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Service Use Findings from the Child STEPs Effectiveness Trial: Additional Support for Modular Designs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 43:135-40. [PMID: 25583271 DOI: 10.1007/s10488-015-0625-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study expands upon the Chorpita et al. (J Consult Clin Psychol 81:999-1009, 2013) findings by examining the impact of treatment protocol on youths' service utilization up to 2 years after starting an episode of: standard manualized treatment (Standard); modular treatment (Modular); or usual care (UC). Results showed that youths who received Modular accessed fewer service settings at their one-year follow-up relative to youths who received Standard or UC. Findings suggest that modular treatment may offer an advantage over standardized treatment manuals and UC in terms of sustained clinical benefits, and highlight the importance of treatment design considerations for service systems.
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252
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Dunn EC, Brown RC, Dai Y, Rosand J, Nugent NR, Amstadter AB, Smoller JW. Genetic determinants of depression: recent findings and future directions. Harv Rev Psychiatry 2015; 23:1-18. [PMID: 25563565 PMCID: PMC4309382 DOI: 10.1097/hrp.0000000000000054] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to: 1. Evaluate current evidence regarding the genetic determinants of depression 2. Assess findings from studies of gene-environment interaction 3. Identify challenges to gene discovery in depression Depression is one of the most prevalent, disabling, and costly mental health conditions in the United States and also worldwide. One promising avenue for preventing depression and informing its clinical treatment lies in uncovering the genetic and environmental determinants of the disorder as well as their interaction (G × E). The overarching goal of this review article is to translate recent findings from studies of genetic association and G × E related to depression, particularly for readers without in-depth knowledge of genetics or genetic methods. The review is organized into three major sections. In the first, we summarize what is currently known about the genetic determinants of depression, focusing on findings from genome-wide association studies (GWAS). In the second section, we review findings from studies of G × E, which seek to simultaneously examine the role of genes and exposure to specific environments or experiences in the etiology of depression. In the third section, we describe the challenges to genetic discovery in depression and promising strategies for future progress.
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Affiliation(s)
- Erin C. Dunn
- Center for Human Genetic Research, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT
| | - Ruth C. Brown
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
| | - Yael Dai
- Center for Human Genetic Research, Massachusetts General Hospital
| | - Jonathan Rosand
- Center for Human Genetic Research, Massachusetts General Hospital
- Department of Neurology, Massachusetts General Hospital
- Program in Medical and Population Genetics, The Broad Institute of Harvard and MIT
| | - Nicole R. Nugent
- Department of Psychiatry and Human Behavior, Alpert Brown Medical School
| | - Ananda B. Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
| | - Jordan W. Smoller
- Center for Human Genetic Research, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT
- Center on the Developing Child, Harvard University
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253
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Davey CG, Chanen AM, Cotton SM, Hetrick SE, Kerr MJ, Berk M, Dean OM, Yuen K, Phelan M, Ratheesh A, Schäfer MR, Amminger GP, Parker AG, Piskulic D, Harrigan S, Mackinnon AJ, Harrison BJ, McGorry PD. The addition of fluoxetine to cognitive behavioural therapy for youth depression (YoDA-C): study protocol for a randomised control trial. Trials 2014; 15:425. [PMID: 25370185 PMCID: PMC4230740 DOI: 10.1186/1745-6215-15-425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the Youth Depression Alleviation–Combined Treatment (YoDA-C) study is to determine whether antidepressant medication should be started as a first-line treatment for youth depression delivered concurrently with psychotherapy. Doubts about the use of medication have been raised by meta-analyses in which the efficacy and safety of antidepressants in young people have been questioned, and subsequent treatment guidelines for youth depression have provided only qualified support. Methods/Design YoDA-C is a double-blind, randomised controlled trial funded by the Australian government’s National Health and Medical Research Council. Participants between the ages of 15 and 25 years with moderate to severe major depressive disorder will be randomised to receive either (1) cognitive behavioural therapy (CBT) and fluoxetine or (2) CBT and placebo. The treatment duration will be 12 weeks, and follow-up will be conducted at 26 weeks. The primary outcome measure is change in the Montgomery-Åsberg Depression Rating Scale (MADRS) after 12 weeks of treatment. The MADRS will be administered at baseline and at weeks 4, 8, 12 and 26. Secondary outcome measures will address additional clinical outcomes, functioning, quality of life and safety. Trial registration Australian and New Zealand Clinical Trials Registry ID: ACTRN12612001281886 (registered on 11 December 2012)
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Affiliation(s)
- Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia.
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254
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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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255
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Abstract
Attention deficit/hyperactivity disorder (ADHD) often persists into adolescence and has the same functional impairments as were present during childhood. Medications lessen ADHD symptoms yet do not reliably affect functioning. Thus, there exists a great need for psychosocial treatments in adolescents with ADHD. Nonetheless, relative to the vast literature that has been reported on children with ADHD, much less data have been reported about psychosocial interventions for adolescents with ADHD. Cognitive behavioral therapy interventions that are being used with adolescents rely more on traditional behavioral principles than cognitive therapy tenets.
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256
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Kennard BD, Emslie GJ, Mayes TL, Nakonezny PA, Jones JM, Foxwell AA, King J. Sequential treatment with fluoxetine and relapse--prevention CBT to improve outcomes in pediatric depression. Am J Psychiatry 2014; 171:1083-90. [PMID: 24935082 PMCID: PMC4182111 DOI: 10.1176/appi.ajp.2014.13111460] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The authors evaluated a sequential treatment strategy of fluoxetine and relapse-prevention cognitive-behavioral therapy (CBT) to determine effects on remission and relapse in youths with major depressive disorder. METHOD Youths 8-17 years of age with major depression were treated openly with fluoxetine for 6 weeks. Those with an adequate response (defined as a reduction of 50% or more on the Children's Depression Rating Scale-Revised [CDRS-R]) were randomly assigned to receive continued medication management alone or continued medication management plus CBT for an additional 6 months. The CBT was modified to address residual symptoms and was supplemented by well-being therapy. Primary outcome measures were time to remission (with remission defined as a CDRS-R score of 28 or less) and rate of relapse (with relapse defined as either a CDRS-R score of 40 or more with a history of 2 weeks of symptom worsening, or clinical deterioration). RESULTS Of the 200 participants enrolled in acute-phase treatment, 144 were assigned to continuation treatment with medication management alone (N=69) or medication management plus CBT (N=75). During the 30-week continuation treatment period, time to remission did not differ significantly between treatment groups (hazard ratio=1.26, 95% CI=0.87, 1.82). However, the medication management plus CBT group had a significantly lower risk of relapse than the medication management only group (hazard ratio=0.31, 95% CI=0.13, 0.75). The estimated probability of relapse by week 30 was lower with medication management plus CBT than with medication management only (9% compared with 26.5%). CONCLUSIONS Continuation-phase relapse-prevention CBT was effective in reducing the risk of relapse but not in accelerating time to remission in children and adolescents with major depressive disorder.
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Affiliation(s)
- Betsy D. Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center,Children’s Medical Center of Dallas
| | - Graham J. Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center,Children’s Medical Center of Dallas
| | - Taryn L. Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center,Children’s Medical Center of Dallas
| | - Paul A. Nakonezny
- Department of Psychiatry, University of Texas Southwestern Medical Center,Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center
| | - Jessica M. Jones
- Department of Psychiatry, University of Texas Southwestern Medical Center,Children’s Medical Center of Dallas
| | - Aleksandra A. Foxwell
- Department of Psychiatry, University of Texas Southwestern Medical Center,Children’s Medical Center of Dallas
| | - Jessica King
- Department of Psychiatry, University of Texas Southwestern Medical Center,Children’s Medical Center of Dallas
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258
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Rice SM, Goodall J, Hetrick SE, Parker AG, Gilbertson T, Amminger GP, Davey CG, McGorry PD, Gleeson J, Alvarez-Jimenez M. Online and social networking interventions for the treatment of depression in young people: a systematic review. J Med Internet Res 2014; 16:e206. [PMID: 25226790 PMCID: PMC4180352 DOI: 10.2196/jmir.3304] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/22/2014] [Accepted: 08/04/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Major depression accounts for the greatest burden of all diseases globally. The peak onset of depression occurs between adolescence and young adulthood, and for many individuals, depression displays a relapse-remitting and increasingly severe course. Given this, the development of cost-effective, acceptable, and population-focused interventions for depression is critical. A number of online interventions (both prevention and acute phase) have been tested in young people with promising results. As these interventions differ in content, clinician input, and modality, it is important to identify key features (or unhelpful functions) associated with treatment outcomes. OBJECTIVE A systematic review of the research literature was undertaken. The review was designed to focus on two aspects of online intervention: (1) standard approaches evaluating online intervention content in randomized controlled designs (Section 1), and (2) second-generation online interventions and services using social networking (eg, social networking sites and online support groups) in any type of research design (Section 2). METHODS Two specific literature searches were undertaken. There was no date range specified. The Section 1 search, which focused on randomized controlled trials, included only young people (12-25 years) and yielded 101 study abstracts, of which 15 met the review inclusion criteria. The Section 2 search, which included all study design types and was not restricted in terms of age, yielded 358 abstracts, of which 22 studies met the inclusion criteria. Information about the studies and their findings were extracted and tabulated for review. RESULTS The 15 studies identified in Section 1 described 10 trials testing eight different online interventions, all of which were based on a cognitive behavioral framework. All but one of the eight identified studies reported positive results; however, only five of the 15 studies used blinded interviewer administered outcomes with most trials using self-report data. Studies varied significantly in presentation of intervention content, treatment dose, and dropout. Only two studies included moderator or clinician input. Results for Section 2 were less consistent. None of the Section 2 studies reported controlled or randomized designs. With the exception of four studies, all included participants were younger than 25 years of age. Eight of the 16 social networking studies reported positive results for depression-related outcomes. The remaining studies were either mixed or negative. Findings for online support groups tended to be more positive; however, noteworthy risks were identified. CONCLUSIONS Online interventions with a broad cognitive behavioral focus appear to be promising in reducing depression symptomology in young people. Further research is required into the effectiveness of online interventions delivering cognitive behavioral subcomponents, such as problem-solving therapy. Evidence for the use of social networking is less compelling, although limited by a lack of well-designed studies and social networking interventions. A range of future social networking therapeutic opportunities are highlighted.
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Affiliation(s)
- Simon M Rice
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
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259
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Vélez CE, Krause ED, Brunwasser SM, Freres DR, Abenavoli RM, Gillham JE. Parent predictors of adolescents' explanatory style. THE JOURNAL OF EARLY ADOLESCENCE 2014; 35:931-946. [PMID: 28090130 PMCID: PMC5226089 DOI: 10.1177/0272431614547050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The current study tested the prospective relations (six month lag) between three aspects of the parent-child relationship at Time 1 (T1) and adolescents' explanatory styles at Time 2 (T2): caregiving behaviors, parents' explanatory style for their own negative events, and parents' explanatory style for their children's negative events. The sample included 129 adolescents aged 11 to 14 years at baseline and their parents. Adolescents reported on their own explanatory style and their parents' caregiving behaviors; parents self-reported on their caregiving behaviors and their explanatory style for their own and their children's events. Regression analyses identified maternal acceptance as a significant predictor of T2 adolescents' explanatory style. Marginal effects emerged for fathers' psychological control and fathers' explanatory style for their children's events. Findings suggest that the ways parents - especially mothers - interact with their children may play a role in adolescents' cognitive vulnerability to depression.
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Affiliation(s)
- Clorinda E. Vélez
- Department of Psychology, Quinnipiac University, Hamden, CT
- Department of Psychology, Swarthmore College, Swarthmore, PA
| | - Elizabeth D. Krause
- Department of Psychology, Swarthmore College, Swarthmore, PA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA
| | | | - Derek R. Freres
- Annenberg School, University of Pennsylvania, Philadelphia, PA
| | - Rachel M. Abenavoli
- Human Development and Family Studies, Pennsylvania State University, University Park, PA
| | - Jane E. Gillham
- Department of Psychology, Swarthmore College, Swarthmore, PA
- Positive Psychology Center, University of Pennsylvania, Philadelphia, PA
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260
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Henje Blom E, Duncan LG, Ho TC, Connolly CG, LeWinn KZ, Chesney M, Hecht FM, Yang TT. The development of an RDoC-based treatment program for adolescent depression: "Training for Awareness, Resilience, and Action" (TARA). Front Hum Neurosci 2014; 8:630. [PMID: 25191250 PMCID: PMC4137278 DOI: 10.3389/fnhum.2014.00630] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/28/2014] [Indexed: 01/08/2023] Open
Abstract
Major depressive disorder (MDD) is one of the current leading causes of disability worldwide. Adolescence is a vulnerable period for the onset of depression, with MDD affecting 8–20% of all youth. Traditional treatment methods have not been sufficiently effective to slow the increasing prevalence of adolescent depression. We therefore propose a new model for the treatment of adolescent depression – Training for Awareness, Resilience, and Action (TARA) – that is based on current understanding of developmental and depression neurobiology. The TARA model is aligned with the Research Domain Criteria (RDoC) of the National Institute of Mental Health. In this article, we first address the relevance of RDoC to adolescent depression. Second, we identify the major RDoC domains of function involved in adolescent depression and organize them in a way that gives priority to domains thought to be driving the psychopathology. Third, we select therapeutic training strategies for TARA based on current scientific evidence of efficacy for the prioritized domains of function in a manner that maximizes time, resources, and feasibility. The TARA model takes into consideration the developmental limitation in top-down cognitive control in adolescence and promotes bottom-up strategies such as vagal afference to decrease limbic hyperactivation and its secondary effects. The program has been informed by mindfulness-based therapy and yoga, as well as modern psychotherapeutic techniques. The treatment program is semi-manualized, progressive, and applied in a module-based approach designed for a group setting that is to be conducted one session per week for 12 weeks. We hope that this work may form the basis for a novel and more effective treatment strategy for adolescent depression, as well as broaden the discussion on how to address this challenge.
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Affiliation(s)
- Eva Henje Blom
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden ; Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Larissa G Duncan
- Department of Family and Community Medicine, University of California San Francisco San Francisco, CA, USA ; Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA
| | - Tiffany C Ho
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Colm G Connolly
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
| | - Margaret Chesney
- Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA ; Department of Medicine, University of California San Francisco San Francisco, CA, USA
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California San Francisco San Francisco, CA, USA ; Department of Medicine, University of California San Francisco San Francisco, CA, USA
| | - Tony T Yang
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Francisco San Francisco, CA, USA
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261
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Clarke AM, Kuosmanen T, Barry MM. A systematic review of online youth mental health promotion and prevention interventions. J Youth Adolesc 2014; 44:90-113. [PMID: 25115460 DOI: 10.1007/s10964-014-0165-0] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/26/2014] [Indexed: 11/29/2022]
Abstract
The rapid growth in the use of online technologies among youth provides an opportunity to increase access to evidence-based mental health resources. The aim of this systematic review is to provide a narrative synthesis of the evidence on the effectiveness of online mental health promotion and prevention interventions for youth aged 12-25 years. Searching a range of electronic databases, 28 studies conducted since 2000 were identified. Eight studies evaluating six mental health promotion interventions and 20 studies evaluating 15 prevention interventions were reviewed. The results from the mental health promotion interventions indicate that there is some evidence that skills-based interventions presented in a module-based format can have a significant impact on adolescent mental health, however, an insufficient number of studies limits this finding. The results from the online prevention interventions indicate the significant positive effect of computerized cognitive behavioral therapy on adolescents' and emerging adults' anxiety and depression symptoms. The rates of non-completion were moderate to high across a number of studies. Implementation findings provide some evidence that participant face-to-face and/or web-based support was an important feature in terms of program completion and outcomes. Additional research examining factors affecting exposure, adherence and outcomes is required. The quality of evidence across the studies varied significantly, thus highlighting the need for more rigorous, higher quality evaluations conducted with more diverse samples of youth. Although future research is warranted, this study highlights the potential of online mental health promotion and prevention interventions in promoting youth wellbeing and reducing mental health problems.
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Affiliation(s)
- Aleisha M Clarke
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland,
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262
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Queen AH, Barlow DH, Ehrenreich-May J. The trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic treatment. J Anxiety Disord 2014; 28:511-21. [PMID: 24960439 DOI: 10.1016/j.janxdis.2014.05.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/12/2014] [Indexed: 11/28/2022]
Abstract
Anxiety and depressive disorders commonly co-occur during adolescence, share multiple vulnerability factors, and respond to similar psychosocial and pharmacological interventions. However, anxiety and depression may also be considered distinct constructs and differ on some underlying properties. Prior research efforts on evidence-based treatments for youth have been unable to examine the concurrent trajectories of primary anxiety and depressive concerns across the course of treatment. The advent of transdiagnostic approaches for these emotional disorders in youth allows for such examination. The present study examined the separate trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic intervention, the Unified Protocol for the Treatment of Emotional Disorders in Adolescence (UP-A; Ehrenreich et al., 2008), as well as up to six months following treatment. The sample included 59 adolescents ages 12-17 years old (M=15.42, SD=1.71) who completed at least eight sessions of the UP-A as part of an open trial or randomized, controlled trial across two treatment sites. Piecewise latent growth curve analyses found adolescent self-rated anxiety and depressive symptoms showed similar rates of improvement during treatment, but while anxiety symptoms continued to improve during follow-up, depressive symptoms showed non-significant improvement after treatment. Parent-rated symptoms also showed similar rates of improvement for anxiety and depression during the UP-A to those observed for adolescent self-report, but little improvement after treatment across either anxiety or depressive symptoms. To a certain degree, the results mirror those observed among other evidence-based treatments for youth with anxiety and depression, though results hold implications for future iterations of transdiagnostic treatments regarding optimization of outcomes for adolescents with depressive symptoms.
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Affiliation(s)
| | - David H Barlow
- Center for Anxiety and Related Disorders, Boston University, United States
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263
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Differential susceptibility in longitudinal models of gene-environment interaction for adolescent depression. Dev Psychopathol 2014; 25:991-1003. [PMID: 24229544 DOI: 10.1017/s0954579413000321] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although family support reliably predicts the development of adolescent depression and suicidal behaviors, relatively little is known about the interplay of family support with potential genetic factors. We tested the association of the 44 base pair polymorphism in the serotonin transporter linked promoter region gene (5-HTTLPR), family support (i.e., cohesion, communication, and warmth), and their interaction with self-reported depression symptoms and risk for suicide in 1,030 Caucasian adolescents and young adults from the National Longitudinal Study of Adolescent Health. High-quality family support predicted fewer symptoms of depression and reduced risk for suicidality. There was also a significant interaction between 5-HTTLPR and family support for boys and a marginally significant interaction for girls. Among boys with poor family support, youth with at least one short allele had more symptoms of depression and a higher risk for suicide attempts relative to boys homozygous for the long allele. However, in the presence of high family support, boys with the short allele had the fewest depression symptoms (but not suicide attempts). Results suggest that the short allele may increase reactivity to both negative and positive family influences in the development of depression. We discuss the potential role of interactive exchanges between family support and offspring genotype in the development of adolescent depression and suicidal behaviors.
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264
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Rousseau C, Nadeau L, Pontbriand A, Johnson-Lafleur J, Measham T, Broadhurst J. La santé mentale jeunesse : un domaine à la croisée des chemins. SANTE MENTALE AU QUEBEC 2014. [DOI: 10.7202/1025909ar] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Si l’importance grandissante de la santé mentale des jeunes fait consensus, de multiples questionnements émergent cependant quant aux spécificités de ce domaine, qui ne peut être conçu comme une extension des services adultes pour des groupes plus jeunes. Cet article aborde ces questionnements en croisant les savoirs provenant de la documentation et ceux qui émergent à la suite de l’implantation du Plan d’action en santé mentale au Québec.
Le Plan d’action en santé mentale a mis de l’avant la collaboration et le partenariat entre institutions et disciplines. Malgré des avancées significatives, des discontinuités peu favorables à une prise en charge écosystémique persistent. Un ensemble de recherches récentes suggère que les contextes organisationnels qui encadrent les services influencent à la fois la façon dont les interventions sont mises en place et leurs résultats cliniques. Une structure de gestion flexible qui engage les intervenants en favorisant une appropriation du pouvoir, tout en minimisant les sources de stress au travail et en facilitant la création de partenariats, semble nécessaire pour favoriser la concertation interdisciplinaire et intersectorielle. Celle-ci est essentielle à la mise en place de services en santé mentale jeunesse.
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Affiliation(s)
- Cécile Rousseau
- Professeur titulaire, Université McGill
- CSSS de la Montagne (CLSC de Parc-Extension)
| | | | | | | | | | - Joanna Broadhurst
- Chef de programme DI/TED DP et santé mentale jeunesse CSSS de la Montagne
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265
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Aggarwal NK, Balaji M, Kumar S, Mohanraj R, Rahman A, Verdeli H, Araya R, Jordans MJD, Chowdhary N, Patel V. Using consumer perspectives to inform the cultural adaptation of psychological treatments for depression: a mixed methods study from South Asia. J Affect Disord 2014; 163:88-101. [PMID: 24836093 PMCID: PMC4037874 DOI: 10.1016/j.jad.2014.03.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Integrating consumer perspectives in developing and adapting psychological treatments (PTs) can enhance their acceptability in diverse cultural contexts. OBJECTIVE To describe the explanatory models (EMs) of depression in South Asia with the goal of informing the content of culturally appropriate PTs for this region. METHODS Two methods were used: a systematic review of published literature on the EMs of depression in South Asia; and in-depth interviews with persons with depression and family caregivers in two sites in India. Findings from both were analysed independently and then triangulated. RESULTS There were 19 studies meeting our inclusion criteria. Interviews were conducted with 27 patients and 10 caregivers. Findings were grouped under four broad categories: illness descriptions, perceived impact, causal beliefs and self-help forms of coping. Depression was characterised predominantly by somatic complaints, stress, low mood, and negative and ruminative thoughts. Patients experienced disturbances in interpersonal relationships occupational functioning, and stigma. Negative life events, particularly relationship difficulties, were perceived as the main cause. Patients mostly engaged in distracting activities, religious practices, and received support from family and friends to cope with the illness. LIMITATIONS The primary data are entirely from India but the studies from the literature review covering South Asia are consistent with these findings. This study also does not include literature in local languages or explore how consumer perspectives change over time. CONCLUSIONS EMs can inform cultural adaptations to PTs for depression in South Asia by defining target outcomes, content for psycho-education, and culturally appropriate treatment strategies.
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Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 11, New York, NY 10032, USA.
| | - Madhumitha Balaji
- Parivartan Trust, Plot no. 20, Vijaya Villa Survey, No. 235A, Sanjay Park, Lane no. 1, Lohgaon Airport Road, Pune 411014, India; Sangath Centre, 841/1 Alto-Porvorim, Sangath, Goa 403521, India.
| | - Shuba Kumar
- Samarth, No. 100, Warren Road, Mylapore, Chennai 600004, India.
| | - Rani Mohanraj
- Samarth, No. 100, Warren Road, Mylapore, Chennai 600004, India.
| | - Atif Rahman
- University of Liverpool, Institute of Psychology, Health & Society, Child Mental Health Unit, Alder Hey Children׳s NHS Foundation Trust, Mulberry House, Eaton Road, Liverpool L12 2AP, UK.
| | - Helena Verdeli
- Department of Counselling and Clinical Psychology, Teachers College, Columbia University, 525W 120th Street, New York City, NY 10027, USA.
| | - Ricardo Araya
- Academic Unit of Psychiatry, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK.
| | - M J D Jordans
- Health Net TPO, Lizzy Ansinghstraat 163, 1073 RG Amsterdam, The Netherlands; Center for Global Mental Health, Institute of Psychiatry, King's College London, Box P029, De Crespigny Park, London SE5 8AF, UK.
| | - Neerja Chowdhary
- Sangath Centre, 841/1 Alto-Porvorim, Sangath, Goa 403521, India.
| | - Vikram Patel
- Sangath Centre, 841/1 Alto-Porvorim, Sangath, Goa 403521, India; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7H, UK.
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266
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Kovacs M, Yaroslavsky I. Practitioner review: Dysphoria and its regulation in child and adolescent depression. J Child Psychol Psychiatry 2014; 55:741-57. [PMID: 24256499 PMCID: PMC4029932 DOI: 10.1111/jcpp.12172] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND By emphasizing the importance of emotions, the 'affect revolution' in how human behavior is conceptualized has inspired a new generation of studies on dysphoric experience and its regulation in clinical depression, and novel efforts to characterize the precursors of affective disorders in juveniles at familial risk for depression. METHOD We review clinical, behavioral, and functional neuroimaging studies of dysphoric experience and its regulation in depressed children and adolescents, and in juvenile offspring of parents with histories of clinical depression. We discuss the implication of the literature in the context of maternal depression. RESULTS Findings confirm the high rate of clinically significant dysphoria in depressed children and adolescents and reveal notable affective lability in daily life as a function of context and activity. Findings also show that depressed youngsters have problems in attenuating dysphoria. Similarly, never-depressed offspring at familial risk for depression display problems in mood repair and impaired mood repair mechanisms. Brain neuroimaging findings indicate that, overall, depressed, and high-risk youngsters differ from never depressed controls in neural functioning (activation, connectivity) both at rest and in response to emotion triggers. CONCLUSION The evaluation of depressed youngsters should include questions about reactivity of dysphoric mood to the changing contexts of daily life and about how they manage (respond to) their own sadness and distress. The resultant information may help the clinician to restructure a young patient's day for the better and identify helpful mood repair responses. Evidence of impaired mood repair mechanisms in youngsters at high-risk for depression suggests the need for early intervention. But interventions must consider that many depressed and high-risk children have depressed mothers, who may be constrained in their ability to help offspring's emotion regulation efforts. To optimize treatment response of offspring, mothers of depressed children should therefore be routinely screened for depression and treated, as warranted.
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Affiliation(s)
- Maria Kovacs
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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267
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Brand-Gothelf A, Yoeli-Bligh N, Gilboa-Schechtman E, Benaroya-Milshtein N, Apter A. Perceptions of self, mother and family and behavior of prepubertal depressed children. Eur Psychiatry 2014; 30:69-74. [PMID: 24969104 DOI: 10.1016/j.eurpsy.2014.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/09/2014] [Accepted: 05/20/2014] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To characterize the perceptions of self, mother and family of prepubertal children and to determine if the perceptions of children with depression and their behavior towards their mothers are different from children with anxiety disorders and nonpsychiatric controls. METHODS Children (aged 7-13 years) with major depressive disorder (n=30), anxiety disorders (n=37) and nonpsychiatric controls (n=32) underwent structured psychiatric evaluations and completed questionnaires on their perceptions of themselves and their relations with their mothers and families. The child-mother dyad was observed during structured interactions. RESULTS Self-perceptions of depressed children were significantly more negative than those of children with anxiety and controls. Depression severity negatively correlated with the child's self-perception and positively correlated with perceptions of the mother as being more rejecting, controlling, less accepting and less allowing autonomy, and of the family as being less cohesive. Depression severity was also positively associated with the child's hostile attitude towards the mother during the interactions. CONCLUSION Our findings of greater negative perceptions of self, mother and family in depressed children compared to children with anxiety disorders and nonpsychiatric children suggest that approaches specifically addressing negative perceptions and targeting familial relationships could be especially effective for treating young children with depression.
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Affiliation(s)
- A Brand-Gothelf
- The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - N Yoeli-Bligh
- The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel; Department of Psychology and the Gonda Brain Science Center, Bar-Ilan University, Ramat-Gan, Israel
| | - E Gilboa-Schechtman
- Department of Psychology and the Gonda Brain Science Center, Bar-Ilan University, Ramat-Gan, Israel
| | - N Benaroya-Milshtein
- The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Apter
- The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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268
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Vaz S, Falkmer M, Parsons R, Passmore AE, Parkin T, Falkmer T. School belongingness and mental health functioning across the primary-secondary transition in a mainstream sample: multi-group cross-lagged analyses. PLoS One 2014; 9:e99576. [PMID: 24967580 PMCID: PMC4072543 DOI: 10.1371/journal.pone.0099576] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/16/2014] [Indexed: 02/04/2023] Open
Abstract
The relationship between school belongingness and mental health functioning before and after the primary-secondary school transition has not been previously investigated in students with and without disabilities. This study used a prospective longitudinal design to test the bi-directional relationships between these constructs, by surveying 266 students with and without disabilities and their parents, 6-months before and after the transition to secondary school. Cross-lagged multi-group analyses found student perception of belongingness in the final year of primary school to contribute to change in their mental health functioning a year later. The beneficial longitudinal effects of school belongingness on subsequent mental health functioning were evident in all student subgroups; even after accounting for prior mental health scores and the cross-time stability in mental health functioning and school belongingness scores. Findings of the current study substantiate the role of school contextual influences on early adolescent mental health functioning. They highlight the importance for primary and secondary schools to assess students' school belongingness and mental health functioning and transfer these records as part of the transition process, so that appropriate scaffolds are in place to support those in need. Longer term longitudinal studies are needed to increase the understanding of the temporal sequencing between school belongingness and mental health functioning of all mainstream students.
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Affiliation(s)
- Sharmila Vaz
- School of Occupational Therapy and Social Work, Centre for Research into Disability and Society, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Marita Falkmer
- School of Occupational Therapy and Social Work, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
- School of Education and Communication, CHILD programme, Institution of Disability Research Jönköping University, Jönköping, Sweden
| | - Richard Parsons
- School of Occupational Therapy and Social Work, and School of Pharmacy, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Anne Elizabeth Passmore
- School of Occupational Therapy and Social Work, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Timothy Parkin
- School of Occupational Therapy and Social Work, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Torbjörn Falkmer
- School of Occupational Therapy and Social Work, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
- School of Occupational Therapy, La Trobe University, Melbourne, Vic., Australia
- Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University and Pain and Rehabilitation Centre, UHL, County Council, Linköping, Sweden
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269
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Ma D, Zhang Z, Zhang X, Li L. Comparative efficacy, acceptability, and safety of medicinal, cognitive-behavioral therapy, and placebo treatments for acute major depressive disorder in children and adolescents: a multiple-treatments meta-analysis. Curr Med Res Opin 2014; 30:971-95. [PMID: 24188102 DOI: 10.1185/03007995.2013.860020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND New generation antidepressant therapies, including serotonin-norepinephrine reuptake inhibitor (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) were introduced in the late 1980s; however, few comprehensive studies compared the benefits and risks of various contemporary treatments for major depressive disorder (MDD) in pediatric patients. OBJECTIVE Multiple-treatments meta-analysis (MTM) was conducted to assess efficacy, acceptability, and safety of contemporary interventions in children and adolescents with MDD. METHODS Cochrane Library, AMED, CINAHL, EMBASE, LiLACS, MEDLINE, PSYCINFO, PSYNDEX, and Journal of Medicine and Pharmacy databases were searched for randomized controlled trials (RCTs) comparing medicinal interventions (citalopram, escitalopram, fluoxetine, mirtazapine, paroxetine, sertraline, venlafaxine), cognitive behavioral therapy (CBT), combined fluoxetine with CBT, and placebo treatment for acute MDD from January 1988 to March 2013. Treatment success, dropout rate, and suicidal ideation/attempt outcomes were measured. Bayesian methods were used to conduct a MTM including age and funding subgroups. RESULTS A total of 21 RCTs (4969 participants) were identified. Combined fluoxetine/CBT exhibited the highest efficacy, with fluoxetine alone superior to CBT, paroxetine, sertraline, citalopram, escitalopram, and placebo treatment. Sertraline, paroxetine, escitalopram, and venlafaxine showed superior acceptability to fluoxetine and combined fluoxetine/CBT. Combined fluoxetine/CBT combination was less safe, though CBT was safer than fluoxetine alone. Combined fluoxetine/CBT, fluoxetine, and mirtazapine exhibited the highest efficacy; sertraline, escitalopram, venlafaxine, and paroxetine were the best tolerated; and mirtazapine and venlafaxine were the safest. CONCLUSIONS Sertraline and mirtazapine exhibited optimally balanced efficacy, acceptability, and safety for first-line acute treatment of child and adolescent MDD.
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Affiliation(s)
- Dongfeng Ma
- Affiliated ZhongDa Hospital and the Institution Neuropsychiatry of Southeast University , Nanjing , China
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270
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Cummings CM, Caporino NE, Kendall PC. Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychol Bull 2014; 140:816-45. [PMID: 24219155 PMCID: PMC4006306 DOI: 10.1037/a0034733] [Citation(s) in RCA: 520] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youths with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youths with coprimary generalized anxiety disorder and depression, and Pathway 3 including depressed youths with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted.
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271
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Development and Implementation of Health and Wellness CBT for Individuals with Depression and HIV. COGNITIVE AND BEHAVIORAL PRACTICE 2014; 21:237-246. [PMID: 24795524 DOI: 10.1016/j.cbpra.2013.07.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Rates of depression are reported to be between 22-33% in adults with HIV, which is double that of the general population. Depression negatively affects treatment adherence and health outcomes of those with medical illnesses. Further, it has been shown in adults that reducing depression may improve both adherence and health outcomes. To address the issues of depression and non-adherence, Health and Wellness (H&W) Cognitive Behavioral Therapy (CBT) and medication management (MM) treatment strategies have been developed specifically for youth living with both HIV and depression. H&W CBT is based on other studies with uninfected youth and upon research on adults with HIV. H&W CBT uses problem-solving, motivational interviewing, and cognitive-behavioral strategies to decrease adherence obstacles and increase wellness. The intervention is delivered in 14 planned sessions over a 6-month period, with three different stages of CBT. This paper summarizes the feasibility and acceptability data from an open depression trial with 8 participants, 16-24 years of age, diagnosed with HIV and with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis of depression, conducted at two treatment sites in the Adolescent Trials Network (ATN). Both therapists and subjects completed a Session Evaluation Form (SEF) after each session, and results were strongly favorable. Results from The Quick Inventory of Depressive Symptomatology-Clinician (QIDS-C) also showed noteworthy improvement in depression severity. A clinical case vignette illustrates treatment response. Further research will examine the use of H&W CBT in a larger trial of youth diagnosed with both HIV and depression.
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272
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Riley AR, Gaynor ST. Identifying mechanisms of change: utilizing single-participant methodology to better understand behavior therapy for child depression. Behav Modif 2014; 38:636-64. [PMID: 24742468 DOI: 10.1177/0145445514530756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined therapeutic mechanisms of action at the single-participant level in a behavior therapy (BT) for youth depression. By controlling for non-specific early responses, identifying potential mechanisms of action a priori, taking frequent measures of hypothesized mechanisms and dependent variables, rigorously evaluating internal validity, and using a variety of analytic methods, a unique model for analysis of potential mediators was created. Eleven children (M age = 9.84) meeting criteria on the Children's Depression Rating Scale-Revised (M = 55.36) and Children's Depression Inventory (M = 23.45) received non-directive therapy (NDT), followed by BT for those still displaying significant symptoms. Four participants (36%) had a clinically significant response to NDT. For the remaining seven, statistically significant changes in depressive symptoms and family interactions during the BT interval were found at the group level. At the single-participant level, evidence suggesting that outcome was at least partially mediated by changes in treatment targets was obtained for four of seven (57%). As the field further embraces efforts to learn not only whether treatments work but also how they work, the single-participant approach to evaluating mediators provides a useful framework for evaluating theories of therapeutic change.
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273
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van der Zanden R, Galindo-Garre F, Curie K, Kramer J, Cuijpers P. Online cognitive-based intervention for depression: exploring possible circularity in mechanisms of change. Psychol Med 2014; 44:1159-1170. [PMID: 23866103 DOI: 10.1017/s003329171300175x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study investigates possible circularity in mechanisms of change in participants of Master Your Mood (MYM), a cognitive-based, online intervention for young adults with depressive symptoms. A previous study showed that MYM effectively reduced depression and anxiety and strengthened mastery. METHOD We randomized 244 participants with depressive symptoms into MYM or a wait-list control condition. We explored the circularity hypothesis by several analyses. Correlations were computed to determine the association between (change in) depression and anxiety. Path analysis mediation models were used to explore whether change in anxiety and mastery mediated the intervention effect on depression, whether depression and mastery mediated the effect on anxiety and whether depression and anxiety mediated the effect on mastery. We used linear regression to explore whether early changes in anxiety predicted later changes in depression, and whether early changes in depression predicted later changes in anxiety. RESULTS Co-morbidity between depression and anxiety was high (69.2%) and the association between depression and anxiety change was strong (r = 0.677, p < 0.01). Changes in anxiety and mastery mediated change in depression (mediation proportion 44%); changes in depression mediated change in anxiety (79%) and mastery (75%). We did not find an early change in anxiety predictive for a late change in depression, and vice versa. CONCLUSIONS This study appears to confirm the hypothesized circularity in the recovery process. We found high co-morbidity and strong correlation between depression and anxiety levels and bi-directional relationships between potential mediators and outcomes. Early anxiety change scores were not predictive of late depression change scores, and vice versa.
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Affiliation(s)
- R van der Zanden
- Centre for Youth Mental Health Studies, Trimbos Institute, Utrecht, The Netherlands
| | - F Galindo-Garre
- EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - K Curie
- Department of Health Sciences, VU University, Amsterdam, The Netherlands
| | - J Kramer
- Innovation Centre of Mental Health and Technology, Trimbos Institute, Utrecht, The Netherlands
| | - P Cuijpers
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
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274
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Straub J, Sproeber N, Plener PL, Fegert JM, Bonenberger M, Koelch MG. A brief cognitive-behavioural group therapy programme for the treatment of depression in adolescent outpatients: a pilot study. Child Adolesc Psychiatry Ment Health 2014; 8:9. [PMID: 24655595 PMCID: PMC3994391 DOI: 10.1186/1753-2000-8-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/11/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The goal of this pilot study was to examine the feasibility and clinical outcomes of a brief (6-session) group therapy programme in adolescent outpatients with depression. The programme had previously been assessed in in-patients, with positive results. METHODS A total of 15 outpatients aged 13 to 18 years took part in the programme between October 2010 and May 2011, in 3 separate groups of 4-6 participants each. The outcomes measured were feasibility of the programme, as assessed by attendance rate, user feedback, fidelity of implementation, and response to treatment, as assessed by pre- and post-intervention measurement of depressive symptoms, quality of life, and suicidal ideation. RESULTS The programme demonstrated good feasibility, with a mean attendance rate of 5.33 out of 6 sessions, a mean rating by participants on overall satisfaction with the programme of 7.21 out of 10 (SD = 1.89), and a 93% concurrence between the contents of the sessions and the contents of the treatment manual. Compared to baseline scores, depressive symptoms at follow-up test were significantly reduced, as assessed by the Children's Depression Rating Scale Revised (F(1, 12) = 11.76, p < .01) and the Beck Depression Inventory Revision (F(1, 32) = 11.19, p < .01); quality of life improved, as assessed by the Inventory of Quality of Life (F(1, 31) = 5.27, p < .05); and suicidal ideation was reduced. No significant changes were seen on the measures of the Parent Rating Scale for Depression and the Clinical Global Impression scale. CONCLUSIONS Based on the results of this pilot study, it is feasible to further assess this brief outpatient treatment programme in a randomized controlled trial without further modifications.
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Affiliation(s)
- Joana Straub
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital, Ulm, Germany
| | - Nina Sproeber
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital, Ulm, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital, Ulm, Germany
| | - Joerg M Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital, Ulm, Germany
| | - Martina Bonenberger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital, Ulm, Germany
| | - Michael G Koelch
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital, Ulm, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospitals, Berlin, Germany
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275
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Yap MBH, Pilkington PD, Ryan SM, Kelly CM, Jorm AF. Parenting strategies for reducing the risk of adolescent depression and anxiety disorders: a Delphi consensus study. J Affect Disord 2014; 156:67-75. [PMID: 24359862 DOI: 10.1016/j.jad.2013.11.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/20/2013] [Accepted: 11/21/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND The family setting, particularly parents, is a strategic target for preventive interventions for youth depression and anxiety disorders. However, more effective translation of relevant research evidence is required. METHOD This study employed the Delphi methodology to establish expert consensus on parenting strategies that are important for preventing adolescent depression or anxiety disorders. A literature search identified 402 recommendations for parents. These were presented to a panel of 27 international experts over three survey rounds, who rated their preventive importance. RESULTS One-hundred and ninety parenting strategies were endorsed as important or essential in reducing adolescents' risk of developing depression or anxiety disorders by ≥90% of the panel. These strategies were written into a document suitable for parents, categorised under 11 sub-headings: You can reduce your child's risk of depression and anxiety problems, Establish and maintain a good relationship with your teenager, Be involved and support increasing autonomy, Establish family rules and consequences, Minimise conflict in the home, Encourage supportive relationships, Help your teenager deal with problems, Encourage good health habits, Help your teenager to deal with anxiety, Encourage professional help seeking when needed, and Don׳t blame yourself. LIMITATIONS This study utilised an international panel of experts from Western countries, hence the strategies identified may not be relevant for families from other cultural groups. CONCLUSIONS This study produced a set of parenting strategies that are supported by research evidence and/or international experts, which can now be promoted in Western English-speaking communities to help parents protect their adolescents from depression and anxiety disorders.
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Affiliation(s)
- Marie B H Yap
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia.
| | - Pamela D Pilkington
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
| | - Siobhan M Ryan
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
| | - Claire M Kelly
- Mental Health First Aid Australia, Australia; School of Psychology, Deakin University, Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
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276
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Yap MBH, Pilkington PD, Ryan SM, Jorm AF. Parental factors associated with depression and anxiety in young people: a systematic review and meta-analysis. J Affect Disord 2014; 156:8-23. [PMID: 24308895 DOI: 10.1016/j.jad.2013.11.007] [Citation(s) in RCA: 326] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 09/16/2013] [Accepted: 11/12/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a burgeoning and varied literature examining the associations between parental factors and depression or anxiety disorders in young people. However, there is hitherto no systematic review of this complex literature with a focus on the 12-18 years age range, when the first onset for these disorders peaks. Furthermore, to facilitate the application of the evidence in prevention, a focus on modifiable factors is required. METHODS Employing the PRISMA method, we conducted a systematic review of parental factors associated with depression and anxiety disorders in young people which parents can potentially modify. RESULTS We identified 181 articles altogether, with 140 examining depression, 17 examining anxiety problems, and 24 examining both outcomes. Stouffer's method of combining p values was used to determine whether associations between variables were reliable, and meta-analyses were conducted to estimate the mean effect sizes of associations between each parental factor and outcome. LIMITATIONS Limitations include sacrificing micro-level detail for a macro-level synthesis of the literature, not systematically reviewing moderators and mediators, the lack of generalizability across cultures and to younger or adult children, and the inability to conduct a meta-analysis on all included studies. CONCLUSIONS Parental factors with a sound evidence base indicating increased risk for both depression and anxiety include less warmth, more inter-parental conflict, over-involvement, and aversiveness; and for depression additionally, they include less autonomy granting and monitoring.
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Affiliation(s)
- Marie Bee Hui Yap
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Pamela Doreen Pilkington
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Siobhan Mary Ryan
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Anthony Francis Jorm
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia
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277
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Zack S, Saekow J, Kelly M, Radke A. Mindfulness Based Interventions for Youth. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2014. [DOI: 10.1007/s10942-014-0179-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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278
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Rashid T, Anjum A, Chu R, Stevanovski S, Zanjani A, Lennox C. Strength Based Resilience: Integrating Risk and Resources Towards Holistic Well-being. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/978-94-017-8669-0_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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279
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Ames CS, Richardson J, Payne S, Smith P, Leigh E. Mindfulness-based cognitive therapy for depression in adolescents. Child Adolesc Ment Health 2014; 19:74-78. [PMID: 32878358 DOI: 10.1111/camh.12034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mindfulness-Based Cognitive Therapy (MBCT) has been shown to be effective in preventing relapse of depression in adults, but has not previously been applied to adolescents who have residual symptoms of depression following treatment. METHOD An 8-week MBCT group was adapted for adolescents, and evaluated using qualitative and quantitative measures. RESULTS Participants report high levels of satisfaction with the group intervention. Qualitative analysis of semi-structured interviews provides areas for future development of this intervention. Pilot data indicate reductions in depressive symptoms, alongside positive change in mindfulness skills, quality of life and rumination. CONCLUSIONS Preliminary evidence for the use of MBCT with this group of adolescents is provided.
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Affiliation(s)
- Catherine S Ames
- National and Specialist Child and Adolescent Mental Health Service, South London and Maudsley NHS Foundation Trust Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ, UK.,Psychology Department, Institute of Psychiatry, King's College London, London, UK
| | - Jessica Richardson
- National and Specialist Child and Adolescent Mental Health Service, South London and Maudsley NHS Foundation Trust Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ, UK
| | - Susanna Payne
- Bethlem Adolescent Unit, South London and Maudsley NHS Foundation Trust Bethlem Royal Hospital, Beckenham, UK
| | - Patrick Smith
- National and Specialist Child and Adolescent Mental Health Service, South London and Maudsley NHS Foundation Trust Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ, UK.,Psychology Department, Institute of Psychiatry, King's College London, London, UK
| | - Eleanor Leigh
- National and Specialist Child and Adolescent Mental Health Service, South London and Maudsley NHS Foundation Trust Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ, UK.,Psychology Department, Institute of Psychiatry, King's College London, London, UK
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Li JJ, Lee SS. Negative emotionality mediates the association of 5-HTTLPR genotype and depression in children with and without ADHD. Psychiatry Res 2014; 215:163-9. [PMID: 24287203 DOI: 10.1016/j.psychres.2013.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 09/06/2013] [Accepted: 10/16/2013] [Indexed: 11/29/2022]
Abstract
The 44-base-pair polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) has been implicated in the etiology of depression, but relatively little is known about potential mediators of this association. Although dimensions of temperament are likely to be proximal to the neurobiological and genetic factors underlying depression, studies have yet to formally evaluate temperament as a potential causal pathway. We examined individual differences in dimensions of temperament [negative emotionality (NE), prosociality (PRO), and daring (DA)] as potential mediators of 5-HTTLPR genotype and child depression. Using a multiple mediation framework, we tested the association of child 5-HTTLPR genotype and these dimensions of temperament with multi-informant ratings of child depression in a sample of 218 children with and without attention-deficit/hyperactivity disorder (ADHD). The long allele of 5-HTTLPR was associated with higher NE and lower PRO, but not DA. High NE mediated the association of 5-HTTLPR genotype and separate parent and teacher ratings of depression. ADHD status did not moderate the mediational role of NE for 5-HTTLPR and depression. Results suggest that NE may constitute a pathway between 5-HTTLPR and child depression. The role of genetic variation and temperament dimensions as intermediate traits in the development of depression is discussed.
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Affiliation(s)
- James J Li
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, United States
| | - Steve S Lee
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, United States.
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281
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Asarnow JR, Miranda J. Improving care for depression and suicide risk in adolescents: innovative strategies for bringing treatments to community settings. Annu Rev Clin Psychol 2014; 10:275-303. [PMID: 24437432 PMCID: PMC4295487 DOI: 10.1146/annurev-clinpsy-032813-153742] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article reviews the literature on interventions and services for depression and suicide prevention among adolescents, with the goals of placing this science within the context of currently changing health care environments and highlighting innovative models for improving health and mental health. We examine the challenges and opportunities offered by new initiatives and legislation designed to transform the US health and mental health care systems; summarize knowledge regarding the treatment of depression and suicidality/self-harm in adolescents; and describe innovative models for partnering with health systems and communities. This review demonstrates that treatment models and service delivery strategies are currently available for increasing evidence-based care, particularly for depression, and concludes with recommendations for future research and quality improvement initiatives aimed at inspiring additional efforts to put science to work, bridge science and community practice, and develop strategies for partnering with communities to improve care, mental health, and well-being among adolescents.
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Affiliation(s)
- Joan Rosenbaum Asarnow
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California 90095; ,
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282
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Erford BT, Paul LE, Oncken C, Kress VE, Erford MR. Counseling Outcomes for Youth With Oppositional Behavior: A Meta-Analysis. JOURNAL OF COUNSELING AND DEVELOPMENT 2014. [DOI: 10.1002/j.1556-6676.2014.00125.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Lauren E. Paul
- Education Specialties Department, Loyola University Maryland
| | - Conor Oncken
- Education Specialties Department, Loyola University Maryland
| | - Victoria E. Kress
- Department of Counseling and Special Education, Youngstown State University
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283
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Khatoon H. Case study of depression with substance abuse: intervention-based cognitive behavioural therapy in an outpatient setting. ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2014. [DOI: 10.1080/21507686.2013.842603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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284
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Abstract
Psychotherapies for children and adolescents have been tested in hundreds of randomized controlled trials across five decades, and many of these youth therapies have now been classified as empirically supported treatments (ESTs). A burgeoning movement is underway to implement these ESTs in clinical practice settings, but questions arise as to whether the treatments are ready for practice and whether they will improve outcomes for clinically referred youths. Our data show ESTs to be more effective than usual care, on average, but only modestly so, and there are troubling exceptions. One reason may be that the design of most ESTs (e.g., single-disorder focus, linear session sequence) does not fit the characteristics of referred youths or clinical practice very well. Indeed, youth psychotherapy research has not focused much on the clients or contexts of actual clinical care. An alternative empirical approach, the deployment-focused model, proposes developing and testing interventions with the clients, clinicians, and contexts for which they are ultimately intended. Recent application of the model highlights its potential for stimulating robust treatments that are effective in clinical practice.
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285
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Jacobs RH, Becker SJ, Curry JF, Silva SG, Ginsburg GS, Henry DB, Reinecke MA. Increasing Positive Outlook Partially Mediates the Effect of Empirically Supported Treatments on Depression Symptoms Among Adolescents. J Cogn Psychother 2014; 28:3-19. [PMID: 24944436 DOI: 10.1891/0889-8391.28.1.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Among adolescents there is evidence that cognitive change partially mediates the effect of cognitive behavioral therapy (CBT) on depression outcome. However, prior studies have been limited by small samples, narrow measures of cognition, and failure to compare cognitive change following CBT to cognitive change following antidepressant medication. This study examined whether change in four cognitive constructs (cognitive distortions, cognitive avoidance, positive outlook, and solution-focused thinking) mediated change in depression severity in a sample of 291 adolescents who participated in the Treatment for Adolescents with Depression Study (TADS). TADS assessed the effects of CBT, fluoxetine, and their combination on depression severity. All three treatments were associated with change in the cognitive constructs and combination treatment produced the greatest change. Furthermore, change in the cognitive constructs partially mediated change in depression severity within all three treatments. Results implicated positive outlook as the construct most associated with change in depression severity over 36 weeks.
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Affiliation(s)
| | | | | | | | - Golda S Ginsburg
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Mark A Reinecke
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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286
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Psychotherapeutische Behandlung von depressiven Kindern und Jugendlichen. PSYCHOTHERAPEUT 2013. [DOI: 10.1007/s00278-013-1026-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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287
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288
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Stikkelbroek Y, Bodden DHM, Deković M, van Baar AL. Effectiveness and cost effectiveness of cognitive behavioral therapy (CBT) in clinically depressed adolescents: individual CBT versus treatment as usual (TAU). BMC Psychiatry 2013; 13:314. [PMID: 24261913 PMCID: PMC4222498 DOI: 10.1186/1471-244x-13-314] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 11/11/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depressive disorders occur in 2 to 5% of the adolescents and are associated with a high burden of disease, a high risk of recurrence and a heightened risk for development of other problems, like suicide attempts. The effectiveness of cognitive behaviour therapy (CBT), cost-effectiveness of this treatment and the costs of illness of clinical depression in adolescents are still unclear. Although several Randomized Controlled Trials (RCT) have been conducted to establish the efficacy of CBT, the effectiveness has not been established yet. Aim of this study is to conduct a RCT to test the effectiveness of CBT and to establish the cost-effectiveness of CBT under rigorous conditions within routine care provided by professionals already working in mental health institutions. METHOD/DESIGN CBT is investigated with a multi-site, RCT using block randomisation. The targeted population is 140 clinically referred depressed adolescents aged 12 to 21 years old. Adolescents are randomly assigned to the experimental (N = 70, CBT) or control condition (N = 70, TAU). Four assessments (pre, post, follow up at 6 and 12 months) and two mediator assessments during treatment are conducted. Primary outcome measure is depression diagnosis based on a semi-structured interview namely the K-SADS-PL. Secondary outcome measures include depressive symptoms, severity and improvement of the depression, global functioning, quality of life, suicide risk, comorbidity, alcohol and drug use, parental depression and psychopathology, parenting and conflicts. Costs and treatment characteristics will also be assessed. Furthermore, moderator and mediator analyses will be conducted. DISCUSSION This trial will be the first to compare CBT with TAU under rigorous conditions within routine care and with a complex sample. Furthermore, cost-effectiveness of treatment and cost-of-illness of clinical depression are established which will provide new insights on depression as a disorder and its treatment. TRIAL REGISTRATION Dutch Trial register number NTR2676. The study was financially supported by a grant from ZonMw, the Netherlands organization for health research and development, grant number 157004005.
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Affiliation(s)
- Yvonne Stikkelbroek
- Department of Child and Adolescent Studies, Utrecht University, PO Box 80.140, NL-3508 TC Utrecht, Netherlands
| | - Denise HM Bodden
- Department of Child and Adolescent Studies, Utrecht University, PO Box 80.140, NL-3508 TC Utrecht, Netherlands
| | - Maja Deković
- Department of Child and Adolescent Studies, Utrecht University, PO Box 80.140, NL-3508 TC Utrecht, Netherlands
| | - Anneloes L van Baar
- Department of Child and Adolescent Studies, Utrecht University, PO Box 80.140, NL-3508 TC Utrecht, Netherlands
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289
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Lewis AJ, Bertino MD, Skewes J, Shand L, Borojevic N, Knight T, Lubman DI, Toumbourou JW. Adolescent depressive disorders and family based interventions in the Family Options multicenter evaluation: study protocol for a randomized controlled trial. Trials 2013; 14:384. [PMID: 24220547 PMCID: PMC3842795 DOI: 10.1186/1745-6215-14-384] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing community and government recognition of the magnitude and impact of adolescent depression. Family based interventions have significant potential to address known risk factors for adolescent depression and could be an effective way of engaging adolescents in treatment. The evidence for family based treatments of adolescent depression is not well developed. The objective of this clinical trial is to determine whether a family based intervention can reduce rates of unipolar depressive disorders in adolescents, improve family functioning and engage adolescents who are reluctant to access mental health services. METHODS/DESIGN The Family Options study will determine whether a manualized family based intervention designed to target both individual and family based factors in adolescent depression (BEST MOOD) will be more effective in reducing unipolar depressive disorders than an active (standard practice) control condition consisting of a parenting group using supportive techniques (PAST). The study is a multicenter effectiveness randomized controlled trial. Both interventions are delivered in group format over eight weekly sessions, of two hours per session. We will recruit 160 adolescents (12 to 18 years old) and their families, randomized equally to each treatment condition. Participants will be assessed at baseline, eight weeks and 20 weeks. Assessment of eligibility and primary outcome will be conducted using the KID-SCID structured clinical interview via adolescent and parent self-report. Assessments of family mental health, functioning and therapeutic processes will also be conducted. Data will be analyzed using Multilevel Mixed Modeling accounting for time x treatment effects and random effects for group and family characteristics. This trial is currently recruiting. Challenges in design and implementation to-date are discussed. These include diagnosis and differential diagnosis of mental disorders in the context of adolescent development, non-compliance of adolescents with requirements of assessment, questionnaire completion and treatment attendance, breaking randomization, and measuring the complexity of change in the context of a family-based intervention. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry Title: engaging youth with high prevalence mental health problems using family based interventions; number 12612000398808. Prospectively registered on 10 April 2012.
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Affiliation(s)
- Andrew J Lewis
- School of Psychology, Faculty of Health, Deakin University, Burwood Highway, Burwood, Victoria 3125, Australia.
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290
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Straub J, Koelch M, Fegert J, Plener P, Gonzalez-Aracil I, Voit A, Sproeber N. Innovations in Practice: MICHI, a brief cognitive-behavioural group therapy for adolescents with depression - a pilot study of feasibility in an inpatient setting. Child Adolesc Ment Health 2013; 18:247-250. [PMID: 32847305 DOI: 10.1111/j.1475-3588.2012.00678.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Group therapy is an economic intervention, allowing for fast access, for the treatment of several depressed adolescents simultaneously; evaluated manualised programs, however, are scarce. METHOD Nine depressive adolescent inpatients (M = 16.33 years; SD = 1.92) participated between October 2009 and March 2010 in a brief manualised group therapy programme (MICHI), which was evaluated with respect to feasibility and trends of efficacy. RESULTS MICHI demonstrated good feasibility, was positively evaluated by the participants by means of an evaluation questionnaire ranging from 1 (very bad) to 10 (very good) (M = 7.22; SD = 1.79), and showed significant reduction of depressive symptoms (z = -2.66, p = .008) assessed by means of a clinical interview. CONCLUSIONS Feasibility of MICHI was demonstrated and larger trials for efficacy will follow.
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Affiliation(s)
- Joana Straub
- Kinder- und Jugendpsychiatrie des Universitätsklinikums Ulm, Steinhövelstraße 5, Ulm, 89075, Germany
| | - Michael Koelch
- Vivantes Klinikum im Friedrichshain, Landsberger Allee, Kinder- und Jugendpsychiatrie, Berlin, Germany
| | - Joerg Fegert
- Kinder- und Jugendpsychiatrie des Universitätsklinikums Ulm, Steinhövelstraße 5, Ulm, 89075, Germany
| | - Paul Plener
- Kinder- und Jugendpsychiatrie des Universitätsklinikums Ulm, Steinhövelstraße 5, Ulm, 89075, Germany
| | - Inma Gonzalez-Aracil
- Kinder- und Jugendpsychiatrie des Universitätsklinikums Ulm, Steinhövelstraße 5, Ulm, 89075, Germany
| | - Anja Voit
- Kinder- und Jugendpsychiatrie des Universitätsklinikums Ulm, Steinhövelstraße 5, Ulm, 89075, Germany
| | - Nina Sproeber
- Kinder- und Jugendpsychiatrie des Universitätsklinikums Ulm, Steinhövelstraße 5, Ulm, 89075, Germany
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291
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Mazurek Melnyk B, Kelly S, Lusk P. Outcomes and Feasibility of a Manualized Cognitive-Behavioral Skills Building Intervention: Group COPE for Depressed and Anxious Adolescents in School Settings. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2013; 27:3-13. [PMID: 24131237 DOI: 10.1111/jcap.12058] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PROBLEM Despite the increasing prevalence of depressive and anxiety disorders in adolescents, less than 25% of affected teens receive any treatment. METHODS A preexperimental one-group pre- and posttest pilot study design with 4-week follow-up was used to assess the feasibility and preliminary effects of the COPE (Creating Opportunities for Personal Empowerment) brief-focused manualized seven-session cognitive-behavioral skills building group intervention delivered in two high schools to 16 adolescents referred by a school-based nurse practitioner for depression or elevated anxiety symptoms. FINDINGS Adolescents reported significant decreases in depression and anxiety on the Beck Youth Inventory as well as increases in personal beliefs about managing negative emotions. Evaluations indicated that the group COPE intervention was a positive experience for the teens. CONCLUSIONS COPE is a promising brief-focused cognitive behavioral therapy-based intervention that can be delivered effectively to teens in school settings using a group format.
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Affiliation(s)
- Bernadette Mazurek Melnyk
- The Ohio State University College of Nursing, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephanie Kelly
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Pamela Lusk
- The Ohio State University College of Nursing, Columbus, OH, USA
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292
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Garvik M, Idsoe T, Bru E. Effectiveness study of a CBT-based adolescent coping with depression course. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2013. [DOI: 10.1080/13632752.2013.840959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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293
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Perloe A, Esposito-Smythers C, Curby TW, Renshaw KD. Concurrent trajectories of change in adolescent and maternal depressive symptoms in the TORDIA study. J Youth Adolesc 2013; 43:612-28. [PMID: 23975354 DOI: 10.1007/s10964-013-9999-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/10/2013] [Indexed: 11/26/2022]
Abstract
Depression has a heightened prevalence in adolescence, with approximately 15 % of adolescents experiencing a major depressive episode by age 18. Depression in adolescence also poses a risk for future distress and impairment. Despite treatment advances, many adolescents relapse after initial remission. Family context may be an important factor in the developmental trajectory of adolescent depression, and thus in enhancing treatment. This study examined concurrent change over time in adolescent and maternal depressive symptoms in the context of the Treatment of Resistant Depression in Adolescents study. Participants were 334 adolescents (mean age: 16; SD: 1.6; 70 % female, 84 % Caucasian), and their mothers (n = 241). All adolescents were clinically depressed when they entered the study and had received previous selective serotonin reuptake inhibitor (SSRI) treatment. Adolescents received acute treatment for 12 weeks and additional treatment for 12 more weeks. Adolescent depression and suicidal ideation were assessed at 0, 6, 12, 24, 48 and 72 weeks, while maternal depressive symptoms were assessed at 0, 12, 24, 48 and 72 weeks. Latent basis growth curve analyses showed a significant correlation over 72 weeks between trajectories of maternal and adolescent depressive symptoms, supporting the hypothesis of concurrent patterns of change in these variables. The trajectories were correlated more strongly in a subsample that included only dyads in which mothers reported at least one depressive symptom at baseline. Results did not show a correlation between trajectories of maternal depressive symptoms and adolescent suicidal ideation. These findings suggest that adolescent and maternal depressive symptoms change in tandem, and that treatment for adolescent depression can benefit the wider family system. Notably, most mothers in this sample had subclinical depressive symptoms. Future research might explore these trajectories in dyads with more severely depressed mothers.
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Affiliation(s)
- Alexandra Perloe
- Department of Psychology, George Mason University, 4400 University Drive, MS 3F5, Fairfax, VA, 22030, USA,
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294
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Dorsey S, Pullmann MD, Deblinger E, Berliner L, Kerns SE, Thompson K, Unützer J, Weisz JR, Garland AF. Improving practice in community-based settings: a randomized trial of supervision - study protocol. Implement Sci 2013; 8:89. [PMID: 23937766 PMCID: PMC3751139 DOI: 10.1186/1748-5908-8-89] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 07/31/2013] [Indexed: 11/29/2022] Open
Abstract
Background Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes. Methods/Design The study has two phases. We will conduct an initial descriptive study (Phase I) of supervision practices within public mental health in Washington State followed by a randomized controlled trial of gold standard supervision strategies (Phase II), with randomization at the clinician level (i.e., supervisors provide both conditions). Study participants will be 35 supervisors and 130 clinicians in community mental health centers. We will enroll one child per clinician in Phase I (N = 130) and three children per clinician in Phase II (N = 390). We use a multi-level mixed within- and between-subjects longitudinal design. Audio recordings of supervision and therapy sessions will be collected and coded throughout both phases. Child outcome data will be collected at the beginning of treatment and at three and six months into treatment. Discussion This study will provide insight into how supervisors can optimally support clinicians delivering evidence-based treatments. Phase I will provide descriptive information, currently unavailable in the literature, about commonly used supervision strategies in community mental health. The Phase II randomized controlled trial of gold standard supervision strategies is, to our knowledge, the first experimental study of gold standard supervision strategies in community mental health and will yield needed information about how to leverage supervision to improve clinician fidelity and client outcomes. Trial registration ClinicalTrials.gov NCT01800266
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Affiliation(s)
- Shannon Dorsey
- Department of Psychology, University of Washington, 335 Guthrie Hall, Seattle, WA 98195, USA.
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295
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Horigian VE, Weems CF, Robbins MS, Feaster DJ, Ucha J, Miller M, Werstlein R. Reductions in anxiety and depression symptoms in youth receiving substance use treatment. Am J Addict 2013; 22:329-37. [PMID: 23795871 PMCID: PMC4103979 DOI: 10.1111/j.1521-0391.2013.12031.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/26/2011] [Accepted: 10/26/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Research shows that interventions for substance use disorders may be helpful in reducing internalizing disorders in adolescents. This paper examines the prevalence and reductions of anxiety and depression symptoms among youth receiving substance use treatment. METHODS Four hundred eighty adolescents ages 12-17 who received treatment for substance abuse as part of the Brief Strategic Family Therapy effectiveness trial were screened for anxiety and depression using the Diagnostic Interview Schedule for Children-Predictive Scales (DISC-PS). Twelve-month post-randomization assessments were completed by 327 parents and 315 youth. Sixty-five percent of the sample was found to have probability of at least one anxiety disorder or depression diagnosis. RESULTS Significant reduction of anxiety and depressive symptoms and significant reductions in probable anxiety and depression diagnoses were observed at follow-up. Few differences by treatment type and by ethnic group were noticed. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Findings indicate that substance use interventions might help reduce the prevalence of anxiety and depressive symptoms and the probability of these disorders.
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Affiliation(s)
- Viviana E Horigian
- Department of Epidemiology and Public Health, Center for Family Studies, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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296
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Melnyk BM, Kelly S, Jacobson D, Belyea M, Shaibi G, Small L, O'Haver J, Marsiglia FF. The COPE healthy lifestyles TEEN randomized controlled trial with culturally diverse high school adolescents: baseline characteristics and methods. Contemp Clin Trials 2013; 36:41-53. [PMID: 23748156 DOI: 10.1016/j.cct.2013.05.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/23/2013] [Accepted: 05/29/2013] [Indexed: 12/24/2022]
Abstract
Obesity and mental health disorders remain significant public health problems in adolescents. Substantial health disparities exist with minority youth experiencing higher rates of these problems. Schools are an outstanding venue to provide teens with skills needed to improve their physical and mental health, and academic performance. In this paper, the authors describe the design, intervention, methods and baseline data for a randomized controlled trial with 779 culturally diverse high-school adolescents in the southwest United States. Aims for this prevention study include testing the efficacy of the COPE TEEN program versus an attention control program on the adolescents' healthy lifestyle behaviors, Body Mass Index (BMI) and BMI%, mental health, social skills and academic performance immediately following the intervention programs, and at six and 12 months post interventions. Baseline findings indicate that greater than 40% of the sample is either overweight (n = 148, 19.00%) or obese (n = 182, 23.36%). The predominant ethnicity represented is Hispanic (n = 526, 67.52%). At baseline, 15.79% (n = 123) of the students had above average scores on the Beck Youth Inventory Depression subscale indicating mildly (n = 52, 6.68%), moderately (n = 47, 6.03%), or extremely (n = 24, 3.08%) elevated scores (see Table 1). Anxiety scores were slightly higher with 21.56% (n = 168) reporting responses suggesting mildly (n = 81, 10.40%), moderately (n = 58, 7.45%) or extremely (n = 29, 3.72%) elevated scores. If the efficacy of the COPE TEEN program is supported, it will offer schools a curriculum that can be easily incorporated into high school health courses to improve adolescent healthy lifestyle behaviors, psychosocial outcomes and academic performance.
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297
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Abstract
This paper reviews the current state of psychotherapy supervision in psychiatric training programmes. A focused literature search was carried out that examined three questions concerning the content, process and outcome of psychotherapy supervision. Results indicate that although requirements for training have broadened somewhat, methods of instruction in supervision have remained the same for many decades. In addition, there is a lack of discussion on what supervision outcomes should be assessed. This paper explores these areas and provides some suggestions for the future of psychotherapy supervision that are evidence-based and generalizable to an international audience. It is time to arrive at an international consensus about guidelines for psychotherapy supervision in psychiatry training programmes. This paper attempts to provide a starting place for psychotherapy supervisors and educators so that we can advance the field forward.
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Affiliation(s)
- Priyanthy Weerasekera
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
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298
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Bender SL, Sherry NA, Masia R. Case records of the Massachusetts General Hospital. Case 16-2013. A 12-year-old girl with irritability, hypersomnia, and somatic symptoms. N Engl J Med 2013; 368:2015-24. [PMID: 23697517 PMCID: PMC4766583 DOI: 10.1056/nejmcpc1208145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Suzanne L Bender
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA
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299
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McGrady ME, Hood KK. Cognitive–behavioral therapy for adolescents with Type 1 diabetes and subclinical depressive symptoms. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/dmt.13.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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300
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McCarty CA, Violette HD, Duong MT, Cruz RA, McCauley E. A randomized trial of the Positive Thoughts and Action program for depression among early adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2013; 42:554-63. [PMID: 23560384 PMCID: PMC3702625 DOI: 10.1080/15374416.2013.782817] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study was conducted to compare the outcomes of a group-based cognitive-behavioral preventive intervention (Positive Thoughts and Actions [PTA]) tailored to youth in middle school with a brief, individually administered supportive intervention (Individual Support Program [ISP]). A randomized, controlled trial was conducted with 120 early adolescents (72 girls, 48 boys; age = 11-15 years) who had elevated depressive symptoms and were selected from a school-based population. Measures of internalizing problems, externalizing problems, personal adjustment, school problems, and interpersonal relations were obtained from parents, youth, and/or teachers at preintervention (Time 1) and postintervention (Time 2, 5-7 months after preintervention). General linear model repeated measures analyses yielded a significant Group × Time interaction on youth-reported, but not parent-reported, depressive symptoms and internalizing symptoms. Youth in the PTA group showed greater decreases following intervention compared to youth who received ISP, yielding effect sizes (Cohen's d) of 0.36 for depressive symptoms, 95% CI [-.02, .73], and 0.44, 95% CI [.05, .82], for internalizing symptoms. PTA youth also showed improvements in their personal adjustment (sense of inadequacy, self-esteem), and parent-reported social skills, but no differences emerged between groups for externalizing symptoms, school problems, or interpersonal relationships. Cognitive-behavioral preventive interventions in which youth engage in personal goal-setting and practice social-emotional skills, such as PTA, may be beneficial for the reduction of depressive symptoms over and above general support and empathy.
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Affiliation(s)
- Carolyn A. McCarty
- University of Washington and Seattle Children’s Research Institute P.O. Box 5371, Seattle, Washington 98145,
| | - Heather D. Violette
- Seattle Children’s Research Institute P.O. Box 5371 M/S: CW8-6, Seattle, Washington 98115,
| | - Mylien T. Duong
- University of Washington Seattle, Washington 98145, mylien.duong@seattlech
| | - Rick A. Cruz
- University of Washington Seattle, Washington 98145,
| | - Elizabeth McCauley
- University of Washington, P.O. Box 5371 M/S: CW8-6, Seattle, Washington 98115,
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