Gutierrez-Colina
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
- Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Stephen Aichele
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
- Colorado School of Public Health, Aurora, Colorado, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Natalia Sanchez
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Isabel Thorstad
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
| | - Lauren D Gulley
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
- Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jill E Emerick
- Department of Pediatrics, Uniformed Services University, Bethesda, Maryland, USA
| | - Ruby Schrag
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
| | - Victoria Thomas
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
| | - Holly Spinner
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
| | - Thomas Arnold
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
| | - Andrew Heroy
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
| | - Mark C Haigney
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Marian Tanofsky-Kraff
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, Maryland, USA
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
- Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz and Children's Hospital Colorado, Aurora, Colorado, USA
- Colorado School of Public Health, Aurora, Colorado, USA
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Davis M, Jones JD, Schwartz KTG, Dysart G, So A, Young JF. Emerging Risk of Adolescent Depression and Suicide Detected Through Pediatric Primary Care Screening. J Pediatr Psychol 2024; 49:111-119. [PMID: 38001561 DOI: 10.1093/jpepsy/jsad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE The goal of the current study was to document patterns of stability and change in adolescent depression and suicide risk detected via universal depression screening in pediatric primary care and to determine who may go on to experience emerging risk. METHODS Retrospective electronic health record information (sociodemographic data and depression screening results for 2 timepoints) was extracted for adolescents aged 12-17 who attended well-visits between November 15, 2017, and February 1, 2020, in a large pediatric primary care network. A total of 27,335 adolescents with 2 completed depression screeners were included in the current study. RESULTS While most adolescents remained at low risk for depression and suicide across the 2 timepoints, others experienced emerging risk (i.e., low risk at time 1 but elevated risk at time 2), decreasing risk (i.e., high risk at time 1 but low risk at time 2) or stable high risk for depression or suicide. Odds of experiencing emerging depression and suicide risk were higher among adolescents who were female (compared to males), Black (compared to White), and had Medicaid insurance (compared to private insurance). Odds of experiencing emerging depression risk were also higher among older adolescents (compared to younger adolescents) as well as adolescents who identified as Hispanic/Latino (compared to non-Hispanic/Latino). CONCLUSIONS Findings can inform symptom monitoring and opportunities for prevention in primary care.
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Affiliation(s)
- Molly Davis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
- Clinical Futures, Children's Hospital of Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, USA
| | - Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, USA
| | - Karen T G Schwartz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - Gillian Dysart
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - Amy So
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA
- PolicyLab, Children's Hospital of Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, USA
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Hankin BL, Griffith JM. What Do We Know About Depression Among Youth and How Can We Make Progress Toward Improved Understanding and Reducing Distress? A New Hope. Clin Child Fam Psychol Rev 2023; 26:919-942. [PMID: 37285011 PMCID: PMC10245370 DOI: 10.1007/s10567-023-00437-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
This paper summarizes many findings about depression among children and adolescents. Depression is prevalent, highly distressing, and exerts considerable burden worldwide. Rates surge from childhood through young adulthood and have increased over the last decade. Many risk factors have been identified, and evidence-based interventions exist targeting mostly individual-level changes via psychological or pharmacological means. At the same time, the field appears stuck and has not achieved considerable progress in advancing scientific understanding of depression's features or delivering interventions to meet the challenge of youth depression's high and growing prevalence. This paper adopts several positions to address these challenges and move the field forward. First, we emphasize reinvigoration of construct validation approaches that may better characterize youth depression's phenomenological features and inform more valid and reliable assessments that can enhance scientific understanding and improve interventions for youth depression. To this end, history and philosophical principles affecting depression's conceptualization and measurement are considered. Second, we suggest expanding the range and targets of treatments and prevention efforts beyond current practice guidelines for evidence-based interventions. This broader suite of interventions includes structural- and system-level change focused at community and societal levels (e.g., evidence-based economic anti-poverty interventions) and personalized interventions with sufficient evidence base. We propose that by focusing on the FORCE (Fundamentals, Openness, Relationships, Constructs, Evidence), youth depression research can provide new hope.
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Affiliation(s)
- Benjamin L Hankin
- Department of Psychology, University of Illinois Urbana Champaign, 603 E. Daniel Street, Champaign, IL, 61820, USA.
| | - Julianne M Griffith
- Department of Psychology, University of Illinois Urbana Champaign, 603 E. Daniel Street, Champaign, IL, 61820, USA
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Weisz JR, Fitzpatrick OM, Venturo-Conerly KE, Sternberg A, Steinberg JS, Ng MY. Research Review: The internalizing paradox - youth anxiety and depression symptoms, psychotherapy outcomes, and implications for research and practice. J Child Psychol Psychiatry 2023; 64:1720-1734. [PMID: 37222162 PMCID: PMC10667566 DOI: 10.1111/jcpp.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Youth anxiety and depression have long been combined within the empirically derived internalizing syndrome. The two conditions show substantial comorbidity, symptom co-occurrence, and overlap in treatment procedures, but paradoxically diverge in psychotherapy outcomes: strong, positive effects for anxiety and weak effects for depression. METHODS Drawing on recent research, we examine candidate explanations for this paradox to help identify strategies for addressing it by improving outcomes for youth depression. RESULTS Candidate explanations include that youth depression, compared with youth anxiety, has more varied comorbidities and more heterogeneous symptom combinations, has greater uncertainty regarding mediators and mechanisms of change, is treated with more complex and potentially confusing protocols, and has characteristics that may impede client engagement. Candidate strategies for shrinking the psychotherapy effectiveness gap include personalizing through transdiagnostic modular treatment, simplifying therapy by focusing on empirically supported principles of change, developing effective strategies for engaging family members as intervention allies, using shared decision-making to inform clinical decisions and boost client engagement, capitalizing on youth-friendly technological advances, and shortening and digitizing treatments to enhance their accessibility and appeal. CONCLUSIONS Recent advances suggest explanations for the internalizing paradox, which in turn suggest strategies for shrinking the youth anxiety-depression psychotherapy outcome gap; these form an agenda for a promising new era of research.
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Affiliation(s)
- John R. Weisz
- Department of Psychology, Harvard University, Cambridge, MA 02138 USA
| | | | | | - Ariel Sternberg
- Department of Psychology, Harvard University, Cambridge, MA 02138 USA
| | | | - Mei Yi Ng
- Department of Psychology, Florida International University, Miami, FL 33199 USA
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Argiros A, Venanzi L, Dao A, Dickey L, Herman N, Pegg S, Hill K, Stewart J, Kujawa A. Social Support and Parental Conflict as Predictors of Outcomes of Group Cognitive Behavioral Therapy for Adolescent Depression. Int J Cogn Ther 2023; 16:202-221. [PMID: 37228300 PMCID: PMC10043524 DOI: 10.1007/s41811-023-00159-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
Group cognitive behavioral therapy (CBT) is an effective treatment for adolescent depression, but outcomes vary. Our goal was to examine interpersonal factors that predict response to group CBT for adolescent depression using a broad range of outcomes, including depressive symptoms, session attendance, treatment completion, engagement, and improvement. Seventy adolescents (age 14-18) with depression completed self-report measures of social support and parental conflict and were offered an established 16-session group CBT program. Correlation and regression analyses were conducted for interpersonal predictors and CBT outcomes. Accounting for pre-treatment depressive symptoms, fewer social supports predicted lower likelihood of finishing treatment and less clinician-rated improvement. Greater pre-treatment parental conflict predicted fewer sessions attended, lower clinician-rated engagement, and less clinician-rated improvement. Results highlight the need to consider interpersonal difficulties in CBT, as they may present a barrier to treatment attendance, engagement, and improvement.
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Affiliation(s)
- Alexandra Argiros
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN 37203-5721 USA
| | - Lisa Venanzi
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN 37203-5721 USA
| | - Anh Dao
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN 37203-5721 USA
| | - Lindsay Dickey
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN 37203-5721 USA
| | - Nicole Herman
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN 37203-5721 USA
| | - Samantha Pegg
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN 37203-5721 USA
| | - Kaylin Hill
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN 37203-5721 USA
| | | | - Autumn Kujawa
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN 37203-5721 USA
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6
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Jones JD, Long EE, Hankin BL, Gallop R, Davis M, Young JF. Personalized Depression Prevention Reduces Dependent Stressors Among Adolescents: Results from a Randomized Controlled Trial. J Clin Child Adolesc Psychol 2023:1-14. [PMID: 36940144 PMCID: PMC10509329 DOI: 10.1080/15374416.2023.2188562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Depression and stressors both increase during adolescence. The stress generation model posits that depression symptoms and associated impairment contribute to the generation of dependent stressors. Adolescent depression prevention programs have been shown to reduce the risk of depression. Recently, risk-informed personalization approaches have been adopted to enhance the efficacy of depression prevention, and preliminary evidence supports the beneficial effects of personalized prevention on depression symptoms. Given the close association between depression and stress, we examined the hypothesis that personalized depression prevention programs would reduce adolescents' experience of dependent stressors (interpersonal and non-interpersonal) over longitudinal follow-up. METHOD The present study included 204 adolescents (56% girls, 29% racial minority) who were randomized to receive either a cognitive-behavioral or an interpersonal prevention program. Youth were categorized as high or low on cognitive and interpersonal risk using a previously established risk classification system. Half of the adolescents received a prevention program that matched their risk profile (e.g., high cognitive risk randomized to cognitive-behavioral prevention); half received a mismatched program (e.g., high interpersonal risk randomized to cognitive-behavioral prevention). Exposure to dependent and independent stressors was assessed repeatedly over an 18-month follow-up period. RESULTS Matched adolescents reported fewer dependent stressors during the post-intervention follow-up period (d = .46, p = .002) and from baseline through 18-months post-intervention (d = .35, p = .02) compared to mismatched youth. As expected, there were no differences between matched and mismatched youth on the experience of independent stressors. CONCLUSIONS These findings further highlight the potential of personalized approaches to depression prevention and demonstrate benefits that go beyond depression symptom reduction.
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Affiliation(s)
- Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
| | - Erin E Long
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Benjamin L Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign
| | | | - Molly Davis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
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7
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Frederick J, Ng MY, Valente MJ, Chorpita BF, Weisz JR. Do specific modules of cognitive behavioral therapy for depression have measurable effects on youth internalizing symptoms? An idiographic analysis. Psychother Res 2023; 33:265-281. [PMID: 36328998 PMCID: PMC10133003 DOI: 10.1080/10503307.2022.2131475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Understanding the efficacy of each module of cognitive behavioral therapy (CBT) may inform efforts to improve outcomes for youth depression, but effects of specific modules have been difficult to examine. Idiographic interrupted time series models offer a robust way to estimate module effects on an individual's symptoms. This study examined the association of specific CBT modules for depression on internalizing symptoms among depressed youths who received modular CBT in a randomized trial. METHODS Individual models were created for three youths who met study criteria. Youths completed weekly symptom reports, and clinicians completed records of modules delivered. First order auto-regressive models quantified the change in average internalizing symptom severity between pre- and post-module delivery. RESULTS All youths had 1-3 modules that were significantly associated with symptom reduction and 1-3 modules associated with deterioration. The 5 modules associated with improvement in at least one youth also lacked association (engagement, relaxation, cognitive reframing), or were associated with worsening (activity selection, parent psychoeducation) in others. Seven modules showed no measurable benefit, or detriment to any youth. CONCLUSION This study demonstrated that specific modules have measurable effects, but more work is needed to build an evidence base of specific module effects to inform treatment personalization for youth depression.
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Affiliation(s)
- Jennifer Frederick
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami FL 33199
| | - Mei Yi Ng
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami FL 33199
| | - Matthew J. Valente
- College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL 33612
| | - Bruce F. Chorpita
- Psychology Department, University of California, Los Angeles, 502 Portola Plaza, Los Angeles CA 90095
| | - John R. Weisz
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge MA 02138
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Kanine RM, Bush ML, Davis M, Jones JD, Sbrilli MD, Young JF. Depression Prevention in Pediatric Primary Care: Implementation and Outcomes of Interpersonal Psychotherapy-Adolescent Skills Training. Child Psychiatry Hum Dev 2023; 54:96-108. [PMID: 34379228 DOI: 10.1007/s10578-021-01222-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 01/27/2023]
Abstract
This study evaluated the fidelity, feasibility, acceptability, and preliminary outcomes of a depression prevention program, interpersonal psychotherapy-adolescent skills training (IPT-AST), in urban pediatric primary care (PC) with a sample of primarily Black youth. Twenty-two adolescents with elevated depressive symptoms participated in this open clinical trial. Adolescents were identified through a screening questionnaire completed at well visits. Ratings of IPT-AST fidelity and session attendance were recorded. Youth and caregivers reported on their attitudes toward the intervention and completed measures of adolescents' symptoms and functioning pre- and post-intervention. Results demonstrated high levels of fidelity, attendance, and acceptability, despite some difficulties with recruitment. Adolescents and caregivers reported significant improvements in functioning. There were marginally significant reductions in self-reported depression, anxiety, and total mental health symptoms. Caregivers reported a significant decrease in total mental health symptoms. Findings provide preliminary information regarding the implementation and effects of IPT-AST when delivered in PC.
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Affiliation(s)
- Rebecca M Kanine
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.
| | - Morgan L Bush
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA
| | - Molly Davis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marissa D Sbrilli
- Clinical-Community Psychology PhD Program, Department of Psychology, University of Illinois - Urbana Champaign, Champaign, IL, USA
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Jones JD, Hankin BL, Gallop R, Haraden D, Sbrilli MD, Garber J, Young JF. Effects of personalized depression prevention on anxiety through 18-month follow-up: A randomized controlled trial. Behav Res Ther 2022; 156:104156. [DOI: 10.1016/j.brat.2022.104156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/09/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
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10
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Otto MW, Birk JL, Fitzgerald HE, Chauvin GV, Gold AK, Carl JR. Stage models for major depression: Cognitive behavior therapy, mechanistic treatment targets, and the prevention of stage transition. Clin Psychol Rev 2022; 95:102172. [DOI: 10.1016/j.cpr.2022.102172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
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Garber J. The Development of Psychosocial Therapeutic and Preventive Interventions for Mental Disorders (R61/R33): A User's Guide. J Clin Child Adolesc Psychol 2022; 51:360-373. [PMID: 35549571 PMCID: PMC9177818 DOI: 10.1080/15374416.2022.2062762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
One of the four major goals outlined in the National Institute of Mental Health (NIMH) strategic plan (2021) is to develop and test new treatments and prevention strategies. The aim of the Funding Opportunity Announcement (FOA) for the R61/R33 grant mechanism has been to support the efficient pilot testing of exploratory clinical trials of novel interventions for mental disorders in adults and children through an experimental therapeutics approach. The present commentary (a) describes the R61/R33 grant mechanism, defines terms, and summarizes information about current grants in the system, (b) outlines the review criteria, and (c) highlights several common critiques. Frequent concerns expressed by applicants as well as reviewers include defining and measuring the target/mechanism, establishing dose, selecting an appropriate control group, measuring fidelity, and determining power. Finally, alternative pathways for conducting randomized clinical trials for intervention development are discussed in contrast to or in addition to the experimental therapeutics approach for discovering novel interventions aimed at reducing and preventing mental illness across the lifespan.
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Affiliation(s)
- Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
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Owens M, Bunce HLI. The Potential for Outdoor Nature-Based Interventions in the Treatment and Prevention of Depression. Front Psychol 2022; 13:740210. [PMID: 35401311 PMCID: PMC8984301 DOI: 10.3389/fpsyg.2022.740210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/15/2022] [Indexed: 01/05/2023] Open
Abstract
There is growing interest in nature-based interventions (NBI) to improve human health and wellbeing. An important nascent area is exploring the potential of outdoor therapies to treat and prevent common mental health problems like depression. In this conceptual analysis on the nature-depression nexus, we distil some of the main issues for consideration when NBIs for depression are being developed. We argue that understanding the mechanisms, or 'active ingredients' in NBIs is crucial to understand what works and for whom. Successfully identifying modifiable mediating intervention targets will pave the way for interventions with increased efficacy. We highlight a non-exhaustive list of five clinically relevant putative, candidate mechanisms which may underly the beneficial effects of NBIs on depression: stress, rumination, mindfulness, sleep and exercise. We also make the case that when developing NBIs it is important to not neglect young people, explore personalised approaches and focus on both treatment and prevention approaches. To achieve these aims methodologically rigorous programmes of clinical research are needed that include well-powered and controlled experimental designs including randomised controlled trials, qualitative research, longitudinal studies and large prospective cohorts.
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Affiliation(s)
- Matthew Owens
- Department of Psychology, The Mood Disorders Centre, University of Exeter, Exeter, United Kingdom
| | - Hannah L. I. Bunce
- CEDAR, University of Exeter and Somerset Foundation Trust NHS, Taunton, United Kingdom
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Merry SN. Editorial: Optimizing Depression Prevention: The Way Forward? J Am Acad Child Adolesc Psychiatry 2021; 60:1064-1065. [PMID: 34216778 DOI: 10.1016/j.jaac.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022]
Abstract
Since the advent of cognitive-behavioral therapy (CBT) and interpersonal therapy in the 1960s and 1970s, the progress on "talking therapies" has been slow. An extensive review of prevention and treatment studies over the past 50 years has shown that, although the therapies are effective, for depression the effect size is moderate, even for treatment, and has not changed in 50 years,1 with some indication that efficacy may have decreased.2 The approaches used in treatment have also been the mainstay of depression prevention approaches,3,4 with evidence of a small-to-moderate reduction in depressive symptoms but with no convincing evidence of reduction in the incidence of depressive disorder in meta-analyses.3,4.
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Abstract
Depression is a prevalent, distressing, often recurrent, disorder. Adolescence represents a vulnerable developmental period when rates of depression surge and many experience their first episode. Some professional agencies now recommend universal screening starting at age 12. This paper advocates for a risk-based approach to screening for adolescent depression that can improve upon current approaches to screening and facilitate more seamless connections to enable personalizing prevention of depression based on risk group classification. Empirical examples are reviewed for screening based on established risk factors that predict later depression. Evidence is provided that risk groups can reliably and validly classify adolescents at risk for future development of depression based on cognitive and interpersonal vulnerabilities. These risk groups inform one approach to personalizing prevention of depression by matching youths' risk to established, evidence-based prevention programs (cognitive or interpersonal). Promising data from a randomized trial suggest that this personalized depression prevention strategy can reduce depression better than a "one size fits all" approach.
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