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Stuart S, Schultz J, Molina AP, Siber-Sanderowitz S. Interpersonal Psychotherapy: A Review of Theory, History, and Evidence of Efficacy. Psychodyn Psychiatry 2024; 52:370-407. [PMID: 39254940 DOI: 10.1521/pdps.2024.52.3.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Interpersonal psychotherapy (IPT) is an empirically validated treatment for mood disorders, anxiety disorders, eating disorders, and trauma. IPT is based on the concept of "relational frame"-that an individual's experience of psychological distress impacts those around them, and that their social support network impacts the distressed individual. This concept, along with the specific techniques and tools that flow from it and the theoretical bases of IPT (attachment and interpersonal theory) make IPT unique. In this article we review the theoretical bases of IPT (attachment and communication) and provide a brief history of IPT, as well as the evidence supporting its use for a variety of disorders. We also describe its application to groups, adolescents, and other diverse populations. Future directions for research and treatment development are proposed, particularly research in the area of combining IPT with other psychotherapeutic modalities.
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Affiliation(s)
- Scott Stuart
- Director, IPT Institute; Adjunct Professor, University of Southern California, Department of Psychiatry; Professor Emeritus, University of Iowa Department of Psychiatry
| | - Jessica Schultz
- Associate Professor of Psychology, Augustana College, Rock Island, Illinois
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Close J, Arshad SH, Soffer SL, Lewis J, Benton TD. Adolescent Health in the Post-Pandemic Era: Evolving Stressors, Interventions, and Prevention Strategies amid Rising Depression and Suicidality. Pediatr Clin North Am 2024; 71:583-600. [PMID: 39003003 DOI: 10.1016/j.pcl.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Abstract
Prior to COVID-19, there were already increasing rates of youth with mental health concerns, including an increase in youth presenting to medical emergency departments (EDs) with mental health chief complaints and limited access to treatment. This trend worsened during the pandemic, and rates of youth presenting to medical EDs with suicidal ideation and self-harm increased 50% from 2019 to 2022. This resulted in a "boarding" crisis, in part, due to a lack of inpatient psychiatric hospitalization beds, and many youth were left without access to adequate treatment. Additional study of innovations in health care delivery will be paramount in meeting this need.
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Affiliation(s)
- Jeylan Close
- National Clinician Scholars Program, Department of Psychiatry and Behavioral Sciences, Child & Family Mental Health & Community Psychiatry Division, Duke University School of Medicine, 710 West Main Street, Durham, NC 27701, USA; Duke Margolis Center for Health Policy, Duke University, 710 West Main Street, Durham, NC 27701, USA.
| | - Sarah H Arshad
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine and UC Irvine School of Medicine, The Hub for Clinical Collaboration, DCAPBS, Floor 12, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Stephen L Soffer
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 4601 Market Street, 3rd Floor, Philadelphia, PA 19139, USA
| | - Jason Lewis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 4601 Market Street, 3rd Floor, Philadelphia, PA 19139, USA
| | - Tami D Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 4601 Market Street, 3rd Floor, Philadelphia, PA 19139, USA
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Li Y, Ye Y, Zhou X. Parent-child relationship, parenting behaviors, and adolescents' depressive symptoms after an earthquake: unraveling within-adolescent associations from between-adolescent differences. Eur Child Adolesc Psychiatry 2024; 33:2301-2318. [PMID: 37924379 DOI: 10.1007/s00787-023-02319-0] [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] [Received: 04/28/2023] [Accepted: 10/15/2023] [Indexed: 11/06/2023]
Abstract
This study assessed temporal associations between parent-child relationship, parenting behaviors (i.e., warmth, rejection, and overprotection), and adolescents' depressive symptoms after trauma, using random-intercept cross-lagged panel models to distinguish between- and within-adolescent differences. We surveyed Chinese adolescents 12 (Aug 2018; T1), 21 (May 2019; T2), 27 (Nov 2019; T3) months after the Jiuzhaigou earthquake that occurred in August 2017. Of the 585 adolescents who participated in at least two waves of the study, mean age at T1 was 15.50 years old (SD = 1.58 years) and 57.8% were girls. Controlling adolescents' gender, age, ethnicity, trauma exposure at T1, and parents' marital status, between-adolescent results showed that parent-child relationship and parenting behaviors, parent-child relationship and depressive symptoms were correlated across models of parental warmth, rejection, and overprotection, whereas depressive symptoms were only correlated with parental rejection and overprotection. Within-adolescent results indicated that parent-child relationship and adolescents' depressive symptoms had bidirectional associations via the mediation of parental warmth from T1 to T3. Over the longer term following the earthquake, we found that parental rejection was bidirectionally associated with adolescents' depressive symptoms, whereas parental overprotection was unidirectionally influenced by adolescents' depressive symptoms from T2 to T3. In addition, more depressive symptoms in adolescents were associated with worsening parent-child relationship from T2 to T3. In conclusion, shortly after trauma, interventions should focus on improving parent-child relationship and relieving adolescents' depressive symptoms. Over the longer term after trauma, relieving adolescents' depressive symptoms should be prioritized to avoid its eroding effects on parent-child relationship and parenting behaviors, and to break the "vicious cycle".
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Affiliation(s)
- Yifan Li
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, China
| | - Yingying Ye
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, China.
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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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Xian X, Niu T, Zhang Y, Zhou X, Wang X, Du X, Qu L, Mao B, He Y, Chen X, Ye M. The relationship between appearance anxiety and depression among students in a medical university in China: a serial multiple mediation model. PeerJ 2024; 12:e17090. [PMID: 38563007 PMCID: PMC10984188 DOI: 10.7717/peerj.17090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
Background Appearance anxiety and depression have become common and global public health problems worldwide, especially among adolescents. However, few studies have revealed the mechanisms between them. This study aimed to explore the multiple mediating roles of interpersonal sensitivity and social support between appearance anxiety and depression among medical college students. Methods With 13 invalid samples excluded, 724 college students participated in our survey and completed questionnaires. The average age of 724 samples was 19.8 ± 2.02 including freshman to senior year and graduate school and above; 31.9% of the participants were male and 68.1% were female. SPSS 25.0 and Hayes' PROCESS macro were used for statistical description, correlation analysis and built multiple mediation models. Results Appearance anxiety can not only directly affect depression, but also indirectly affect depression through three significant mediating pathways: (1) IS (B = 0.106, 95% CI [0.082-0.132]), which accounted for 49.77% of the total effect, (2) SS (B = 0.018, 95% CI [0.008-0.031]), which accounted for 8.45% of the total effect, and (3) IS and SS (B = 0.008, 95% CI [0.003-0.014]), which accounted for 3.76% of the total effect. And the total mediating effect was 61.97%. Limitations It is a cross-sectional research method and the causal relationship is unclear. Conclusions This study found that lower interpersonal sensitivity and higher social support can effectively reduce depression caused by appearance anxiety among college students. The schools and relevant departments should take measures to reduce the interpersonal sensitivity of college students and establish reliable social support, so as to reduce the occurrence of depression.
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Affiliation(s)
- Xiaobing Xian
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Tengfei Niu
- Department of Basic Courses, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Yu Zhang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xilin Zhou
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Xinxin Wang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Xin Du
- The Second Clinical College, Chongqing Medical University, Chongqing, China
| | - Linhan Qu
- The First Clinical College, Chongqing Medical University, Chongqing, China
| | - Binyi Mao
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Ying He
- The Second Clinical College, Chongqing Medical University, Chongqing, China
| | - Xiyu Chen
- College of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Mengliang Ye
- School of Public Health, Chongqing Medical University, Chongqing, China
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Bozzatello P, Blua C, Marin G, Rocca P, Bellino S. Group interpersonal psychotherapy (IPT-G) for borderline personality disorder: A randomized controlled study. J Psychiatr Res 2023; 168:157-164. [PMID: 37913742 DOI: 10.1016/j.jpsychires.2023.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023]
Abstract
Recent evidence supported the notion that add-on group therapy should be provided to individuals with borderline personality disorder (BPD) who already undergo individual psychotherapy. The present 20 week-study was aimed to evaluate the efficacy of the adjunction of group interpersonal psychotherapy (IPT-G) to individual interpersonal psychotherapy adapted for BPD - revised (IPT-BPD-R) in comparison with individual IPT-BPD-R alone in a group of BPD patients. In addition, demographical and clinical characteristics that can be considered predictors of response to add-on group therapy were investigated. Forty-six patients were randomly assigned to 1) IPT-BPD-R plus IPT-G or to 2) IPT-BPD-R in the waiting list for IPT-G. Patients were assessed at baseline and after 20 weeks with: the Clinical Global Impression Scale, Severity item (CGI-S); the Social Occupational Functioning Assessment Scale (SOFAS); the Satisfaction Profile (SAT-P); the Borderline Personality Disorder Severity Index (BPDSI); the Modified Overt Aggression Scale (MOAS); the Childhood Trauma Questionnaire - Short Form (CTQ-SF); the Inventory of Interpersonal Problems (IIP-32); and the Reading the Mind in the Eyes Test (RMET). Statistical analyses included: ANOVA for repeated measures to compare score changes of the rating scales within groups (trial duration) and between groups (treatment modalities), and multiple regression analysis to identify which clinical factors are significantly and independently related to the difference of BPDSI score between baseline and week 20 (Δ BPDSI). The significance level was P ≤ 0.05. Both significant within-subjects effects (duration) and between-subjects effects (treatment modalities) were found for the following rating scales: MOAS; BPDSI items "feelings of emptiness", "outbursts of anger," and "affective instability"; RMET; SAT-P items "work" and "sleep, food, free time"; and IIP-32 scale "domineering/controlling". At the multiple regression analysis BPDSI item "impulsivity", RMET, and the subscale "socially inhibited" of the IIP-32 were significantly and independently related to Δ BPDSI score. In conclusion, the add-on of IPT-G produced higher improvement in core BPD symptoms, social cognition, a dysfunctional interpersonal style, and subjective quality of life. Subjects who were less impulsive, less socially inhibited, and with higher abilities in social cognition obtained greater benefits from the adjunction of group therapy. CLINICAL TRIALS REGISTRATION NUMBER: ACTRN12623000002684, Australian New Zealand Clinical Trials Registry (ANZCTR).
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Affiliation(s)
- Paola Bozzatello
- Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Cecilia Blua
- Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Giacomo Marin
- Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Paola Rocca
- Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Silvio Bellino
- Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
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Sayegh CS, Brammer WA, Wright SM, Wee CP, Sherer S. Pilot Study of Group Interpersonal Psychotherapy for Depression Among Young People With Chronic Illness. Am J Psychother 2023; 76:93-99. [PMID: 36908229 DOI: 10.1176/appi.psychotherapy.20210042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Interpersonal psychotherapy (IPT) is an evidence-based treatment for depression, demonstrating efficacy with adolescents and young adults. Social support is proposed to be an important treatment component and may be helpful for adolescents and young adults with chronic illness. The authors sought to assess the feasibility of delivering IPT to this population and to examine changes in depressive symptoms and perceived social support. METHODS An open-label feasibility trial of group-based IPT was conducted for adolescents and young adults with chronic illness (N=17). The 12-session group IPT was concurrent with group members' individual psychotherapy, and group IPT was focused on providing support in navigating interpersonal challenges related to the participants' chronic illness. Participants completed questionnaires assessing depressive symptoms and social support before treatment, midtreatment (6 weeks), and after treatment (12 weeks). Generalized estimating equation models, adjusted for repeated measures, were used to assess changes in depressive symptoms and social support over the course of treatment. RESULTS Deidentified clinical examples illustrated how IPT was practiced in a community mental health setting. Evidence for the feasibility of group IPT was mixed. Although participants had poor session attendance, there was a significant decrease in depressive symptoms (β=-2.94, 95% CI=-5.30 to -0.59, p=0.014) and a significant increase in perceived social support (β=4.24, 95% CI=0.51 to 7.98, p=0.026) by the end of treatment. CONCLUSIONS IPT may help address depressive symptoms and enhance social support among adolescents and young adults with chronic illness. Further research and adaptation are needed to address feasibility challenges in delivering group IPT to this population.
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Affiliation(s)
- Caitlin S Sayegh
- Children's Hospital Los Angeles, Los Angeles (all authors); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles (Sayegh, Sherer)
| | - Whitney A Brammer
- Children's Hospital Los Angeles, Los Angeles (all authors); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles (Sayegh, Sherer)
| | - Stephanie M Wright
- Children's Hospital Los Angeles, Los Angeles (all authors); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles (Sayegh, Sherer)
| | - Choo Phei Wee
- Children's Hospital Los Angeles, Los Angeles (all authors); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles (Sayegh, Sherer)
| | - Sara Sherer
- Children's Hospital Los Angeles, Los Angeles (all authors); Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles (Sayegh, Sherer)
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Zheng K, Xu H, Qu C, Sun X, Xu N, Sun P. The effectiveness of Interpersonal Psychotherapy-Adolescent Skills Training for adolescents with depression: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1147864. [PMID: 37588027 PMCID: PMC10425533 DOI: 10.3389/fpsyt.2023.1147864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/17/2023] [Indexed: 08/18/2023] Open
Abstract
Background Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) is a standardized depression prevention program for adolescents conducted in campus settings. The purpose of this review is to examine the randomized controlled trials of IPT-AST for the prevention of adolescent depression in the past 20 years. Methods A systematic search of relevant electronic databases (PubMed, WOS, Embase, PsycINFO, the Cochrane Library, CNKI and WANFANG DATA) and study reference lists was conducted. Any study investigating the effectiveness of IPT-AST in 12- to 20-year-olds with depressive symptoms was eligible. Synthesis was via narrative summary and meta-analysis. Results A total of 6 studies met the inclusion criteria. Meta-analysis results showed a remarkable improvement in patients' depressive symptoms after IPT-AST intervention (WMD = -5.05, 95% CI = -8.11 to -1.98, p < 0.05, I2 = 77%). Six month follow-up data showed that the intervention outcomes of IPT-AST remained significant (WMD = -3.09, 95% CI: -5.23 to -0.94, p < 0.05, I2 = 57%). Conclusion This meta-analysis showed that IPT-AST was effective in adolescents with depressive symptoms at post-prevention and at 6-month follow-up. However, these conclusions are cautious, as they are based on a small number of studies and the presence of author duplication. Future studies should use multi-center, large-sample randomized controlled trials to evaluate the efficacy of IPT-AST for preventing depression in adolescents. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023393047.
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Affiliation(s)
- Kewei Zheng
- School of Humanities and Social Sciences, Binzhou Medical University, Yantai, China
- Qingdao Mental Health Center, Qingdao, China
| | - Huimin Xu
- School of Humanities and Social Sciences, Binzhou Medical University, Yantai, China
| | - Chunhui Qu
- Qingdao Mental Health Center, Qingdao, China
| | | | - Na Xu
- School of Humanities and Social Sciences, Binzhou Medical University, Yantai, China
| | - Ping Sun
- Qingdao Mental Health Center, Qingdao, China
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Jones JD, Long EE, Hankin BL, Gallop R, Davis M, Young JF. Personalized Depression Prevention Reduces Dependent Stressors Among Adolescents: Results from a Randomized Controlled Trial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-14. [PMID: 36940144 PMCID: PMC10509329 DOI: 10.1080/15374416.2023.2188562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Depression and stressors both increase during adolescence. The stress generation model posits that depression symptoms and associated impairment contribute to the generation of dependent stressors. Adolescent depression prevention programs have been shown to reduce the risk of depression. Recently, risk-informed personalization approaches have been adopted to enhance the efficacy of depression prevention, and preliminary evidence supports the beneficial effects of personalized prevention on depression symptoms. Given the close association between depression and stress, we examined the hypothesis that personalized depression prevention programs would reduce adolescents' experience of dependent stressors (interpersonal and non-interpersonal) over longitudinal follow-up. METHOD The present study included 204 adolescents (56% girls, 29% racial minority) who were randomized to receive either a cognitive-behavioral or an interpersonal prevention program. Youth were categorized as high or low on cognitive and interpersonal risk using a previously established risk classification system. Half of the adolescents received a prevention program that matched their risk profile (e.g., high cognitive risk randomized to cognitive-behavioral prevention); half received a mismatched program (e.g., high interpersonal risk randomized to cognitive-behavioral prevention). Exposure to dependent and independent stressors was assessed repeatedly over an 18-month follow-up period. RESULTS Matched adolescents reported fewer dependent stressors during the post-intervention follow-up period (d = .46, p = .002) and from baseline through 18-months post-intervention (d = .35, p = .02) compared to mismatched youth. As expected, there were no differences between matched and mismatched youth on the experience of independent stressors. CONCLUSIONS These findings further highlight the potential of personalized approaches to depression prevention and demonstrate benefits that go beyond depression symptom reduction.
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Affiliation(s)
- Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
| | - Erin E Long
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Benjamin L Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign
| | | | - Molly Davis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
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Tornivuori A, Kronström K, Aromaa M, Salanterä S, Karukivi M. Accessible mental well-being intervention for adolescents in school settings: a single-group intervention study using a pretest-post-test design. Child Adolesc Psychiatry Ment Health 2023; 17:28. [PMID: 36805796 PMCID: PMC9940674 DOI: 10.1186/s13034-023-00576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND A growing number of adolescents seek treatment for mental health problems, a circumstance that stresses the importance of implementing accessible treatment options. This study evaluates the impacts of brief, mental well-being intervention for adolescents in a school environment. As mental health interventions are often targeted at specific disorders, we sought a comprehensive approach to reach adolescents with a range of mental health symptoms. METHODS Single-group intervention study with a pretest-posttest design was utilized and conducted in lower, upper secondary, and vocational schools on adolescents ages 12-18 who sought medical attention for mental health symptoms. The cut-off point for inclusion was ≥ 14, for the Young Persons Clinical Outcomes for routine Evaluation (YP-CORE) measurement. The intervention included six face-to-face visits implemented by psychiatric nurses who received a 3-day training course. The impacts were evaluated after 6 weeks (n = 87) and again at 6 months (n = 68) and assessed using the YP-CORE, Beck Depression Inventory (BDI-II) and Overall Anxiety Severity and Impairment Scale (OASIS). RESULTS The participants reported significant levels of mental distress at baseline with a YP-CORE mean score = 21.48, a BDI-II mean score = 23.60, OASIS mean score = 10.98. Post-intervention results at 6 weeks for the primary outcome YP-CORE showed a significant (p < .001) mean score decrease of - 3.82, a medium effect size d = .627. For participants attending upper secondary and vocational schools the YP-CORE scores changed significantly from baseline to 6-weeks (p = .005) and from baseline to 6-months (p < .001). Long-term outcomes at 6-months showed a - 1.14 decrease (p = non-significant), effect size d = .175. After the 6-week intervention, 12% of the participants were assessed as not requiring additional visits. CONCLUSIONS This easily accessible intervention in a school setting indicated improvement for those participants with mild to moderate mental disorder symptoms and attending upper secondary and vocational schools. After the 6-week intervention, significant positive effects were observed. Participants reported substantial levels of mental distress at the baseline, which could contribute to the decline of symptoms and need for extended care during the 6 months follow-up. Trial registration Retrospectively registered with Clinicaltrials.gov identifier NCT05356949.
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Affiliation(s)
- Anna Tornivuori
- Department of Nursing Science, University of Turku, Turku, Finland.
| | - Kim Kronström
- Department of Adolescent Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Aromaa
- Outpatient Clinic for Children and Adolescents, Turku University Hospital, Turku, Finland
- Outpatient Clinic for Children and Adolescents, Turku University Hospital, Turku, Finland
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Administration, Turku, Finland
| | - Max Karukivi
- Department of Adolescent Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
- Psychiatric Care Division, Satakunta Hospital District, Pori, Finland
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11
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Kanine RM, Bush ML, Davis M, Jones JD, Sbrilli MD, Young JF. Depression Prevention in Pediatric Primary Care: Implementation and Outcomes of Interpersonal Psychotherapy-Adolescent Skills Training. Child Psychiatry Hum Dev 2023; 54:96-108. [PMID: 34379228 DOI: 10.1007/s10578-021-01222-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 01/27/2023]
Abstract
This study evaluated the fidelity, feasibility, acceptability, and preliminary outcomes of a depression prevention program, interpersonal psychotherapy-adolescent skills training (IPT-AST), in urban pediatric primary care (PC) with a sample of primarily Black youth. Twenty-two adolescents with elevated depressive symptoms participated in this open clinical trial. Adolescents were identified through a screening questionnaire completed at well visits. Ratings of IPT-AST fidelity and session attendance were recorded. Youth and caregivers reported on their attitudes toward the intervention and completed measures of adolescents' symptoms and functioning pre- and post-intervention. Results demonstrated high levels of fidelity, attendance, and acceptability, despite some difficulties with recruitment. Adolescents and caregivers reported significant improvements in functioning. There were marginally significant reductions in self-reported depression, anxiety, and total mental health symptoms. Caregivers reported a significant decrease in total mental health symptoms. Findings provide preliminary information regarding the implementation and effects of IPT-AST when delivered in PC.
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Affiliation(s)
- Rebecca M Kanine
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.
| | - Morgan L Bush
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA
| | - Molly Davis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marissa D Sbrilli
- Clinical-Community Psychology PhD Program, Department of Psychology, University of Illinois - Urbana Champaign, Champaign, IL, USA
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Room 8472, Philadelphia, PA, 19146, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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12
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Bian C, Zhao WW, Yan SR, Chen SY, Cheng Y, Zhang YH. Effect of interpersonal psychotherapy on social functioning, overall functioning and negative emotions for depression: A meta-analysis. J Affect Disord 2023; 320:230-240. [PMID: 36183821 DOI: 10.1016/j.jad.2022.09.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Interpersonal psychotherapy (IPT) has been widely used for depression. However, current studies of IPT have been restricted to depressive symptoms, and the results for improving social functioning were controversial. METHODS A comprehensive literature search of randomized controlled trials (RCTs) was conducted through eleven databases. Data analysis was performed by RevMan5.3, and effects were summarized by using a random effects model of mean differences with 95 % confidence intervals. RESULTS From 2443 records, eleven studies met inclusion and exclusion criteria were used for meta-analysis. The results showed that IPT had significant effects on improving social functioning (SMD: -0.53, 95 % CI: -0.80 to -0.26), reducing depression (SMD: -0.49, 95 % CI: -0.80 to -0.19) and anxiety (SMD: -0.90, 95 % CI: -1.28 to -0.52), but the effect on the overall functioning (SMD: -0.37, 95 % CI: -0.73 to -0.01) is not obvious. Moreover, subgroup analysis showed that IPT was effective in improving social functioning in adolescent depression (SMD: -0.35, 95 % CI: -0.58 to -0.13) and perinatal depression (SMD: -1.01, 95 % CI: -1.35 to -0.67), while there was no significant difference in the adult depression group (SMD: -0.39, 95 % CI: -1.05 to 0.27). LIMITATION The blind method cannot be carried out in most studies due to the particularity of psychotherapy, heterogeneity in some results. CONCLUSION IPT has a significant effect on improving social functioning and reducing depression and anxiety, while the effect on overall functioning requires further research. Overall, IPT is one of the effective nonpharmacological treatments for depression.
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Affiliation(s)
- Cheng Bian
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Wei-Wei Zhao
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shi-Rui Yan
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shu-Yan Chen
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yin Cheng
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yan-Hong Zhang
- School of Nursing, Nanjing Medical University, Nanjing, China; The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
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13
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Sbrilli MD, Jones JD, Kanine RM, Gallop R, Young JF. The Depression Prevention Initiative: Trauma as a Moderator of Prevention Outcomes. JOURNAL OF EMOTIONAL AND BEHAVIORAL DISORDERS 2022; 30:247-259. [PMID: 36353335 PMCID: PMC9640185 DOI: 10.1177/1063426620945665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) is an evidence-based indicated depression prevention program that has been shown to reduce depression symptoms. Research is needed to identify moderators of IPT-AST's effects. Although trauma history has emerged as a moderator of depression treatment outcomes, the impact of trauma on short- and long-term outcomes in the context of preventive interventions for adolescent depression is unknown. This study examines the impact of trauma on prevention outcomes in a school-based randomized controlled trial (RCT) in which 186 adolescents (mean age = 14.01 years, SD = 1.22; 67% female) were randomly assigned to IPT-AST delivered by research staff or group counseling (GC) provided by school counselors. Trauma history significantly moderated intervention outcomes during the active phase of the intervention, but not during long-term follow-up. During the active phase, youth in IPT-AST with low or no trauma exposure experienced significantly greater reductions in depression symptoms than youth in GC with low or no trauma exposure, but there were no significant differences in rates of change between the two interventions for youth with high or any trauma exposure. These findings highlight the importance of assessing trauma and investigating whether these interventions can be tailored or supplemented to enhance the effects for youth with trauma exposure.
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Affiliation(s)
| | | | | | | | - Jami F. Young
- Children’s Hospital of Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, USA
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14
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Back to Basics: Lifestyle Interventions for Adolescent Depression. Harv Rev Psychiatry 2022; 30:283-302. [PMID: 36103683 DOI: 10.1097/hrp.0000000000000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
LEARNING OBJECTIVES After completing this activity, practitioners will be better able to:• Discuss and better understand the recently adopted screening standards for adolescents with depression and the potential advantages of using "lifestyle medicine"• Set up a process for providing effective interventions for the increased number of patients with adolescent depression• Design or update their toolbox of treatment options for adolescents with depression based on the new literature and increased demand. ABSTRACT Recently adopted quality standards recommend that pediatricians screen adolescents for depression and that they document follow-up plans for those who screen positive. As a result of these new recommendations, pediatricians and other pediatric providers, as well as psychiatrists and other mental health professionals, may face an increasing number of referrals and a growing need for effective interventions for adolescent depression. Given the widely acknowledged scarcity of traditional mental health resources, the current study reviewed the rapidly expanding array of evidence-based, but nontraditional, interventions applicable to outpatient pediatric and mental health care settings. Many of these interventions come from a lifestyle medicine framework. Lifestyle medicine interventions are congruent with the cultures of pediatrics and outpatient psychiatry, and offer additional evidence-based tools for providers managing adolescent depression. These interventions can be implemented individually or within group or community settings, and may be used in conjunction with more common interventions such as psychotherapy or psychotropic medications.
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15
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Young JF, Jones JD, Gallop R, Benas JS, Schueler CM, Garber J, Hankin BL. Personalized Depression Prevention: A Randomized Controlled Trial to Optimize Effects Through Risk-Informed Personalization. J Am Acad Child Adolesc Psychiatry 2021; 60:1116-1126.e1. [PMID: 33189876 PMCID: PMC8116944 DOI: 10.1016/j.jaac.2020.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 10/05/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate whether evidence-based depression prevention programs can be optimized by matching youths to interventions that address their psychosocial vulnerabilities. METHOD This randomized controlled trial included 204 adolescents (mean [SD] age = 14.26 [1.65] years; 56.4% female). Youths were categorized as high or low on cognitive and interpersonal risks for depression and randomly assigned to Coping With Stress (CWS), a cognitive-behavioral program, or Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), an interpersonal program. Some participants received a match between risk and prevention (eg, high cognitive-low interpersonal risk teen in CWS, low cognitive-high interpersonal risk teen in IPT-AST), others received a mismatch (eg, low cognitive-high interpersonal risk teen in CWS). Outcomes were depression diagnoses and symptoms through 18 months postintervention (21 months total). RESULTS Matched adolescents showed significantly greater decreases in depressive symptoms than mismatched adolescents from postintervention through 18-month follow-up and across the entire 21-month study period (effect size [d] = 0.44, 95% CI = 0.02, 0.86). There was no significant difference in rates of depressive disorders among matched adolescents compared with mismatched adolescents (12.0% versus 18.3%, t193 = .78, p = .44). CONCLUSION This study illustrates one approach to personalizing depression prevention as a form of precision mental health. Findings suggest that risk-informed personalization may enhance effects beyond a one-size-fits-all approach. CLINICAL TRIAL REGISTRATION INFORMATION Bending Adolescent Depression Trajectories Through Personalized Prevention; https://www.clinicaltrials.gov/; NCT01948167.
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16
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Cuijpers P, Pineda BS, Ng MY, Weisz JR, Muñoz RF, Gentili C, Quero S, Karyotaki E. A Meta-analytic Review: Psychological Treatment of Subthreshold Depression in Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2021; 60:1072-1084. [PMID: 33596437 DOI: 10.1016/j.jaac.2020.11.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/13/2020] [Accepted: 02/08/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Subthreshold depression has been found to be associated with considerable impairment and an increased risk of developing major depression. Although several randomized trials have examined the effects of psychological interventions for subthreshold depression in children and adolescents, no meta-analysis has integrated the results of these trials. METHOD We searched 4 bibliographic databases and included randomized trials comparing psychological interventions with control conditions in children and adolescents scoring above a cut-off of a depression questionnaire but not meeting diagnostic criteria for major depression (or persistent depressive disorder) according to a diagnostic interview. Effect sizes and incidence rates of major depression were pooled with random effects meta-analyses. RESULTS A total of 12 trials with 1,576 children and adolescents met inclusion criteria. The overall effect size indicating the difference between treatment and control at post-test was g = 0.38 (95% CI = 0.14-0.63), which corresponds to a number-needed-to-treat (NNT) of 8.4. Heterogeneity was moderate to high (I2 = 61; 95% CI = 28-79), and there was significant risk of publication bias (p < .04). The 2 studies in children less than 12 years of age showed nonsignificant effects (g = 0.01; 95% CI = -1.16 to 1.18). We found no significant effect on the incidence of major depression at follow-up (relative risk = 0.52; 95% CI = 0.25-1.08), although this may be related to low statistical power. CONCLUSION Interventions for subthreshold depression may have positive acute effects in adolescents. There is currently insufficient evidence, however, that these interventions are effective in children less than 12 years of age, or that they prevent the onset of major depression at follow-up.
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Affiliation(s)
- Pim Cuijpers
- Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.
| | - Blanca S Pineda
- Institute for International Internet Interventions for Health (i4Health), Palo Alto University, California
| | - Mei Yi Ng
- Florida International University, Miami
| | | | - Ricardo F Muñoz
- Institute for International Internet Interventions for Health (i4Health), Palo Alto University, California
| | | | - Soledad Quero
- Universitat Jaume I, Castellón, Spain, and CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Eirini Karyotaki
- Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands
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17
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Caldwell DM, Davies SR, Thorn JC, Palmer JC, Caro P, Hetrick SE, Gunnell D, Anwer S, López-López JA, French C, Kidger J, Dawson S, Churchill R, Thomas J, Campbell R, Welton NJ. School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: a systematic review and network meta-analysis. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background
Schools in the UK increasingly have to respond to anxiety, depression and conduct disorder as key causes of morbidity in children and young people.
Objective
The objective was to assess the comparative effectiveness of educational setting-based interventions for the prevention of anxiety, depression and conduct disorder in children and young people.
Design
This study comprised a systematic review, a network meta-analysis and an economic evaluation.
Data sources
The databases MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), PsycInfo® (American Psychological Association, Washington, DC, USA) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to 4 April 2018, and the NHS Economic Evaluation Database (NHS EED) was searched on 22 May 2019 for economic evaluations. No language or date filters were applied.
Main outcomes
The main outcomes were post-intervention self-reported anxiety, depression or conduct disorder symptoms.
Review methods
Randomised/quasi-randomised trials of universal or targeted interventions for the prevention of anxiety, depression or conduct disorder in children and young people aged 4–18 years were included. Screening was conducted independently by two reviewers. Data extraction was conducted by one reviewer and checked by a second. Intervention- and component-level network meta-analyses were conducted in OpenBUGS. A review of the economic literature and a cost–consequence analysis were conducted.
Results
A total of 142 studies were included in the review, and 109 contributed to the network meta-analysis. Of the 109 studies, 57 were rated as having an unclear risk of bias for random sequence generation and allocation concealment. Heterogeneity was moderate. In universal secondary school settings, mindfulness/relaxation interventions [standardised mean difference (SMD) –0.65, 95% credible interval (CrI) –1.14 to –0.19] and cognitive–behavioural interventions (SMD –0.15, 95% CrI –0.34 to 0.04) may be effective for anxiety. Cognitive–behavioural interventions incorporating a psychoeducation component may be effective (SMD –0.30, 95% CrI –0.59 to –0.01) at preventing anxiety immediately post intervention. There was evidence that exercise was effective in preventing anxiety in targeted secondary school settings (SMD –0.47, 95% CrI –0.86 to –0.09). There was weak evidence that cognitive–behavioural interventions may prevent anxiety in universal (SMD –0.07, 95% CrI –0.23 to 0.05) and targeted (SMD –0.38, 95% CrI –0.84 to 0.07) primary school settings. There was weak evidence that cognitive–behavioural (SMD –0.04, 95% CrI –0.16 to 0.07) and cognitive–behavioural + interpersonal therapy (SMD –0.18, 95% CrI –0.46 to 0.08) may be effective in preventing depression in universal secondary school settings. Third-wave (SMD –0.35, 95% CrI –0.70 to 0.00) and cognitive–behavioural interventions (SMD –0.11, 95% CrI –0.28 to 0.05) incorporating a psychoeducation component may be effective at preventing depression immediately post intervention. There was no evidence of intervention effectiveness in targeted secondary, targeted primary or universal primary school settings post intervention. The results for university settings were unreliable because of inconsistency in the network meta-analysis. A narrative summary was reported for five conduct disorder prevention studies, all in primary school settings. None reported the primary outcome at the primary post-intervention time point. The economic evidence review reported heterogeneous findings from six studies. Taking the perspective of a single school budget and based on cognitive–behavioural therapy intervention costs in universal secondary school settings, the cost–consequence analysis estimated an intervention cost of £43 per student.
Limitations
The emphasis on disorder-specific prevention excluded broader mental health interventions and restricted the number of eligible conduct disorder prevention studies. Restricting the study to interventions delivered in the educational setting may have limited the number of eligible university-level interventions.
Conclusions
There was weak evidence of the effectiveness of school-based, disorder-specific prevention interventions, although effects were modest and the evidence not robust. Cognitive–behavioural therapy-based interventions may be more effective if they include a psychoeducation component.
Future work
Future trials for prevention of anxiety and depression should evaluate cognitive–behavioural interventions with and without a psychoeducation component, and include mindfulness/relaxation or exercise comparators, with sufficient follow-up. Cost implications must be adequately measured.
Study registration
This study is registered as PROSPERO CRD42016048184.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah R Davies
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Joanna C Thorn
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer C Palmer
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paola Caro
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Sarah E Hetrick
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
| | - Sumayya Anwer
- Centre for Reviews and Dissemination, University of York, York, UK
| | - José A López-López
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain
| | - Clare French
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Judi Kidger
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - James Thomas
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), University College London, London, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
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Facilitating improvements in young people's social relationships to prevent or treat depression: A review of empirically supported interventions. Transl Psychiatry 2021; 11:305. [PMID: 34021113 PMCID: PMC8139977 DOI: 10.1038/s41398-021-01406-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 02/04/2023] Open
Abstract
Interpersonal difficulties are often implicated in the onset of depressive disorders, and typically exacerbate depressive symptoms. This is particularly true for young people, given rapid changes in, and the increased importance of, their social relationships. The purpose of this narrative review was to identify empirically supported interventions that aim to prevent or treat depression in young people by facilitating improvements in their social environment. We conducted a search of controlled trials, systematic reviews and meta-analyses of such interventions, published between 1980 and June 2020. Our literature search and interpretation of results was informed by consultations with clinical experts and youth consumers and advocates. A number of promising approaches were identified with respect to prevention and treatment. Preliminary evidence was identified suggesting that school- and Internet-based approaches present a viable means to prevent the worsening of depressive symptoms in young people. Notably, delivering interpersonal psychotherapy-adolescent skills training (IPT-AST) in schools appears to be a promising early intervention strategy for young people at risk of full-threshold depressive disorder. In terms of treating depressive disorders in young people, there is strong evidence for the efficacy of interpersonal psychotherapy for adolescents (IPT-A), and preliminary evidence in favour of attachment-based family therapy (ABFT). Results are discussed with respect to recommendations for future research and practice.
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Kodish T, Weiss B, Duong J, Rodriguez A, Anderson G, Nguyen H, Olaya C, Lau AS. Interpersonal Psychotherapy-Adolescent Skills Training With Youth From Asian American and Immigrant Families: Cultural Considerations and Intervention Process. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:147-166. [PMID: 35422577 DOI: 10.1016/j.cbpra.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although research has identified effective evidence-based depression prevention interventions for diverse youth, little is known about how the intervention process unfolds with immigrant family youth. This study utilized a qualitative approach to explore cultural and clinical differences in the implementation of Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) in two schools, one serving youth from primarily immigrant, Asian American families and the second, youth from mostly nonimmigrant, non-Hispanic White families. A total of 131 IPT-AST sessions were audio recorded, transcribed, and coded for presence and patterns of cultural and clinical constructs. Results revealed that sessions with immigrant family youth were more likely to contain discussions of interpersonal problems characterized by estrangement, goals of spending time together with important others, mentions of emotion suppression and academic achievement expectations, conversations about acculturation, differences in value orientation, and discomfort with implementing new intervention skills. Dialogue from interventionist and youth exchanges is presented to illustrate how these themes emerged and were addressed by interventionists in a culturally responsive manner. The study highlights how IPT-AST with immigrant family and Asian American youth may unfold differently compared to youth from nonimmigrant families. Implications of findings for providers are discussed.
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20
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Jones JD, Gallop R, Gillham JE, Mufson L, Farley AM, Kanine R, Young JF. The Depression Prevention Initiative: Mediators of Interpersonal Psychotherapy-Adolescent Skills Training. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:202-214. [PMID: 31429601 PMCID: PMC7031021 DOI: 10.1080/15374416.2019.1644648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Several adolescent depression prevention programs have demonstrated effects on depressive symptoms and overall functioning. Yet, despite an increasing emphasis on elucidating mechanisms of change in interventions, few studies have identified mediators of these preventive interventions. In this study, we examined interpersonal mediators of Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), an evidence-based depression prevention program. The Depression Prevention Initiative is a school-based randomized controlled trial in which 186 adolescents (M age = 14.01, SD = 1.22; 66.7% female; 32.2% racial minority) were assigned to receive either IPT-AST (n = 95) or Group Counseling (GC) (n = 91). We examined whether change in interpersonal conflict, social support, or social functioning from baseline to midintervention mediated the effects of IPT-AST on depressive symptoms and overall functioning at postintervention. At postintervention, youth in IPT-AST had lower depressive symptoms (d = -.31) and higher overall functioning scores (d = .32) than youth in GC. Improvements in adolescent romantic functioning, reductions in peer conflict, and improvements in a factor score reflecting mother-adolescent conflict and difficulties in family functioning emerged as significant mediators. However, the effects of the intervention on change in the mediators were not statistically significant. These findings add to the sparse literature on mediators of psychosocial interventions, provide partial support for the theoretical mechanisms underlying change in IPT-AST, and highlight important directions for future prevention and intervention research.
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Affiliation(s)
- Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and PolicyLab Children's Hospital of Philadelphia
| | | | | | - Laura Mufson
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute
| | | | - Rebecca Kanine
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and PolicyLab Children's Hospital of Philadelphia
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and PolicyLab Children's Hospital of Philadelphia
- Department of Psychiatry, University of Pennsylvania
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21
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Gee B, Wilson J, Clarke T, Farthing S, Carroll B, Jackson C, King K, Murdoch J, Fonagy P, Notley C. Review: Delivering mental health support within schools and colleges - a thematic synthesis of barriers and facilitators to implementation of indicated psychological interventions for adolescents. Child Adolesc Ment Health 2021; 26:34-46. [PMID: 32543016 DOI: 10.1111/camh.12381] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Increasing the role of schools and colleges in the provision of mental health services for young people has the potential to improve early intervention and access to treatment. We aimed to understand what factors influence the successful implementation of indicated psychological interventions within schools and colleges to help guide increased provision of mental health support within education settings. METHODS Systematic search for studies that have reported barriers or facilitators to the implementation of indicated interventions for adolescent emotional disorders delivered within schools and further education/sixth form colleges (CRD42018102830). Databases searched were EMBASE, MEDLINE, PsycINFO, CINAHL, British Nursing Index, ASSIA, ERIC and British Education Index. A thematic synthesis of factors reported to impact implementation was conducted. RESULTS Two thousand five hundred and sixty-nine records and 177 full texts were screened. Fifty studies were identified for inclusion, all of which were of school-based interventions. Eleven analytic themes were developed encompassing intervention characteristics, organisational capacity, training and technical assistance, provider characteristics and community-level factors. Findings indicate the need to select appropriate interventions, consider logistical challenges of the school context and provide training and supervision to enable staff to deliver interventions with fidelity. However, structural and environmental support is required for these facilitators to have the greatest impact on successful implementation. CONCLUSIONS Implementing indicated school-based mental health interventions is challenging. Those involved in planning school-based mental health initiatives must be alert to the impact of factors on multiple interacting levels. There is a lack of research on implementing mental health support within further education and sixth form colleges. KEY PRACTITIONER MESSAGE Increased utilisation of schools and colleges as a setting for early intervention has been proposed as a means of improving access to mental health treatment, but successful implementation of mental health interventions within educational settings is challenging. Based on a synthesis of current evidence, we recommend that young people and education professionals should be involved in the selection of school-based interventions to ensure they are acceptable and practical to deliver within the logistical constraints of the school environment. Those delivering interventions within schools, as well as staff involved in identifying young people who might benefit from these interventions, must receive high-quality ongoing training and support. Senior school leaders play an important role in championing mental health interventions and developing a school culture that prioritises mental well-being. Health and education policy should be designed to promote a cross-sector focus on the emotional health of young people. There is a lack of evidence on the implementation of indicated psychological interventions within sixth form and further education colleges.
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Affiliation(s)
- Brioney Gee
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jon Wilson
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK.,Grenada General Hospital, St. George's University, St. George's, Grenada
| | - Tim Clarke
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sophie Farthing
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Ben Carroll
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Christopher Jackson
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Kahfee King
- Grenada General Hospital, St. George's University, St. George's, Grenada
| | - Jamie Murdoch
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, UK.,Division of Psychology and Language Sciences, University College London, London, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
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Hoagwood KE, Purtle J, Spandorfer J, Peth-Pierce R, Horwitz SM. Aligning dissemination and implementation science with health policies to improve children's mental health. AMERICAN PSYCHOLOGIST 2020; 75:1130-1145. [PMID: 33252950 PMCID: PMC8034490 DOI: 10.1037/amp0000706] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The prevalence of mental health problems among children (ages 0-21) in the United States remains unacceptably high and, post-COVID-19, is expected to increase dramatically. Decades of psychological knowledge about effective treatments should inform the delivery of better services. Dissemination and implementation (D&I) science has been heralded as a solution to the persistent problem of poor quality services and has, to some extent, improved our understanding of the contexts of delivery systems that implement effective practices. However, there are few studies demonstrating clear, population-level impacts of psychological interventions on children. Momentum is growing among communities, cities, states, and some federal agencies to build "health in all policies" to address broad familial, social, and economic factors known to affect children's healthy development and mental health. These health policy initiatives offer a rare opportunity to repurpose D&I science, shifting it from a primary focus on evidence-based practice implementation, to a focus on policy development and implementation to support child and family health and well-being. This shift is critical as states develop policy responses to address the health and mental health impacts of the COVID-19 pandemic on already-vulnerable families. We provide a typology for building research on D&I and children's mental health policy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University
| | - Julia Spandorfer
- Department of Child and Adolescent Psychiatry, New York University Langone Health
| | | | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University Langone Health
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Rose-Clarke K, Pradhan I, Shrestha P, B K P, Magar J, Luitel NP, Devakumar D, Rafaeli AK, Clougherty K, Kohrt BA, Jordans MJD, Verdeli H. Culturally and developmentally adapting group interpersonal therapy for adolescents with depression in rural Nepal. BMC Psychol 2020; 8:83. [PMID: 32787932 PMCID: PMC7425581 DOI: 10.1186/s40359-020-00452-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Evidence-based interventions are needed to reduce depression among adolescents in low- and middle-income countries (LMICs). One approach could be cultural adaptation of psychological therapies developed in high-income countries. We aimed to adapt the World Health Organization's Group Interpersonal Therapy (IPT) Manual for adolescents with depression in rural Nepal. METHODS We used a participatory, multi-stage adaptation process involving: translation and clinical review of the WHO Manual; desk reviews of adaptations of IPT in LMICs, and literature on child and adolescent mental health interventions and interpersonal problems in Nepal; a qualitative study to understand experiences of adolescent depression and preferences for a community-based psychological intervention including 25 interviews with adolescent boys and girls aged 13-18 with depression, four focus group discussions with adolescents, four with parents/caregivers and two with teachers, six interviews with community health workers and one with a representative from a local non-governmental organisation (total of 126 participants); training of IPT trainers and facilitators and practice IPT groups; and consultation with a youth mental health advisory board. We used the Ecological Validity Framework to guide the adaptation process. RESULTS We made adaptations to optimise treatment delivery and emphasise developmental and cultural aspects of depression. Key adaptations were: integrating therapy into secondary schools for delivery by school nurses and lay community members; adding components to promote parental engagement including a pre-group session with the adolescent and parent to mobilise parental support; using locally acceptable terms for mental illness such as udas-chinta (sadness and worry) and man ko samasya (heart-mind problem); framing the intervention as a training programme to de-stigmatise treatment; and including activities to strengthen relationships between group members. We did not adapt the therapeutic goals of IPT and conserved IPT-specific strategies and techniques, making edits only to the way these were described in the Manual. CONCLUSIONS Group IPT can be adapted for adolescents in Nepal and delivered through the education system. A randomised controlled trial is needed to assess the impact and costs of the intervention in this setting. Future research in LMICs to adapt IPT for adolescents could use this adapted intervention as a starting point.
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Affiliation(s)
- Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, WC2B 4BG, UK.
| | - Indira Pradhan
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Pragya Shrestha
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Prakash B K
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Jananee Magar
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Alexandra Klein Rafaeli
- Psychological Services, Ruth and Allen Ziegler Student Services Division, Tel Aviv University, Tel Aviv, Israel
| | - Kathleen Clougherty
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, and Department of Global Health, George Washington University, Washington, DC, USA
| | - Mark J D Jordans
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal.,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
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25
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Gee B, Reynolds S, Carroll B, Orchard F, Clarke T, Martin D, Wilson J, Pass L. Practitioner Review: Effectiveness of indicated school-based interventions for adolescent depression and anxiety - a meta-analytic review. J Child Psychol Psychiatry 2020; 61:739-756. [PMID: 32250447 DOI: 10.1111/jcpp.13209] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Interest in delivering psychological interventions within schools to facilitate early intervention is increasing. However, most reviews have focused on universal or preventative programmes rather than interventions designed to decrease existing symptoms of depression or anxiety. This paper aims to provide a meta-analytic review of randomised controlled trials of indicated psychological interventions for young people aged 10-19 with elevated symptoms of depression and/or anxiety. METHODS Eight electronic databases were systematically searched from inception to April 2019 for eligible trials. Study quality was assessed using two scales designed to evaluate psychotherapy intervention trials. Random effects meta-analyses were conducted separately for trials that recruited participants based on symptoms of depression and based on symptoms of anxiety. RESULTS Data from 45 trials were analysed. Most interventions studied used cognitive and behavioural strategies. Few studies met methodological quality criteria, but effect size was not associated with study quality. Indicated school-based interventions had a small effect on reducing depression symptoms (SMD = .34, 95% CI -0.48, -0.21) and a medium effect on reducing anxiety symptoms (SMD = -.49, 95% CI -0.79, -0.19) immediately postintervention. Subgroup analyses indicated that interventions delivered by internal school staff did not have significant effects on symptoms. Reductions in depression were maintained at short-term (≤6 months) but not medium (>6 months ≤ 12) or long-term (>12-month) follow-up. Reductions in anxiety symptoms were not maintained at any follow-up. CONCLUSIONS Indicated school-based interventions are effective at reducing symptoms of depression and anxiety in adolescents immediately postintervention but there is little evidence that these reductions are maintained. Interventions delivered by school staff are not supported by the current evidence base. Further high-quality randomised controlled trials incorporating assessment of longer-term outcomes are needed to justify increased investment in school-based interventions for adolescent depression and anxiety.
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Affiliation(s)
- Brioney Gee
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Ben Carroll
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Tim Clarke
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - David Martin
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Jon Wilson
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Laura Pass
- Norwich Medical School, University of East Anglia, Norwich, UK.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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26
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Kopelman-Rubin D, Mufson L, Siegel A, Kats-Gold I, Weiss N, Brunstein-Klomek A. I can succeed, a new social emotional learning program for children based on interpersonal psychotherapy for adolescents. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2020. [DOI: 10.1080/17405629.2020.1768068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Daphne Kopelman-Rubin
- Baruch Ivcher School of Psychology, The Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | - Laura Mufson
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Alana Siegel
- Baruch Ivcher School of Psychology, The Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | - Inna Kats-Gold
- Baruch Ivcher School of Psychology, The Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | - Noa Weiss
- Baruch Ivcher School of Psychology, The Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | - Anat Brunstein-Klomek
- Baruch Ivcher School of Psychology, The Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
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27
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Chen R, Liu J, Cao X, Duan S, Wen S, Zhang S, Xu J, Lin L, Xue Z, Lu J. The relationship between mobile phone use and suicide-related behaviors among adolescents: The mediating role of depression and interpersonal problems. J Affect Disord 2020; 269:101-107. [PMID: 32250862 DOI: 10.1016/j.jad.2020.01.128] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 11/17/2019] [Accepted: 01/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study examined (a) the relationship that interpersonal problems and depression share with the intensity of mobile phone use and (b) their effects on suicide-related behaviors (SRBs) and self-harming behaviors among adolescents. METHODS In this cross-sectional study, adolescents were recruited from 11 middle and high schools in Shenzhen, China. They completed self-reported measures that assessed mobile phone use, their history of SRBs (i.e., suicidal ideation, suicidal planning, and attempted suicide) and self-harming behaviors, depression, and interpersonal problems. RESULTS Interpersonal problems and depression mediated the relationship between high-intensity mobile phone use and the risk for SRBs and self-harming behaviors among Chinese adolescents. CONCLUSIONS The findings delineate the pathways through which interpersonal problems and depression increase the risk for SRBs and self-harming behaviors among adolescents who report high-intensity mobile phone use. Future studies should develop interventions that alleviate interpersonal problems and depressive symptoms to reduce the risk for SRBs and self-harming behaviors among adolescents who report high-intensity mobile phone use.
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Affiliation(s)
- Runsen Chen
- Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen 518020, China; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Jianbo Liu
- Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Xiaolan Cao
- Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Suqian Duan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Siyang Wen
- Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Simei Zhang
- Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Jianchang Xu
- Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Ling Lin
- Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Zhenpeng Xue
- Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Jianping Lu
- Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen 518020, China.
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Zisk A, Abbott CH, Bounoua N, Diamond GS, Kobak R. Parent-teen communication predicts treatment benefit for depressed and suicidal adolescents. J Consult Clin Psychol 2019; 87:1137-1148. [PMID: 31647277 DOI: 10.1037/ccp0000457] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Although there are currently several efficacious treatments for depressed and suicidal adolescents, less is known about predictors and moderators of adolescents' treatment response. A growing literature has identified family functioning as a prognostic indicator of adolescents' likelihood of benefiting from treatment. The current study tested both observational and perceived measures of family functioning as indicators of adolescents' response to 2 treatment conditions. METHOD The sample consisted of 129 depressed and suicidal adolescents (Mage = 14.96, 82.9% female, 56% Black/African American) who were randomized to attachment-based family therapy or family-enhanced nondirective supportive therapy (Diamond et al., 2019). Baseline assessments of family functioning included ratings of parent-adolescent communication coded with the Goal-Corrected Partnership in Adolescence Coding System (Lyons-Ruth, Hennighausen, & Holmes, 2005) and adolescent and parent reports of Family Conflict and Cohesion from the Self-Report of Family Functioning (Bloom, 1985). RESULTS Adolescents who engaged in more uncooperative communication with their parents during a 10-min conflict discussion showed greater reductions in depressive symptoms in both treatments. Adolescents from traditionally underserved (non-White or lower income) families showed greater reductions in suicidal ideation in both treatments. CONCLUSIONS Attachment-based family therapy and family-enhanced nondirective supportive therapy were most effective for adolescents from traditionally underserved families and adolescents who engaged in less cooperative communication with their caregivers. Observational ratings of parent-adolescent communication were better prognostic indicators of treatment response than were self-reported indicators of global family functioning. Implications for generalizing these results to other treatments for depressed and suicidal adolescents are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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29
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Feiss R, Dolinger SB, Merritt M, Reiche E, Martin K, Yanes JA, Thomas CM, Pangelinan M. A Systematic Review and Meta-Analysis of School-Based Stress, Anxiety, and Depression Prevention Programs for Adolescents. J Youth Adolesc 2019; 48:1668-1685. [PMID: 31346924 PMCID: PMC7548227 DOI: 10.1007/s10964-019-01085-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
Abstract
Given the recent rise in adolescent mental health issues, many researchers have turned to school-based mental health programs as a way to reduce stress, anxiety, and depressive symptoms among large groups of adolescents. The purpose of the current systematic review and meta-analysis is to identify and evaluate the efficacy of school-based programming aimed at reducing internalizing mental health problems of adolescents. A total of 42 articles, including a total of 7310 adolescents, ages 11-18, met inclusion for the meta-analyses. Meta-analyses were completed for each of the three mental health outcomes (stress, depression, and anxiety) and meta-regression was used to determine the influence of type of program, program dose, sex, race, and age on program effectiveness. Overall, stress interventions did not reduce stress symptoms, although targeted interventions showed greater reductions in stress than universal programs. Overall, anxiety interventions significantly reduced anxiety symptoms, however higher doses may be necessary for universal programs. Lastly, depression interventions significantly reduced depressive symptoms, but this reduction was moderated by a combination of program type, dose, race, and age group. Although, school-based programs aimed at decreasing anxiety and depression were effective, these effects are not long-lasting. Interventions aimed at reducing stress were not effective, however very few programs targeted or included stress as an outcome variable. Implications for practice, policy and research are discussed.
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Affiliation(s)
- Robyn Feiss
- College of Education School of Kinesiology, Auburn University, 301 Wire Rd, Auburn, AL, 36849, USA.
| | - Sarah Beth Dolinger
- College of Education School of Kinesiology, Auburn University, 301 Wire Rd, Auburn, AL, 36849, USA
| | - Monaye Merritt
- College of Education School of Kinesiology, Auburn University, 301 Wire Rd, Auburn, AL, 36849, USA
| | - Elaine Reiche
- College of Education School of Kinesiology, Auburn University, 301 Wire Rd, Auburn, AL, 36849, USA
| | - Karley Martin
- College of Education School of Kinesiology, Auburn University, 301 Wire Rd, Auburn, AL, 36849, USA
| | - Julio A Yanes
- Department of Psychology, Auburn University, 208 Thatch Hall, Auburn, AL, 36849, USA
- Auburn University Magnetic Resonance Imaging Research Center, Auburn University, 560 Devall Dr, Auburn, AL, 36832, USA
| | - Chippewa M Thomas
- Department of Special Education, Rehabilitation and Counseling, Auburn University, 351 W Thach Concourse, Auburn, AL, 36849, USA
- Office of Faculty Engagement-University Outreach, Auburn University, 213 Samford Hall, Auburn, AL, 36849, USA
| | - Melissa Pangelinan
- College of Education School of Kinesiology, Auburn University, 301 Wire Rd, Auburn, AL, 36849, USA
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30
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Girio-Herrera E, Ehrlich CJ, Danzi BA, La Greca AM. Lessons Learned About Barriers to Implementing School-Based Interventions for Adolescents: Ideas for Enhancing Future Research and Clinical Projects. COGNITIVE AND BEHAVIORAL PRACTICE 2019; 26:466-477. [PMID: 32855590 PMCID: PMC7448397 DOI: 10.1016/j.cbpra.2018.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The majority of youth with mental health problems do not receive treatment, highlighting the critical need to transport evidence-based interventions into community settings, such as schools. Despite being able to reach a large number of adolescents and minority youth, the process of implementing evidence-based interventions to schools is challenging. This paper discusses some expected and unexpected challenges experienced during the implementation of an open trial and a pilot randomized controlled trial examining the acceptability and effectiveness of a school-based preventive intervention for adolescents at risk for internalizing disorders. First, we highlight key programs and findings on preventive interventions for adolescents at risk for depression and anxiety. Next, we provide a brief overview of the preventive intervention we implemented in schools. This provides a context for the section that describes implementation issues and highlights specific challenges and potential solutions for intervention implementation. Finally, the paper offers recommendations for researchers and clinicians interested in implementing school-based mental health services for adolescents.
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Spiro-Levitt C, Gallop R, Young JF. Trajectories of change in maternal and adolescent depressive symptoms in the depression prevention initiative. J Affect Disord 2019; 253:176-183. [PMID: 31051322 PMCID: PMC6620130 DOI: 10.1016/j.jad.2019.04.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/16/2019] [Accepted: 04/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given the prevalence and consequences of adolescent depression, depression prevention has become an important area of research. While prevention programs like Interpersonal Psychotherapy - Adolescent Skills Training (IPT-AST) have demonstrated effectiveness, little research to date has studied the relationship between maternal depression and adolescent outcomes in these programs. METHOD The current study investigated the relationship between maternal and adolescent depressive symptoms in 167 mother-adolescent dyads who were enrolled in the Depression Prevention Initiative (DPI), a randomized controlled trial that compared IPT-AST to group counseling (GC). First, the study examined the relationship between initial levels of adolescent and maternal depressive symptoms. The study then investigated whether maternal depressive symptoms improved over the two-year study period. Finally, the study assessed whether maternal and adolescent symptoms changed concurrently across time. RESULTS Results indicated that initial levels of maternal and adolescent symptoms were positively associated. Additionally, maternal symptoms improved across the two-year period. Maternal and adolescent outcomes were related across time: as adolescents improved in our study, their mothers also improved. LIMITATIONS The study utilized self-report data only and did not allow for the testing of causality in the relationship between mother-youth depression. CONCLUSIONS These findings add to the literature demonstrating that as one part of the mother-child dyad improves, the other improves as well. These findings extend the current understanding of the relationship between maternal and adolescent depressive symptom outcomes, and have important implications for the prevention and treatment of depression.
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Affiliation(s)
- Carolyn Spiro-Levitt
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at New York University Langone, United States.
| | - Robert Gallop
- Department of Mathematics, West Chester University, United States
| | - Jami F Young
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, United States; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, United States
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32
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Arora PG, Collins TA, Dart EH, Hernández S, Fetterman H, Doll B. Multi-tiered Systems of Support for School-Based Mental Health: A Systematic Review of Depression Interventions. SCHOOL MENTAL HEALTH 2019. [DOI: 10.1007/s12310-019-09314-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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33
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Gunlicks-Stoessel M, Mufson L, Bernstein G, Westervelt A, Reigstad K, Klimes-Dougan B, Cullen K, Murray A, Vock D. Critical Decision Points for Augmenting Interpersonal Psychotherapy for Depressed Adolescents: A Pilot Sequential Multiple Assignment Randomized Trial. J Am Acad Child Adolesc Psychiatry 2019; 58:80-91. [PMID: 30577943 PMCID: PMC7549148 DOI: 10.1016/j.jaac.2018.06.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/25/2018] [Accepted: 06/21/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Practice parameters recommend systematic assessment of depression symptoms over the course of treatment to inform treatment planning; however, there are currently no guidelines regarding how to use symptom monitoring to guide treatment decisions for psychotherapy. The current study compared two time points (week 4 and week 8) for assessing symptoms during interpersonal psychotherapy for depressed adolescents (IPT-A) and explored four algorithms that use the symptom assessments to select the subsequent treatment. METHOD Forty adolescents (aged 12-17 years) with a depression diagnosis began IPT-A with an initial treatment plan of 12 sessions delivered over 16 weeks. Adolescents were randomized to a week 4 or week 8 decision point for considering a change in treatment. Insufficient responders at either time point were randomized a second time to increased frequency of IPT-A (twice per week) or addition of fluoxetine. Measures were administered at baseline and weeks 4, 8, 12, and 16. RESULTS The week 4 decision point for assessing response and implementing treatment augmentation for insufficient responders was more efficacious for reducing depression symptoms than the week 8 decision point. There were significant differences between algorithms in depression and psychosocial functioning outcomes. CONCLUSION Therapists implementing IPT-A should routinely monitor depression symptoms and consider augmenting treatment for insufficient responders as early as week 4 of treatment. CLINICAL TRIAL REGISTRATION INFORMATION An Adaptive Treatment Strategy for Adolescent Depression. https://clinicaltrials.gov; NCT02017535.
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Affiliation(s)
| | - Laura Mufson
- Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, New York, NY
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34
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McCarthy AE, Young JF, Benas JS, Gallop RJ. SCHOOL-RELATED OUTCOMES FROM A RANDOMIZED CONTROLLED TRIAL OF ADOLESCENT DEPRESSION PREVENTION PROGRAMS. JOURNAL OF EMOTIONAL AND BEHAVIORAL DISORDERS 2018; 26:170-181. [PMID: 30116100 PMCID: PMC6089534 DOI: 10.1177/1063426617717739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Previous research has demonstrated the effectiveness of school-based depression prevention programs in reducing depressive symptoms and improving functioning. This study examined whether these programs have positive effects on school-related outcomes. Students at 10 middle and high schools in New Jersey were randomized to weekly sessions of Interpersonal Psychotherapy - Adolescent Skills Training (IPT-AST) or group counseling (GC). Analyses examined whether there were intervention effects on participants' grades, attendance rates, and disciplinary outcomes over approximately one year post-intervention. Although there were no significant main effects of intervention condition, moderation analyses indicated more favorable effects of IPT-AST among certain higher-risk subgroups (e.g., those from low-income families). Participants who experienced meaningful improvement in their depressive symptoms had significantly more positive outcomes on overall grades than those who did not experience meaningful improvement, regardless of intervention condition. Further research is needed to clarify the effects of depression prevention programs on these school-related outcomes.
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Affiliation(s)
- Alyssa E McCarthy
- Department of Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Road, Piscataway Township, NJ 08854
| | - Jami F Young
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Road, Piscataway Township, NJ 08854
| | - Jessica S Benas
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Road, Piscataway Township, NJ 08854
| | - Robert J Gallop
- Department of Mathematics, West Chester University, 25 University Avenue, West Chester, PA 19383
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35
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Young JF, Jones JD, Sbrilli MD, Benas JS, Spiro CN, Haimm CA, Gallop R, Mufson L, Gillham JE. Long-Term Effects from a School-Based Trial Comparing Interpersonal Psychotherapy-Adolescent Skills Training to Group Counseling. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:S362-S370. [PMID: 29979882 DOI: 10.1080/15374416.2018.1479965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Adolescence represents a vulnerable developmental period for depression and an opportune time for prevention efforts. In this study, 186 adolescents with elevated depressive symptoms (M age = 14.01, SD = 1.22; 66.7% female; 32.2% racial minority) were randomized to receive either Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST; n = 95) delivered by research clinicians or group counseling (GC; n = 91) delivered by school counselors. We previously reported the short-term outcomes of this school-based randomized controlled trial: IPT-AST youth experienced significantly greater improvements in depressive symptoms and overall functioning through 6-month follow-up. Here, we present the long-term outcomes through 24 months postintervention. We examined differences in rates of change in depressive symptoms and overall functioning and differences in rates of depression diagnoses. Youth in both conditions showed significant improvements in depressive symptoms and overall functioning from baseline to 24-month follow-up, demonstrating the efficacy of school-based depression prevention programs. However, the two groups did not differ in overall rates of change or in rates of depression diagnoses from baseline to 24-month follow-up. Although IPT-AST demonstrated advantages over GC in the short term, these effects dissipated over long-term follow-up. Specifically, from 6- to 24-month follow-up, GC youth showed continued decreases in depressive symptoms, whereas IPT-AST youth showed a nonsignificant increase in symptoms. GC youth remained relatively stable in overall functioning, whereas IPT-AST youth experienced a small but statistically significant worsening in functioning. This study highlights the potential of school-based depression prevention efforts and the need for further research.
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Affiliation(s)
- Jami F Young
- a Department of Child and Adolescent Psychiatry and Behavioral Sciences , Children's Hospital of Philadelphia.,b PolicyLab , Children's Hospital of Philadelphia.,c Department of Psychiatry, University of Pennsylvania
| | - Jason D Jones
- a Department of Child and Adolescent Psychiatry and Behavioral Sciences , Children's Hospital of Philadelphia.,b PolicyLab , Children's Hospital of Philadelphia
| | - Marissa D Sbrilli
- a Department of Child and Adolescent Psychiatry and Behavioral Sciences , Children's Hospital of Philadelphia.,b PolicyLab , Children's Hospital of Philadelphia
| | - Jessica S Benas
- d Graduate School of Applied and Professional Psychology , Rutgers University
| | | | | | - Robert Gallop
- f Department of Mathematics , West Chester University
| | - Laura Mufson
- g Department of Psychiatry , Columbia University.,h New York State Psychiatric Institute
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Age-varying associations between coping and depressive symptoms throughout adolescence and emerging adulthood. Dev Psychopathol 2018; 30:665-681. [DOI: 10.1017/s0954579417001183] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractThe objective of the current study was to apply the novel technique of time-varying effect modeling to examine age-varying associations between specific coping strategies and depressive symptoms across adolescence and emerging adulthood (ages 14–24). The participants were drawn from a community sample and followed across 4 years of high school and once 5 years postgraduation (N = 1,251, 53% female, 58% non-Hispanic White). Coping and depressive symptom questionnaires were administered across all data collection time points. Time-varying effect modeling used all available data (N = 5,651 measurement occasions) and adjusted for gender. Venting emotions and denial were associated with more depressive symptoms at a similar magnitude across adolescence and emerging adulthood. A positive association between problem solving oriented strategies (planning, active coping) and depressive symptoms was not observed until age 17.5, after which the magnitude of the association strengthened. More frequent instrumental and emotional support seeking were linked to fewer depressive symptoms between ages 18.8 and 23.6. More frequent use of humor was associated with greater depressive symptoms from ages 14.0 to 14.6, but with fewer depressive symptoms from ages 16.8 to 18.8. The findings illuminate when and how associations between specific coping strategies and depressive symptoms may emerge and change across developmental age, generating both theoretical and clinical implications.
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Lattie EG, Ho J, Sargent E, Tomasino KN, Smith J, Brown CH, Mohr DC. Teens Engaged in Collaborative Health: The Feasibility and Acceptability of an Online Skill-Building Intervention for Adolescents at Risk for Depression. Internet Interv 2017; 8:15-26. [PMID: 28584734 PMCID: PMC5456272 DOI: 10.1016/j.invent.2017.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is an ongoing need for effective and accessible preventive interventions for adolescent depression and substance abuse. This paper reports on a field trial of an online indicated preventive intervention, ProjectTECH, which is based on cognitive-behavioral therapy (CBT) techniques. The study aims to gather information about the feasibility and acceptability of this program. Secondary aims of this study were to examine the impact of the program on depression symptoms, perceived stress, positive affect, and substance use and to compare differences between groups that were led by a peer versus those that were led by a licensed clinician. METHODS High school students (n = 39) were recruited primarily through social media advertisements, and assigned to four groups of 8-12 individuals to collaboratively participate in an 8 week peer network-based online preventive intervention which were led by a trained peer guide or a licensed clinician. Participants were provided with didactic lessons, CBT-based mood management tools, and peer networking features, and completed quantitative and qualitative feedback at baseline, midpoint, end of intervention, and 1 month follow up. RESULTS The program attracted and retained users primarily from social media and was used frequently by many of the participants (system login M = 25.62, SD = 16.58). Participants rated the program as usable, and offered several suggestions for improving the program, including allowing for further personalization by the individual user, and including more prompts to engage with the social network. From baseline to end of intervention, significant decreases were observed in depressive symptoms and perceived stress (p's < .05). Significant increases in positive affect were observed from baseline to midpoint (p < .05) and no changes were observed in substance use, although the rate of substance use was low in this sample. While this study had low power to detect group differences, no consistent differences were observed between participants in a peer-led group and those in a clinician-led group. CONCLUSIONS Results of this study indicates that ProjectTECH, an indicated preventive intervention for high school-aged adolescents, demonstrates both feasibility, acceptability, and short-term, longitudinal psychological benefits for participants. Future iterations of the program may benefit from close attention to user interface design and the continued use of trained peer support guides.
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Affiliation(s)
- Emily G. Lattie
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60611, USA
| | - Joyce Ho
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60611, USA
| | - Elizabeth Sargent
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60611, USA
| | - Kathryn N. Tomasino
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60611, USA
| | - J.D. Smith
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60611, USA
| | - C. Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60611, USA
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60611, USA
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Ho J, Corden ME, Caccamo L, Tomasino KN, Duffecy J, Begale M, Mohr DC. Design and evaluation of a peer network to support adherence to a web-based intervention for adolescents. Internet Interv 2016; 6:50-56. [PMID: 27722095 PMCID: PMC5052813 DOI: 10.1016/j.invent.2016.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Depression during adolescence is common but can be prevented. Behavioral intervention technologies (BITs) designed to prevent depression in adolescence, especially standalone web-based interventions, have shown mixed outcomes, likely due to poor intervention adherence. BIT research involving adults has shown that the presence of coaches or peers promotes intervention use. Developmentally, adolescence is a time when peer-based social relationships take precedence. This study examines whether peer-networked support may promote adherence to BITs in this age group. OBJECTIVE Adopting the framework of the Supportive Accountability model, which defines the types of human support and interactions required to maintain engagement and persistence with BITs, this paper presents a feasibility study of a peer-networked online intervention for depression prevention among adolescents. We described the development of the peer network, the evaluation of participant use of the peer networking features, and qualitative user feedback to inform continued BIT development. METHOD Two groups of adolescents (N = 13) participated in 10-week programs of the peer networked based online intervention. Adolescents had access to didactic lessons, CBT based mood management tools, and peer networking features. The peer networking features are integrated into the site by making use expectations explicit, allow network members to monitor the activities of others, and to supportively hold each other accountable for meeting use expectations. The study collected qualitative feedback from participants as well as usage of site features and tools. RESULTS Participants logged in an average of 12.8 sessions over an average of 10.4 unique days during the 10-week program. On average, 66% of all use sessions occurred within the first 3 weeks of use. The number of "exchange comments", that is, comments posted that were part of an exchange between two or more participants, was significantly positively correlated with mean time spent on site (r = 0.62, p = 0.032), use of the Activity Tracker (r = 0.70, p = 0.012) and Didactic Lesson (r = 0.73, p = 0.007). Qualitative interviews revealed that adolescents generally liked and were motivated by the peer networking features during the first weeks of the intervention when general site use by group members was high. However, the decrease of site use by group members during the subsequent weeks negatively affected participants' desire to log on or engage with group members. CONCLUSIONS This pilot study highlights the potential that a BIT designed to harness the connection among a peer network, thereby promoting supportive accountability, may improve adolescent adherence to BITs for depression prevention.
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Affiliation(s)
- Joyce Ho
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60015, USA
| | - Marya E. Corden
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60015, USA
| | - Lauren Caccamo
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60015, USA
| | - Kathryn Noth Tomasino
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60015, USA
| | - Jenna Duffecy
- Department of Psychiatry, University of Illinois at Chicago, 1061 W. Taylor St., Chicago, IL 60612, USA
| | - Mark Begale
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60015, USA
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL 60015, USA,Corresponding author.
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Benas JS, McCarthy AE, Haimm CA, Huang M, Gallop R, Young JF. The Depression Prevention Initiative: Impact on Adolescent Internalizing and Externalizing Symptoms in a Randomized Trial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2016; 48:S57-S71. [PMID: 27646462 PMCID: PMC5493504 DOI: 10.1080/15374416.2016.1197839] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This randomized controlled trial examined the longitudinal effects of two school-based indicated depression prevention programs on adolescents' internalizing and externalizing symptoms, as measured by adolescents, their parents, and their teachers. One hundred eighty-six adolescents participated in this study. The average age was 14.01 (SD = 1.22) years, and the sample was 66.7% female. One third of the sample belonged to a racial minority. Youth received either Interpersonal Psychotherapy-Adolescent Skills Training or group counseling. Symptoms were assessed using adolescent, parent, and teacher reports on the Achenbach System of Empirically Based Assessment at baseline, postintervention, and 6-month follow-up. Adolescents reported the most robust effects in favor of Interpersonal Psychotherapy-Adolescent Skills Training. Adolescents in Interpersonal Psychotherapy-Adolescent Skills Training reported significantly greater reductions in internalizing symptoms through the 6-month follow-up and significantly greater reductions in externalizing symptoms during the intervention as compared to group counseling. Less robust effects were found when examining parent and teacher reports, although there was evidence of significant within-group change in parent- and teacher-reported internalizing symptoms for both interventions and significant between-group differences in teacher-reported externalizing symptoms. This study provides additional evidence supporting the efficacy of Interpersonal Psychotherapy-Adolescent Skills Training as a depression prevention program for adolescents. Interpersonal Psychotherapy-Adolescent Skills Training appears to have fast-acting effects on broadband internalizing and externalizing symptoms as reported by adolescents. This suggests that Interpersonal Psychotherapy-Adolescent Skills Training may serve as a transdiagnostic preventive intervention. Moreover, given the disparate reports of adolescents, parents, and teachers, this study demonstrates the significance of collecting information from multiple sources when possible.
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Affiliation(s)
- Jessica S Benas
- a Graduate School of Applied and Professional Psychology, Rutgers University
| | - Alyssa E McCarthy
- a Graduate School of Applied and Professional Psychology, Rutgers University
| | - Caroline A Haimm
- a Graduate School of Applied and Professional Psychology, Rutgers University
| | - Meghan Huang
- a Graduate School of Applied and Professional Psychology, Rutgers University
| | - Robert Gallop
- b Department of Mathematics, West Chester University
| | - Jami F Young
- a Graduate School of Applied and Professional Psychology, Rutgers University
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From Mice to Men: Can Ketamine Enhance Resilience to Stress? Biol Psychiatry 2016; 79:e57-9. [PMID: 27079496 PMCID: PMC5064846 DOI: 10.1016/j.biopsych.2016.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/08/2016] [Indexed: 11/20/2022]
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MacPherson HA, Mackinaw-Koons B, Leffler JM, Fristad MA. Pilot Effectiveness Evaluation of Community-Based Multi-Family Psychoeducational Psychotherapy for Childhood Mood Disorders. ACTA ACUST UNITED AC 2016; 5:43-59. [PMID: 27057423 DOI: 10.1037/cfp0000055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Several psychosocial, family-focused Evidence-Based Treatments (EBTs) for youth with disruptive behavior have proven effective in practice settings. However, limited research has examined community implementation of EBTs for pediatric depression and bipolar disorder. This pilot open trial evaluated Multi-Family Psychoeducational Psychotherapy (MF-PEP) with 41 children ages 7 to 12 (54% male, 92% Caucasian) with mood disorders and their parents in an outpatient setting. MF-PEP is an 8-session, adjunctive EBT with parallel child and parent groups. Fourteen community therapists facilitated six MF-PEP groups at three agencies over two years. Developed checklists were used to evaluate adherence. Clinical outcomes were measured via clinician assessment and self-report questionnaires at pre-treatment, post-treatment, 6-month follow-up, and 12-month follow-up, and analyzed via hierarchical linear modeling. Therapist group adherence ranged from 66.71% to 78.68% (M = 72.14%, SD = 4.85). Children experienced significant improvement in depressive and manic symptoms, and parents reported a significant increase in knowledge of mood disorders. Children with bipolar disorder and families with limited treatment history benefitted most from MF-PEP. Effect sizes (Cohen's d) ranged from small to large for mood outcomes (d = 0.34 to 1.18), knowledge (d = 1.02), and treatment beliefs (d = 0.04 to 0.41). Limitations included small sample, missing data, and open design. Results suggest that MF-PEP may be impactful for families affected by pediatric mood disorders in the community, especially among youth with bipolar disorder and families novice to treatment. Randomized controlled trials are needed to provide more definitive evidence for the effectiveness of MF-PEP in practice settings.
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Affiliation(s)
- Heather A MacPherson
- Departments of Psychology and Psychiatry and Behavioral Health, The Ohio State University
| | | | | | - Mary A Fristad
- Departments of Psychiatry and Behavioral Health, Psychology, and Nutrition, The Ohio State University
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