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Hoagwood KE, Richards-Rachlin S, Baier M, Vilgorin B, Horwitz SM, Narcisse I, Diedrich N, Cleek A. Implementation Feasibility and Hidden Costs of Statewide Scaling of Evidence-Based Therapies for Children and Adolescents. Psychiatr Serv 2024; 75:461-469. [PMID: 38268465 PMCID: PMC11099614 DOI: 10.1176/appi.ps.20230183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE State mental health systems are retraining their workforces to deliver services supported by research. Knowledge about evidence-based therapies (EBTs) for child and adolescent disorders is robust, but the feasibility of their statewide scaling has not been examined. The authors reviewed implementation feasibility for 12 commonly used EBTs, defining feasibility for statewide scaling as an EBT having at least one study documenting acceptability, facilitators and barriers, or fidelity; at least one study with a racially and ethnically diverse sample; an entity for training, certification, or licensing; and fiscal data reflecting the costs of implementation. METHODS The authors reviewed materials for 12 EBTs being scaled in New York State and conducted a literature review with search terms relevant to their implementation. Costs and certification information were supplemented by discussions with treatment developers and implementers. RESULTS All 12 EBTs had been examined for implementation feasibility, but only three had been examined for statewide scaling. Eleven had been studied in populations reflecting racial-ethnic diversity, but few had sufficient power for subgroup analyses to demonstrate effectiveness with these samples. All had certifying or licensing entities. The per-clinician costs of implementation ranged from $500 to $3,500, with overall ongoing costs ranging from $100 to $6,000. A fiscal analysis of three EBTs revealed hidden costs ranging from $5,000 to $24,000 per clinician, potentially limiting sustainability. CONCLUSIONS The evidence necessary for embedding EBTs in state systems has notable gaps that may hinder sustainability. Research-funding agencies should prioritize studies that focus on the practical aspects of scaling to assist states as they retrain their workforces.
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Affiliation(s)
- Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Shira Richards-Rachlin
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Meaghan Baier
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Boris Vilgorin
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Iriane Narcisse
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Nadege Diedrich
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Andrew Cleek
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
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Lindsey MA, Mufson L, Vélez-Grau C, Grogan T, Wilson DM, Reliford AO, Gunlicks-Stoessel M, Jaccard J. Engaging Black youth in depression and suicide prevention treatment within urban schools: study protocol for a randomized controlled pilot. Trials 2024; 25:112. [PMID: 38336803 PMCID: PMC10854091 DOI: 10.1186/s13063-024-07947-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Depression continues to be an ongoing threat to adolescent well-being with Black adolescents being particularly vulnerable to greater burdens of depression as well as lower mental health service utilization. Black adolescents are likely to have untreated depression due to social network influences, varied perceptions of services and providers, or self-stigma associated with experiencing depressive symptoms. Furthermore, if or when treatment is initiated, low engagement and early termination are common. To address this gap, a trial is being conducted to preliminarily test the effectiveness of an engagement intervention targeting Black adolescents with depression in school mental health services in New York City. METHODS A total of 60 Black middle and high school adolescents displaying depressive symptoms are equally randomized (based on school site) to the treatment arms. Both trial arms deliver Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), a time-limited, evidence-based treatment for depression. Additionally, one arm pairs IPT-A with a brief, multi-level engagement intervention, the Making Connections Intervention (MCI), involving adolescents, caregivers, and clinicians. Outcomes of interest are group differences in depression and suicide ideation, adolescent and caregiver engagement, and mental health service use. DISCUSSION This trial will serve as an efficacy assessment of the MCI among a sample of Black adolescent students with depressive symptoms. Clinical and implementation results will be used to inform future research to further test the MCI intervention in a larger sample. TRIAL REGISTRATION Registered by ClinicalTrials.gov on May 3, 2019, identifier: NCT03940508.
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Affiliation(s)
- Michael A Lindsey
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA.
| | - Laura Mufson
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Carolina Vélez-Grau
- School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Tracy Grogan
- McSilver Institute for Poverty Policy and Research, New York University, 708 Broadway, Fifth Floor, New York, NY, 10003, USA
| | - Damali M Wilson
- McSilver Institute for Poverty Policy and Research, New York University, 708 Broadway, Fifth Floor, New York, NY, 10003, USA
| | - Aaron O Reliford
- Child & Adolescent Psychiatry, NYU Langone Health, 1 Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Meredith Gunlicks-Stoessel
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2025 East River Parkway, Minneapolis, MN, 55414, USA
| | - James Jaccard
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
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Marlotte L, Klomhaus A, Ijadi-Maghsoodi R, Aralis H, Lester P, Griffin Esperon K, Kataoka S. Implementing depression care in under-resourced communities: a school-based family resilience skill-building pilot randomized controlled trial in the United States. Front Psychol 2023; 14:1233901. [PMID: 37790229 PMCID: PMC10542892 DOI: 10.3389/fpsyg.2023.1233901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/11/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Youth in under-resourced communities are more likely to have greater social risk factors for mental health needs yet have less access to needed care. School-based mental health services are effective in treating common disorders such as adolescent depression; however, few have a family-centered approach, which may especially benefit specific populations. Methods Utilizing a community-partnered approach, we adapted an established, trauma-informed, resilience skill-building family intervention for adolescents with depression. We conducted a small randomized controlled feasibility pilot of an adapted intervention in a large school district that serves predominately low-income, Latinx students in the Southwest United States between 2014-2017. Youth between the ages of 12-18 years old with a Patient Health Questionnaire (PHQ-8) score of 10 or higher, who spoke English or Spanish, were recruited from 12 school mental health clinics. Twenty-five eligible adolescents with depression and their participating caregivers were enrolled and randomly assigned to receive either the adapted intervention, Families OverComing Under Stress for Families with Adolescent Depression (FOCUS-AD), or usual care, Cognitive Behavioral Therapy (CBT) only. Most of the sample was Latinx and female. We evaluated feasibility, acceptability, and preliminary effectiveness. Results Among participants who completed standardized assessments administered at baseline and approximately five months post-randomization (n = 10 FOCUS-AD, n = 11 CBT only), effectiveness was explored by identifying significant changes over time in adolescent mental health within the FOCUS-AD and CBT only groups and comparing the magnitude of these changes between groups. Nonparametric statistical tests were used. We found the FOCUS-AD intervention to be feasible and acceptable; participant retention was high. Adolescent symptoms of depression (measured by the PHQ-8) improved significantly from baseline to follow-up for youth in both FOCUS-AD (median decrease [MD] = 10, p = 0.02) and control (MD = 6, p = 0.01) groups, with no significant difference across the two groups. Results were similar for symptoms of PTSD (measured by the Child PTSD Symptom Scale; FOCUS-AD MD = 12.5, p = 0.01; CBT only MD = 7, p = 0.04; no significant difference between groups). Conclusion Family-centered approaches to depression treatment among adolescents living in under-resourced communities may lead to improved mental health, although further research is warranted.
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Affiliation(s)
- Lauren Marlotte
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Alexandra Klomhaus
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roya Ijadi-Maghsoodi
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- VA Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Hilary Aralis
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Patricia Lester
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Sheryl Kataoka
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
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Weissman MM. Pursuing the epidemiology and familial risks of depression and developing an evidence based psychotherapy. Psychiatry Res 2022; 317:114754. [PMID: 36070660 DOI: 10.1016/j.psychres.2022.114754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/15/2022]
Abstract
This commentary, as requested, presents the highlights of my research career. The epidemiology of psychiatric disorders study, challenged in a small study, the notion that diagnosis for psychiatric disorders could be made in a community survey. This pilot study was the basis for the Epidemiology Catchment Area Study (ECA) with 18,000 participants and the many more updated surveys, which followed. The families at High and Low Risk for Depression study in its 40th year challenged the notion that children didn't get depressed and showed that parental depression was the major risk for depression, which began in youth and reoccurred over the lifespan. Interpersonal psychotherapy (IPT), now has been tested in over 150 clinical trials, recommended by the World Health Organization (WHO), globally in China, Germany, Ukraine, and many more countries.
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Affiliation(s)
- Myrna M Weissman
- Diane Goldman Kemper Family Professor of Epidemiology and Psychiatry, Chief, Division of Translational Epidemiology, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive -Unit 24, New York, NY 10032, United States.
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Klomek AB, Catalan LH, Apter A. Ultra-brief crisis interpersonal psychotherapy based intervention for suicidal children and adolescents. World J Psychiatry 2021; 11:403-411. [PMID: 34513604 PMCID: PMC8394689 DOI: 10.5498/wjp.v11.i8.403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/06/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
Suicidal behaviors in adolescence are a major public health concern. The dramatic rise in self-injurious behaviors among adolescents has led to an overwhelming increase in the number of those presenting to the emergency rooms. The intervention described below was constructed on the basis of brief and focused interventions that were found to be effective among suicidal adults using an adaptation of interpersonal psychotherapy for adolescents. The intervention has four main objectives: first, a focused treatment for reducing suicide risk; second, a short and immediate response; third, building a treatment plan based on understanding the emotional distress and interpersonal aspects underlying suicidal behavior; and lastly, to generate hope among adolescents and their parents. The intervention includes intensive five weekly sessions, followed by 3 mo of email follow-up.
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Affiliation(s)
- Anat Brunstein Klomek
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya 4610101, Israel
| | - Liat Haruvi Catalan
- Depression and Suicide Clinic, Schneider Children’s Medical Center, Petach Tikva 49202, Israel
| | - Alan Apter
- Depression and Suicide Clinic, Schneider Children’s Medical Center, Petach Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Bearman SK, Bailin A, Rodriguez E, Bellevue A. Partnering with School Providers to Co-Design Mental Health Interventions: An Open Trial of Act & Adapt in Urban Public Middle Schools. PSYCHOLOGY IN THE SCHOOLS 2020; 57:1689-1709. [PMID: 36590313 PMCID: PMC9799065 DOI: 10.1002/pits.22410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Schools are well positioned to provide access to youth mental health services, but implementing effective programs that promote emotional and behavioral functioning in school settings is complicated by the poor fit of interventions developed in research settings to complex school contexts. The current study formed a research-practice partnership with two urban public schools and mental health providers employed by those schools (N = 6, 100% female, 50% Black/African American, 50% White/Caucasian) in the adaptation of a depression prevention intervention, Act & Adapt. The intervention was modified by decreasing meeting time and streamlining session content, increasing flexibility, making intervention materials more similar to academic curriculum, and increasing the focus on managing disruptive behavior within group sessions. In an open trial, 6th grade students (N = 22; 59% boys, 31% Hispanic, 22% Black/African American, 4% Asian, 30% White/Caucasian) at both schools who were identified as clinically "at risk" reported improvements from baseline to post-intervention and at one-year follow-up on measures of emotional and behavioral difficulties and coping strategies, with parallel results by caregiver report. The providers reported satisfaction with the intervention, and qualitative analyses of provider focus groups suggested both barriers and facilitators to research-practice collaborations to implement mental health interventions in schools.
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Affiliation(s)
| | - Abby Bailin
- Department of Educational Psychology, The University of Texas at Austin
| | - Erin Rodriguez
- Department of Educational Psychology, The University of Texas at Austin
| | - Alison Bellevue
- Ferkauf Graduate School of Professional Psychology, Yeshiva University
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Duffy F, Sharpe H, Schwannauer M. Review: The effectiveness of interpersonal psychotherapy for adolescents with depression - a systematic review and meta-analysis. Child Adolesc Ment Health 2019; 24:307-317. [PMID: 32677350 DOI: 10.1111/camh.12342] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Interpersonal psychotherapy for adolescents (IPT-A) is a manualised, time-limited intervention for young people with depression. This systematic review aimed to determine the effectiveness of IPT-A for treating adolescent depression. METHOD A systematic search of relevant electronic databases and study reference lists was conducted. Any study investigating the effectiveness of IPT-A in 12- to 20-year-olds with a depressive disorder was eligible. Synthesis was via narrative summary and meta-analysis. RESULTS Twenty studies were identified (10 randomised trials and 10 open trials/case studies), many of which had small sample sizes and were of varying quality. Following IPT-A, participants experienced large improvements in depression symptoms (d = -1.48, p < .0001, k = 17), interpersonal difficulties with a medium effect (d = -0.68, p < .001, k = 8) and in general functioning with a very large effect (d = 2.85, p < .001, k = 8). When compared against control interventions, IPT-A was more effective than non-CBT active controls in reducing depression symptoms (d = -0.64, p < .001, k = 5) and was no different from CBT (d = 0.05, p = .88, k = 2). There was no difference between IPT-A and active control interventions in reducing interpersonal difficulties (d = -0.26, p = .25, k = 5). CONCLUSIONS Interpersonal psychotherapy for adolescents is an effective intervention for adolescent depression, improving a range of relevant outcomes. IPT-A is consistently superior to less structured interventions and performs similarly to CBT. However, these conclusions are cautious, as they are based on a small number of controlled studies, with minor adaptations to the standard IPT-A protocol, and/or were conducted by the intervention developers. Further robust RCTs are therefore required. The lack of superiority in IPT-A for improving interpersonal difficulties highlights a need for studies to explore the underpinning mechanisms of change.
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Affiliation(s)
- Fiona Duffy
- Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Helen Sharpe
- Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Matthias Schwannauer
- Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Joshi SV, Jassim N, Mani N. Youth Depression in School Settings: Assessment, Interventions, and Prevention. Child Adolesc Psychiatr Clin N Am 2019; 28:349-362. [PMID: 31076113 DOI: 10.1016/j.chc.2019.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In this article, the authors make a compelling case that all clinicians who treat youth with depressive disorders should embrace strategies to engage with school staff to best serve their patients in the classroom. Because these disorders have a high incidence in the school population (13% of US teens experienced at least 1 major depressive episode in 2016), this can affect learning, social interactions, and classroom engagement. Several approaches are highlighted for assessment of depressive symptoms, intervention and treatment in school settings, and prevention strategies, including depression education curricula and programs promoting subjective well-being, such as positive psychology and mindfulness.
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Affiliation(s)
- Shashank V Joshi
- School Mental Health Team, Division of Child and Adolescent Psychiatry, Lucile Packard Children's Hospital @ Stanford, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5719, USA; Lucile Packard Children's Hospital @ Stanford, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5719, USA.
| | - Nadia Jassim
- School Mental Health Team, Division of Child and Adolescent Psychiatry, Lucile Packard Children's Hospital @ Stanford, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5719, USA
| | - Nithya Mani
- Lucile Packard Children's Hospital @ Stanford, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5719, USA
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Goodyer IM, Reynolds S, Barrett B, Byford S, Dubicka B, Hill J, Holland F, Kelvin R, Midgley N, Roberts C, Senior R, Target M, Widmer B, Wilkinson P, Fonagy P. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial. Health Technol Assess 2018; 21:1-94. [PMID: 28394249 DOI: 10.3310/hta21120] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years. OBJECTIVE To determine whether or not either of two specialist psychological treatments, cognitive-behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief psychosocial intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment. DESIGN Observer-blind, parallel-group, pragmatic superiority randomised controlled trial. SETTING A total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London. PARTICIPANTS Adolescents aged 11-17 years with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses. INTERVENTIONS In total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up. MAIN OUTCOME MEASURES Mean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation. RESULTS There were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = -0.578, 95% confidence interval (CI) -2.948 to 4.104; p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = -1.898, 95% CI -4.922 to 1.126; p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49-52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome. CONCLUSIONS The three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings. LIMITATIONS Neither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data. TRIAL REGISTRATION Current Controlled Trials ISRCTN83033550. FUNDING This project was funded by the National Institute for Heath Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 12. See the National Institute for Heath Research Journals Library website for further project information. Funding was also provided by the Department of Health. The funders had no role in the study design, patient recruitment, data collection, analysis or writing of the study, any aspect pertinent to the study or the decision to submit to The Lancet.
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Affiliation(s)
- Ian M Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | - Sarah Byford
- David Goldberg Centre, King's College London, London, UK
| | - Bernadka Dubicka
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Jonathan Hill
- Child and Adolescent Psychiatry, University of Manchester, Manchester, UK.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Fiona Holland
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Raphael Kelvin
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Nick Midgley
- Anna Freud National Centre for Children and Families, London, UK.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chris Roberts
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Rob Senior
- Tavistock and Portman NHS Foundation Trust, London, UK
| | - Mary Target
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Barry Widmer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paul Wilkinson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Youngstrom EA, Van Meter A, Frazier TW, Hunsley J, Prinstein MJ, Ong M, Youngstrom JK. Evidence‐based assessment as an integrative model for applying psychological science to guide the voyage of treatment. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/cpsp.12207] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lyon AR, Maras MA, Pate CM, Igusa T, Vander Stoep A. Modeling the Impact of School-Based Universal Depression Screening on Additional Service Capacity Needs: A System Dynamics Approach. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:168-88. [PMID: 25601192 PMCID: PMC4881856 DOI: 10.1007/s10488-015-0628-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although it is widely known that the occurrence of depression increases over the course of adolescence, symptoms of mood disorders frequently go undetected. While schools are viable settings for conducting universal screening to systematically identify students in need of services for common health conditions, particularly those that adversely affect school performance, few school districts routinely screen their students for depression. Among the most commonly referenced barriers are concerns that the number of students identified may exceed schools' service delivery capacities, but few studies have evaluated this concern systematically. System dynamics (SD) modeling may prove a useful approach for answering questions of this sort. The goal of the current paper is therefore to demonstrate how SD modeling can be applied to inform implementation decisions in communities. In our demonstration, we used SD modeling to estimate the additional service demand generated by universal depression screening in a typical high school. We then simulated the effects of implementing "compensatory approaches" designed to address anticipated increases in service need through (1) the allocation of additional staff time and (2) improvements in the effectiveness of mental health interventions. Results support the ability of screening to facilitate more rapid entry into services and suggest that improving the effectiveness of mental health services for students with depression via the implementation of an evidence-based treatment protocol may have a limited impact on overall recovery rates and service availability. In our example, the SD approach proved useful in informing systems' decision-making about the adoption of a new school mental health service.
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Affiliation(s)
- Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA.
| | | | | | | | - Ann Vander Stoep
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th St., Suite 100, Seattle, WA, 98115, USA
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12
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Abstract
BACKGROUND A large and extensive body of research has examined comorbid anxiety and depression in adults. Children and adolescents also frequently present with comorbid anxiety and depression; however, research and treatment require unique environmental and neurodevelopmental considerations in children. As a result, our understanding of comorbid anxiety and depression in children and adolescents is limited. OBJECTIVE The goal of this systematic review was to examine the current literature focused on comorbid anxiety and depression in children and adolescents. The review included theoretical conceptualizations as well as diagnostic, neurobiological, prevention, and treatment considerations. In addition, a proposed algorithm for the treatment of comorbid anxiety and depression in children/adolescents is provided. METHODS This systematic literature review included 3 discrete searches in Ovid SP Medline, PsycInfo, and PubMed. RESULTS The review included and synthesized 115 articles published between 1987 and 2015. The available evidence suggests that anxiety and depression are common in clinical populations of children and adolescents, and that comorbidity is likely underestimated in children and adolescents. Children and adolescents with comorbid anxiety and depression have unique presentations, greater symptom severity, and treatment resistance compared with those who have either disease in isolation. A dimensional approach may be necessary for the future development of diagnostic strategies and treatments for this population. Nascent neuroimaging work suggests that anxiety and depression each represents a distinct neurobiological phenotype. CONCLUSIONS The literature that is currently available suggests that comorbid anxiety and depression is a common presentation in children and adolescents. This diagnostic picture underscores the importance of comprehensive dimensional assessments and multimodal evidence-based approaches given the high disease severity. Future research on the neurobiology and the treatment of these common clinical conditions is warranted.
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13
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Peterman JS, Read KL, Wei C, Kendall PC. The Art of Exposure: Putting Science Into Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2014.02.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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14
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Dietz LJ, Weinberg RJ, Brent DA, Mufson L. Family-based interpersonal psychotherapy for depressed preadolescents: examining efficacy and potential treatment mechanisms. J Am Acad Child Adolesc Psychiatry 2015; 54:191-9. [PMID: 25721184 PMCID: PMC4347931 DOI: 10.1016/j.jaac.2014.12.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 11/17/2014] [Accepted: 12/24/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To conduct a randomized controlled trial to evaluate the preliminary efficacy of family-based interpersonal psychotherapy (FB-IPT) for treating depression in preadolescents (aged 7-12 years) as compared to child-centered therapy (CCT), a supportive and nondirective treatment that closely approximates the standard of care for pediatric depression in community mental health. METHOD Preadolescents with depression (N = 42) were randomly assigned FB-IPT or CCT. Pre- and posttreatment assessments included clinician-administered measures of depression, parent- and child-reported depression and anxiety symptoms, and parent-child conflict and interpersonal impairment with peers. RESULTS Preadolescents receiving FB-IPT had higher rates of remission (66.0% versus 31%), a greater decrease in depressive symptoms from pre- to posttreatment, and lower depressive symptoms at posttreatment (R(2) = 0.35, ΔR(2) = 0.22; B = -8.15, SE = 2.61, t[37] = -3.13, p = .002, F(2) = 0.28) than did preadolescents with depression receiving CCT. Furthermore, preadolescents in the FB-IPT condition reported significant reductions in anxiety and interpersonal impairment compared with preadolescents in the CCT condition. Changes in social and peer impairment from pre- to posttreatment were associated with preadolescents' posttreatment depressive symptoms. There was a significant indirect effect for decreased social impairment accounting for the association between the FB-IPT and preadolescents' posttreatment depressive symptoms. CONCLUSION Findings indicate FB-IPT is an effective treatment for preadolescent depression and support further investigation of interpersonal mechanisms by which FB-IPT may reduce preadolescent depression. Clinical trial registration information-Phase II Study of Family Based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents; http://clinicaltrials.gov; NCT02054312.
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Affiliation(s)
- Laura J Dietz
- University of Pittsburgh School of Medicine, Pittsburgh.
| | | | - David A Brent
- University of Pittsburgh School of Medicine, Pittsburgh
| | - Laura Mufson
- Columbia University College of Physicians and Surgeons/New York State Psychiatric Institute (NYSPI), New York
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15
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Masia Warner C, Brice C, Esseling PG, Stewart CE, Mufson L, Herzig K. Consultants' perceptions of school counselors' ability to implement an empirically-based intervention for adolescent social anxiety disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 40:541-54. [PMID: 23716144 DOI: 10.1007/s10488-013-0498-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Social anxiety is highly prevalent but goes untreated. Although school-based CBT programs are efficacious when delivered by specialized psychologists, it is unclear whether school counselors can implement these interventions effectively, which is essential to promote sustainable school programs. We present an initial consultation strategy to support school counselor implementation of group CBT for social anxiety and an evaluation of counselors' treatment fidelity. Counselors were highly adherent to the treatment, but competence varied based on measurement. Counselors and consultants demonstrated good agreement for adherence, but relatively modest correspondence in competence ratings. We discuss future directions for school-based implementation efforts informed by these initial findings.
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16
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Toth SL, Gravener-Davis JA, Guild DJ, Cicchetti D. Relational interventions for child maltreatment: past, present, and future perspectives. Dev Psychopathol 2013; 25:1601-17. [PMID: 24342858 PMCID: PMC4063316 DOI: 10.1017/s0954579413000795] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It is well established that child maltreatment has significant deleterious effects for the individual as well as for society. We briefly review research regarding the impact of child maltreatment on the attachment relationship, highlighting the need for relational interventions for maltreated children and their families to effectively thwart negative developmental cascades that are so often observed in the context of child maltreatment. Next, historical and contemporaneous perspectives on relational interventions for individuals with histories of child maltreatment are discussed, with attention to the empirical evidence for and the current evidence-based status of several relationally based interventions for child maltreatment. Differential sensitivity to the environment is then discussed as a theoretical framework with important implications for interventions for individuals who have been reared in maltreating environments. Current research on neurobiology and maltreatment is then reviewed, with an emphasis on the need for future investigations on genetic variants, epigenetics, and the efficacy of relational interventions for maltreated children. We conclude with a discussion of the tenets of developmental psychopathology, their implications for relational interventions for child maltreatment, and recommendations for advancing the development, provision, and evaluation of relational interventions for individuals with histories of child maltreatment.
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Affiliation(s)
| | | | | | - Dante Cicchetti
- Mt. Hope Family Center, University of Rochester
- Institute of Child Development, University of Minnesota
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17
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Al-Obaidi AK, Corcoran T, Hussein MA, Ghazi A. Psychosocial paediatric training in Iraq: perspectives of trainers and students. Med Confl Surviv 2013; 29:45-56. [PMID: 23729097 DOI: 10.1080/13623699.2013.765196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
There is an absence of education regarding psychosocial issues in Iraqi paediatric training programmes. The aim of this study is to examine current knowledge and perspectives around these topics and to explore potential development in these programmes. 56 paediatric trainers and students at the Child Central Teaching Hospital, a hospital affiliated to the Al-Mustansyria medical college in Baghdad, responded to a questionnaire to evaluate knowledge and perspectives regarding psychosocial approaches to child and adolescent health as delivered presently via academic training and used in professional practice. The majority of the respondents reported having no training in psychosocial interventions. Using a scale from 0 ('not relevant') to 10 ('very important'), psychosocial issues were rated 7.1 in their relevance to everyday paediatric practice. On a scale of 0 ('very poor') to 10 ('totally adequate'), respondents rated formal current psychosocial training at 2.5. It is concluded that incorporating psychosocial approaches in paediatric training will lead to a broader base of knowledge in children's health and contribute to the promotion of multidisciplinary practice in Iraq.
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Affiliation(s)
- A K Al-Obaidi
- Institute of International Education, New York, USA.
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18
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Beidas RS, Mychailyszyn MP, Edmunds JM, Khanna MS, Downey MM, Kendall PC. Training School Mental Health Providers to Deliver Cognitive-Behavioral Therapy. SCHOOL MENTAL HEALTH 2012; 4:197-206. [PMID: 24817916 PMCID: PMC4013998 DOI: 10.1007/s12310-012-9074-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anxiety disorders are among the most prevalent mental health difficulties experienced by youth. A well-established literature has identified cognitive-behavior therapy (CBT) as the gold-standard psychosocial treatment for youth anxiety disorders. Access to CBT in community clinics is limited, but a potential venue for the provision of CBT for child anxiety disorders is the school setting. The present study examined a subset of data from a larger study in which therapists from a variety of settings, including schools, were trained in CBT for child anxiety (N = 17). The study investigated the relationship between provider- and organizational-level variables associated with training and implementation among school mental health providers. The present findings indicate a positive relationship between provider attitudes and adherence to CBT. Self-reported barriers to implementation were also identified. Integrating CBT into school mental health providers' repertoires through training and consultation is a critical step for dissemination and implementation of empirically supported psychosocial treatments.
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Affiliation(s)
- Rinad S. Beidas
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew P. Mychailyszyn
- Division of Psychology/Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - Julie M. Edmunds
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Muniya S. Khanna
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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19
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Modular Cognitive Behavioral Therapy for Youth with Anxiety Disorders: A Closer Look at the Use of Specific Modules and their Relation to Treatment Process and Response. SCHOOL MENTAL HEALTH 2012. [DOI: 10.1007/s12310-012-9080-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Mychailyszyn MP, Brodman DM, Read KL, Kendall PC. Cognitive‐behavioral school‐based interventions for anxious and depressed youth: A meta‐analysis of outcomes. ACTA ACUST UNITED AC 2012. [DOI: 10.1111/j.1468-2850.2012.01279.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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A Model of Therapist Competencies for the Empirically Supported Interpersonal Psychotherapy for Adolescent Depression. Clin Child Fam Psychol Rev 2012; 15:93-112. [DOI: 10.1007/s10567-012-0111-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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22
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Improving Collaborative Mental Health Care by School-Based Primary Care and Mental Health Providers. SCHOOL MENTAL HEALTH 2011. [DOI: 10.1007/s12310-010-9047-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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McDonnell CJ, White KS. Assessment and treatment of psychological factors in pediatric chest pain. Pediatr Clin North Am 2010; 57:1235-60. [PMID: 21111116 DOI: 10.1016/j.pcl.2010.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Chest pain is regularly encountered in pediatric medical settings and may be associated with many organic diagnoses that vary widely in morbidity and mortality. Patients with chest pain with and without organic disease may also suffer from comorbid, exacerbating, or causal psychopathology. This article provides practical general guidelines for psychological diagnosis and alleviation of emotional and behavioral difficulties. Specific medical conditions that may benefit from psychological consultation are highlighted. Pediatric chest pain, including an analysis of medically unexplained chest pain, is examined from a psychological perspective that includes a critical review of relevant literature and suggestions for the clinical management of this condition.
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Affiliation(s)
- Cassandra J McDonnell
- Department of Psychology, University of Missouri-Saint Louis, One University Boulevard, 231 Stadler Hall, St Louis, MO 63121, USA
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24
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Garland AF, Hurlburt MS, Brookman-Frazee L, Taylor RM, Accurso EC. Methodological challenges of characterizing usual care psychotherapeutic practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 37:208-20. [PMID: 19757021 PMCID: PMC2877339 DOI: 10.1007/s10488-009-0237-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Accepted: 08/10/2009] [Indexed: 11/03/2022]
Abstract
There is minimal existing research providing detailed, reliable data characterizing usual community-based psychotherapy practice, and, thus, limited established methods for such research. This article identifies methodological challenges of usual care descriptive research, including, (a) general design considerations, (b) measurement, (c) data analytic, and (d) ethical challenges. Case examples drawn from studies reported in this special issue are used to illustrate the implications, strengths, and weaknesses of different methodological decisions. Central themes include achieving an acceptable balance of scientific rigor, feasibility, and generalizable practice relevance, as well as working collaboratively with practice partners to select and implement study methods.
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Affiliation(s)
- Ann F. Garland
- Child and Adolescent Services Research Center at Rady Children’s Hospital, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
- Department of Psychiatry, University of California, San Diego, CA USA
| | - Michael S. Hurlburt
- Child and Adolescent Services Research Center at Rady Children’s Hospital, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
- School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center at Rady Children’s Hospital, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
- Department of Psychiatry, University of California, San Diego, CA USA
| | - Robin M. Taylor
- Child and Adolescent Services Research Center at Rady Children’s Hospital, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
- Department of Psychiatry, University of California, San Diego, CA USA
| | - Erin C. Accurso
- Child and Adolescent Services Research Center at Rady Children’s Hospital, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
- Department of Psychiatry, University of California, San Diego, CA USA
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25
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Mufson L. Interpersonal Psychotherapy for Depressed Adolescents (IPT- A): Extending the Reach from Academic to Community Settings 1. Child Adolesc Ment Health 2010; 15:66-72. [PMID: 32847244 DOI: 10.1111/j.1475-3588.2009.00556.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Depression is a persistent and impairing illness for adolescents. Many adolescents have limited access to care and/or do not receive adequate treatment for their depression. Researchers have developed a number of empirically supported interventions for adolescent depression; the challenge is to bring these treatments into community settings and assess their effectiveness under real world conditions. This paper provides a critical examination of research conducted on the use of Interpersonal Psychotherapy for depressed adolescents (IPT-A). The paper presents evidence for the efficacy and effectiveness of IPT-A. Implementation and dissemination efforts are discussed in regard to lessons learned and directions for future research.
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Affiliation(s)
- Laura Mufson
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, New York 10032, USA. E-mail:
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26
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David-Ferdon C, Kaslow NJ. Evidence-based psychosocial treatments for child and adolescent depression. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2008; 37:62-104. [PMID: 18444054 DOI: 10.1080/15374410701817865] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The evidence-base of psychosocial treatment outcome studies for depressed youth conducted since 1998 is examined. All studies for depressed children meet Nathan and Gorman's (2002) criteria for Type 2 studies whereas the adolescent protocols meet criteria for both Type 1 and Type 2 studies. Based on the Task Force on the Promotion and Dissemination of Psychological Procedures guidelines, the cognitive-behavioral therapy (CBT) based specific programs of Penn Prevention Program, Self-Control Therapy, and Coping with Depression-Adolescent are probably efficacious. Interpersonal Therapy-Adolescent, which falls under the theoretical category of interpersonal therapy (IPT), also is a probably efficacious treatment. CBT provided through the modalities of child group only and child group plus parent components are well-established intervention approaches for depressed children. For adolescents, two modalities are well-established (CBT adolescent only group, IPT individual), and three are probably efficacious (CBT adolescent group plus parent component, CBT individual, CBT individual plus parent/family component). From the broad theoretical level, CBT has well-established efficacy and behavior therapy meets criteria for a probably efficacious intervention for childhood depression. For adolescent depression, both CBT and IPT have well-established efficacy. Future research directions and best practices are offered.
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Ginsburg GS, Becker KD, Kingery JN, Nichols T. Transporting CBT for Childhood Anxiety Disorders into Inner-City School-Based Mental Health Clinics. COGNITIVE AND BEHAVIORAL PRACTICE 2008. [DOI: 10.1016/j.cbpra.2007.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Rosario M, Salzinger S, Feldman RS, Ng-Mak DS. Intervening processes between youths' exposure to community violence and internalizing symptoms over time: the roles of social support and coping. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2008; 41:43-62. [PMID: 18165895 DOI: 10.1007/s10464-007-9147-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The roles of social support and coping as intervening processes between exposure to community violence and internalizing symptoms were examined longitudinally among a community sample of 667 middle school students in the inner city. After controlling for potential confounders (e.g., social desirability, victimization and witnessing of family violence, guardian's psychological symptomatology), internalizing symptoms at Year 2 were predicted by hypothesized changes over 1 year, such that increased community violence exposure, decreased guardian and peer support, and increased use of defensive and confrontational behavioral coping were related to more internalizing symptoms of anxiety, depression and PTSD, although some of these relations varied by gender. The relations between internalizing symptoms at Year 3 and increased changes in exposure to community violence over 2 years were moderated by social support and/or coping, such that decreased guardian support and increased use of defensive and confrontational coping were generally associated with more symptoms for boys exposed to community violence. Girls who witnessed increased community violence and who increased their use of defensive or confrontational coping experienced more internalizing symptoms. The findings underscore the importance of developmental and contextual considerations in the design and implementation of interventions.
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Affiliation(s)
- Margaret Rosario
- Psychology Department, The City University of New York-The City College and Graduate Center, Convent Avenue and 138th Street, New York, NY 10031, USA.
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29
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Abstract
Depression is a common disorder among adolescents and is associated with a high risk of suicide. Suicide is the third leading cause of death among adolescents in the United States. Currently, there are only two evidence-based psychotherapies for adolescence depression: cognitive-behavioral therapy and interpersonal psychotherapy. Furthermore, psychosocial interventions that specifically target suicidal behavior in adolescents are even fewer in number than treatments for depression. This article will review the psychosocial interventions for depression and suicidality in adolescents and will describe a recently developed treatment that is under study for depressed suicidal adolescents.
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Affiliation(s)
- Anat Brunstein Klomek
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY 10032, USA.
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30
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Abstract
Currently our field is actively involved in developing new ways to characterize and treat children and adolescents with psychiatric disorders and in evaluating the effects of our therapies. We also are beginning to examine the effectiveness of our teaching methods. This article presents evidence for, ideas about, and a philosophy to guide individuals who are privileged to train child psychiatrists in psychotherapies. Specifically, it discusses the issues of the evidence base for diagnosis and for nonspecific and specific active elements of child psychotherapy. Evidence for methods of training is presented. The article addressed the need for supervising psychiatrists to keep abreast of developments in teaching methods so that we can best train competent, curious, and compassionate child psychiatrists.
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Affiliation(s)
- Margo Thienemann
- Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5719, USA.
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Hoagwood KE, Kelleher K, Murray LK, Jensen PS. Implementation of evidence-based practices for children in four countries: a project of the World Psychiatric Association. BRAZILIAN JOURNAL OF PSYCHIATRY 2006; 28:59-66. [PMID: 16612492 DOI: 10.1590/s1516-44462006000100012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The present study examined implementation issues in adopting cognitive-behavioral therapies in routine clinical settings in four countries reflecting diverse cultures, languages, settings, and traditions. METHOD A Director's Systems Survey was administered prior to program implementation and one year later. Therapist ratings on attitudes about evidence-based practices and satisfaction were also gathered. RESULTS All sites reported successful adoption of the program, although significant variations existed in fiscal support, family involvement, prior experience with cognitive-behavioral therapies, and plans for sustainability. Therapists' ratings indicated overall satisfaction with the implementation of the project. Findings from the Director's Systems Survey pointed to five factors facilitating implementation: 1) early adoption and guidance by innovative leaders (i.e., the Directors); 2) attention to the "fit" between the intervention model and local practices; 3) attention to front-end implementation processes (e.g., cultural adaptation, translation, training, fiscal issues); 4) attention to back-end processes early in the project (e.g., sustainability); and 5) establishing strong relationships with multiple stakeholders within the program setting. CONCLUSIONS The implementation issues here mirror those identified in other studies of evidence-based practices uptake. Some of the obstacles to implementation of evidence-based practices may be generic, whereas issues such as the impact of political/economic instability, availability of translated materials, constitute unique stressors that differentially affect implementation efforts within specific countries.
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Abstract
This paper reviews the main principles of Interpersonal Psychotherapy and its adaptation for depressed adolescents (IPT-A). The work of IPT-A is put in the context of the significant problem of depression in adolescence and the other treatments and their efficacy in the treatment of adolescent depression. The paper also provides an overview of the approach and specific techniques to be used with adolescents. The efficacy and effectiveness data on IPT-A are presented briefly. IPT-A is an empirically supported psychotherapy for depressed, non-bipolar and non-psychotic adolescents. IPT-A is unique among evidence-based treatments in its demonstrated effectiveness when transported from a laboratory setting to a community setting (school-based health clinics) and delivered by community clinicians. Future studies are needed with other populations that include long-term follow-up of outcomes and are conducted by other investigator teams.
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Affiliation(s)
- Laura Mufson
- Clinical Psychology in Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Dr., Unit 24, New York, NY, 10032, USA.
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