Improvements in Interpersonal Functioning Following Interpersonal Psychotherapy (IPT) with Adolescents and their Association with Change in Depression. Behav Cogn Psychother. 2016;44:257-272. [PMID: 26292976 DOI: 10.1017/s1352465815000442]

The Associations Between Attachment Insecurity and Compulsive Sexual Behavior Disorder or Problematic Pornography Use: The Mediating Role of Emotion Regulation Difficulties

Compulsive sexual behavior disorder (CSBD) was previously considered an attachment disorder, while emotion dysregulation was thought to potentially be a key characteristic of it. However, this theoretical model was not tested in previous empirical research. In our cross-sectional study, we tested whether emotional regulation (ER) difficulties can be adopted as an explanatory mechanism for the relationships between attachment avoidance and anxiety, as well as CSBD and its most prevalent behavioral presentation-problematic pornography use (PPU). Participants (n = 1002; Mage = 50.49 years, SD = 13.32; men: 50.2%) completed an online survey regarding the investigated variables. In mediation analyses, attachment avoidance and anxiety were treated as simultaneous predictors, ER difficulties as a mediating variable, with CSBD/PPU severity as dependent variables. Emotion regulation difficulties and attachment anxiety had a direct positive effect on both CSBD and PPU. The direct effect of attachment avoidance on PPU was non-significant, and significant for CSBD depending on the measure used. Moreover, all the relationships between both insecure attachment dimensions and CSBD/PPU symptom severity were at least partially mediated by ER difficulties. Our results corroborate the theoretical claim that ER difficulties may be a useful framework for explaining the impact of attachment insecurity on CSBD/PPU. Theoretical and practical implications of the findings are discussed.

Examining concurrent validity and item selection of the Session Wants and Needs Outcome Measure (SWAN-OM) in a children and young people web-based therapy service

BACKGROUND

Single-session mental health interventions are frequently attended by children and young people (CYP) in both web-based and face-to-face therapy settings. The Session "Wants" and "Needs" Outcome Measure (SWAN-OM) is an instrument developed in a web-based therapy service to overcome the challenges of collecting outcomes and experiences of single-session therapies (SSTs). It provides pre-defined goals for the session, selected by the young person prior to the intervention, on which progress toward achievement is scored at the end of the session.

OBJECTIVE

The objective of this study was to evaluate the instrument's psychometric properties, including concurrent validity against three other frequently used outcome and experience measures, at a web-based and text-based mental health service.

METHODS

The SWAN-OM was administered for a period of 6 months to 1,401 CYP (aged 10-32 years; 79.3% white; 77.59% female) accessing SST on a web-based service. Item correlations with comparator measures and hierarchical logistic regressions to predict item selection were calculated for concurrent validity and psychometric exploration.

RESULTS

The most frequently selected items were "Feel better" (N = 431; 11.61%) and "Find ways I can help myself" (N = 411; 11.07%); unpopular items were "Feel safe in my relationships" (N = 53; 1.43%) and "Learn the steps to achieve something I want" (N = 58; 1.56%). The SWAN-OM was significantly correlated with the Experience of Service Questionnaire, particularly the item "Feel better" [rs₍₁₀₉₎ = 0.48, p < 0.001], the Youth Counseling Impact Scale, particularly the item "Learn the steps to achieve something I want" [rs₍₂₂₎ = 0.76, p < 0.001], and the Positive and Negative Affect Schedule, particularly the items "Learn how to feel better" [rs₍₂₂₎ = 0.72, p < 0.001] and "Explore how I feel" [rs₍₇₀₎ = -0.44, p < 0.001].

CONCLUSION

The SWAN-OM demonstrates good concurrent validity with common measures of outcome and experience. Analysis suggests that lesser-endorsed items may be removed in future iterations of the measure to improve functionality. Future research is required to explore SWAN-OM's potential to measure meaningful change in a range of therapeutic settings.

Effect of interpersonal psychotherapy on social functioning, overall functioning and negative emotions for depression: A meta-analysis

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.

Interpersonal Psychotherapy's problem areas as an organizing framework to understand depression and sexual and reproductive health needs of Kenyan pregnant and parenting adolescents: a qualitative study

BACKGROUND

Peripartum adolescents experience significant interpersonal transitions in their lives. Depression and emotional distress are often exacerbated by adolescents' responses to these interpersonal changes. Improved understanding of pregnancy-related social changes and maladaptive responses to these shifts may inform novel approaches to addressing the mental health needs of adolescents during the perinatal period. The paper aims to understand the sources of psychological distress in peripartum adolescents and map these to Interpersonal Psychotherapy's (IPT) problem areas as a framework to understand depression.

METHOD

We conducted interviews in two Nairobi primary care clinics with peripartum adolescents ages 16-18 years (n = 23) with experiences of depression, keeping interpersonal psychotherapy framework of problem areas in mind. We explored the nature of their distress, triggers, antecedents of distress associated with an unplanned pregnancy, quality of their relationships with their partner, parents, and other family members, perceived needs, and sources of support.

RESULTS

We found that the interpersonal psychotherapy (IPT) framework of interpersonal problems covering grief and loss, role transitions, interpersonal disputes, and social isolation was instrumental in conceptualizing adolescent depression, anxiety, and stress in the perinatal period.

CONCLUSION

Our interviews deepened understanding of peripartum adolescent mental health focusing on four IPT problem areas. The interpersonal framework yields meaningful information about adolescent depression and could help in identifying strategies for addressing their distress.

Real-World Functioning in Psychiatric Outpatients: Predictive Factors

INTRODUCTION

Investigations on predictors of real-world functioning were mainly performed in patients with schizophrenia, while fewer studies have been conducted in other psychiatric disorders.

OBJECTIVE

Our objective was to identify clinical, socio-demographic, and illness-related predictors of real-world functioning during 12 months of standard treatments in outpatients with different diagnoses.

METHODS

Outpatients (n = 1019) with schizophrenia (SZ), major depressive disorder (MDD), bipolar disorder (BD), and borderline personality disorder (BPD) were evaluated with the following tools: SCID-5-CV and SCID-5-PD, CGI-S, SAT-P, DAI-10, and PSP. Change of PSP (ΔPSP) between baseline and 12 months was used as the dependent variable in multiple regression analysis.

RESULTS

Higher PSP score at baseline and the achievement of main milestones predicted better functioning after follow-up in all subgroups of patients, with the exception of BD. In the total sample, ΔPSP was related to age of onset, treatments, and quality of life, and inversely related to psychiatric anamnesis, antidepressants, and global symptoms. In SZ, ΔPSP was related to adherence and quality of life. In MDD, ΔPSP was related to psychotherapy and quality of life, and inversely related to antidepressants and global symptoms. In BD, ΔPSP was related to age of onset, antipsychotics, and quality of life, while it was inversely related to psychiatric anamnesis. In BPD, antipsychotics, mood stabilizers, psychotherapy, and quality of life were directly related to ΔPSP, while suicidal attempts and global symptoms had an inverse relation. Conclusions: Several socio-demographic and illness-related variables predicted improvement of real-world functioning, besides psychopathology and severity of the disease.

Acceptability and impact of group interpersonal therapy (IPT-G) on Kenyan adolescent mothers living with human immunodeficiency virus (HIV): a qualitative analysis

Background

Task shifting is a well-tested implementation strategy within low- and middle-income countries that addresses the shortage of trained mental health personnel. Task shifting can increase access to care for patients with mental illnesses. In Kenya, community health workers (CHWs) are a combination of community health assistants and community health volunteers and have played a crucial role on this front. In our study, we seek to assess the acceptability and feasibility of Group Interpersonal Psychotherapy (IPT-G) delivered by CHWs among depressed postpartum adolescents (PPAs) living with human immunodeficiency virus (HIV).

Method

The study used theoretical framework of behaviour change including: Capability, Opportunity and Motivation (COM-B model) to help understand behavioural changes due to IPT-G intervention delivered by the CHWs. 24 PPAs were administered IPT-G by trained CHWs from two health centres. A two-arm study design (IPT-G intervention and treatment as usual) with an intent to treat was used to assess the acceptability and feasibility of IPT-G. With purposeful sampling, participants who scored > 10 on the Edinburgh postnatal depression scale and who were 6–12 weeks postpartum were eligible for the study. Participants were equally distributed into two groups: one group for intervention and another as a wait-listed group. This was achieved by randomly allocating numerical numbers and separating those with odd numbers (intervention group) and even numbers (wait-listed group). Focus group discussions and in-depth interviews ascertained the experiences and perceptions of the PPAs and the CHWs during IP-G delivery process. In addition to weekly face-to-face continuous supportive supervision for the CHWs, the researchers also utilized phone calls, short messages services and WhatsApp instant messaging services.

Results

The CHWs found the intervention useful for their own knowledge and skill-set. With regards to participation, 21 out of the 24 adolescents attended all sessions. Most of the adolescents reported an improvement in their interpersonal relationships with reduced distress and lessening of HIV-related stigma. Primary healthcare workers embraced the intervention by accommodating the sessions in their routine clinic activities.

Conclusion

Our study demonstrates the possible benefits of task shifting in addressing mental health problems within low-resource settings in Kenya, and IPT-G is demonstrated to be both acceptable and feasible by health workers and adolescents receiving care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01807-w.

Secret Agent Society: A Randomized Controlled Trial of a Transdiagnostic Youth Social Skills Group Treatment

Group programs are key for targeting social skills (SS) for children with developmental disorders and/or mental illness. Despite promising evidence regarding efficacy of group treatments, there are several limitations to current research regarding generalizability and effectiveness across diagnoses. This randomized control trial assessed whether the Secret Agent Society (SAS) group program was superior to treatment as usual (TAU) in improving social-emotional functioning for children with Attention Deficit-Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and/or anxiety. Eighty-nine youth (8-12) with ADHD, ASD, and/or an anxiety disorder receiving treatment at hospital-based outpatient clinics were randomized to receive SAS (n = 47) or TAU (n = 42) over a three-month period, at which point TAU participants were offered the SAS intervention. Parent report showed significant improvement in Emotion Regulation (ER) and Social Skills (SS) for youth in SAS vs. TAU (Fs ≥ 6.79, ps ≤ 01). Gains for the SAS condition were maintained at 6-months. Intent-to-treat analysis of teacher report indicated youth in SAS had positive gains in SS (F = 0.41, p = 0.475) and ER (F = 0.99, p = 0.322), though not significantly better than youth in TAU. Clinically reliable improvement rates were significantly higher for SAS participants than TAU for parent and teacher reported SS and ER. Improvements were significant for youth with single and comorbid diagnoses. Results suggest that SAS was superior to TAU in improving SS and ER for youth aged 8-12 with ADHD, ASD, and/or anxiety. Gains maintained in the medium-term. Trial registration number NCT02574273, registered 10/12/2015.

Mental Health Surveillance Among Children - United States, 2013-2019

Mental health encompasses a range of mental, emotional, social, and behavioral functioning and occurs along a continuum from good to poor. Previous research has documented that mental health among children and adolescents is associated with immediate and long-term physical health and chronic disease, health risk behaviors, social relationships, education, and employment. Public health surveillance of children's mental health can be used to monitor trends in prevalence across populations, increase knowledge about demographic and geographic differences, and support decision-making about prevention and intervention. Numerous federal data systems collect data on various indicators of children's mental health, particularly mental disorders. The 2013-2019 data from these data systems show that mental disorders begin in early childhood and affect children with a range of sociodemographic characteristics. During this period, the most prevalent disorders diagnosed among U.S. children and adolescents aged 3-17 years were attention-deficit/hyperactivity disorder and anxiety, each affecting approximately one in 11 (9.4%-9.8%) children. Among children and adolescents aged 12-17 years, one fifth (20.9%) had ever experienced a major depressive episode. Among high school students in 2019, 36.7% reported persistently feeling sad or hopeless in the past year, and 18.8% had seriously considered attempting suicide. Approximately seven in 100,000 persons aged 10-19 years died by suicide in 2018 and 2019. Among children and adolescents aged 3-17 years, 9.6%-10.1% had received mental health services, and 7.8% of all children and adolescents aged 3-17 years had taken medication for mental health problems during the past year, based on parent report. Approximately one in four children and adolescents aged 12-17 years reported having received mental health services during the past year. In federal data systems, data on positive indicators of mental health (e.g., resilience) are limited. Although no comprehensive surveillance system for children's mental health exists and no single indicator can be used to define the mental health of children or to identify the overall number of children with mental disorders, these data confirm that mental disorders among children continue to be a substantial public health concern. These findings can be used by public health professionals, health care providers, state health officials, policymakers, and educators to understand the prevalence of specific mental disorders and other indicators of mental health and the challenges related to mental health surveillance.

A cross-lagged panel model for testing the bidirectional relationship between depression and smartphone addiction and the influences of maladaptive metacognition on them in Chinese adolescents

AIMS

Despite the high prevalence of both depression and smartphone addiction among Chinese adolescents, research examining their bidirectional relationship has been limited. Moreover, longitudinal research regarding the influence of maladaptive metacognitive beliefs on smartphone addiction is scarce. This 6-month longitudinal study aimed to address these research gaps by testing a cross-lagged panel model of maladaptive metacognition, depression, and smartphone addiction.

METHODS

Four hundred and fifty-nine Chinese high school students voluntarily completed an anonymous questionnaire at baseline, and 313 of them (36.1% male; age = 14 to 18; M = 16.88, SD = 0.62) completed the same questionnaire at follow-up.

RESULTS

Positive correlations were shown among depression, smartphone addiction, and maladaptive metacognition at both waves (r = 0.16 to 0.57, p < .01). The results of the cross-lagged analysis demonstrated only the prospective effect of depression on smartphone addiction (β = 0.18, p < .001) but not vice versa. Moreover, maladaptive metacognition assessed at baseline significantly predicted subsequent depression (β = 0.14, p < .01) but not smartphone addiction (p>.05). Additional path analysis showed a significant indirect effect of baseline maladaptive metacognition (0.099 [95% CI = 0.042, 0.183]) on subsequent smartphone addiction, via depression.

CONCLUSIONS

Findings of this study showed that the relationship between depression and smartphone addiction was unidirectional rather than bidirectional among Chinese adolescents. Specifically, depression predicted smartphone addiction, while maladaptive metacognition predicted depression. Depression also mediated the relationship between maladaptive metacognition and smartphone addiction. The findings suggest that incorporating metacognition and depression interventions into smartphone addiction prevention designs for adolescents may be beneficial.

Ultra-brief crisis interpersonal psychotherapy based intervention for suicidal children and adolescents

Suicidal behaviors in adolescence are a major public health concern. The dramatic rise in self-injurious behaviors among adolescents has led to an overwhelming increase in the number of those presenting to the emergency rooms. The intervention described below was constructed on the basis of brief and focused interventions that were found to be effective among suicidal adults using an adaptation of interpersonal psychotherapy for adolescents. The intervention has four main objectives: first, a focused treatment for reducing suicide risk; second, a short and immediate response; third, building a treatment plan based on understanding the emotional distress and interpersonal aspects underlying suicidal behavior; and lastly, to generate hope among adolescents and their parents. The intervention includes intensive five weekly sessions, followed by 3 mo of email follow-up.

Evidence Base Update for Measures of Social Skills and Social Competence in Clinical Samples of Youth

Social skills and social competence are key transdiagnostic processes in developmental psychopathology and are the focus of an array of clinical interventions. In this Evidence Base Update, we evaluated the psychometric properties of measures of social skills and social competence used with clinical samples of children and adolescents. A systematic literature search yielded eight widely used measures of social skills and one measure of social competence. Applying the criteria identified by Youngstrom et al. (2017), we found that, with some exceptions, these measures had adequate to excellent norms, internal consistency, and test-retest reliability. There was at least adequate evidence of construct validity and treatment sensitivity in clinical samples for nearly all measures assessed. Many of the scales included items assessing constructs other than social skills and competence (e.g., emotion regulation). Development of updated tools to assess youth's effectiveness in key interpersonal situations, including those occurring online, may yield clinical dividends.

A 6-Year Longitudinal Study of Adolescents and Mothers Depression Symptoms and Their Perception of Support and Conflict

Interpersonal theories of adolescent depression assume that adolescent and maternal depression symptoms affect adolescent and maternal perceptions of their relationship quality. However, little attention has been given to examining potential bidirectional prospective associations between both adolescent and maternal perceptions of the mother-adolescent relationship and adolescent and maternal depression symptoms across adolescence. We hypothesized that the longitudinal associations between adolescent and maternal depression symptoms and adolescent and maternal perception of conflict and support in the mother-adolescent relationship would be bidirectional. In this 6-year longitudinal study, 497 adolescents (Mage = 13.03) and their mothers participated. Each year both adolescents and their mothers completed questionnaires of their depression symptoms and their perception of conflict and support in the mother-adolescent relationship. Structural equation modelling cross-lagged panel models were constructed and analyzed. The cross-lagged panel models found bidirectional longitudinal associations between adolescent depressive symptoms and higher adolescent-reported conflict and lower adolescent-reported support. In contrast, maternal depressive symptoms were only unidirectionally associated with higher maternal-reported conflict, lower maternal-reported support and higher adolescent depression symptoms. Finally, positive bidirectional longitudinal associations were found between adolescent-reported and maternal-reported conflict, and between adolescent-reported and maternal-reported support. The findings of this study are discussed in relation to Interpersonal Psychotherapy for Depressed Adolescents (IPT-A).

Psychosocial risk factors associated with depressive symptoms among adolescents in secondary schools in mainland china: A systematic review and meta-analysis

BACKGROUND

The objective of the study is to systematically estimate the effect size of psychosocial risk factors for depressive symptoms among adolescents in secondary schools in mainland China.

METHOD

A literature search was conducted in both English and Chinese databases. This meta-analysis used a random-effects model to estimate the effect size.

RESULTS

Fifteen psychosocial risk factors were identified in a total of 164 articles. The results revealed the absolute value of effect size ranging from 0.16 to 0.43. Among them, poor parent-child communication (r = 0.43), negative life events (r = 0.40), academic pressure (r = 0.40), abuse (r = 0.33), poor family functioning (r = 0.33), bullying (r = 0.32), and poor family cohesion (r = 0.32) were associated with depression with a medium to large effect. Moderator analysis shows that grade, study quality, mean age, and gender were significant moderators of at least one factor for depression.

LIMITATIONS

Limitations included the heterogeneity which is largely unexplained, and the inability to investigate the interactions of different factors and to determine the direction of causal relationships between psychosocial factors and depression in the present meta-analysis.

CONCLUSIONS

This study suggests that family-related factors and school-related factors may be significantly associated with depressive symptoms in Chinese secondary school students. Further research is needed to develop effective strategies to modify these factors in depression prevention programmes.

Ultra-Brief Crisis IPT-A Based Intervention for Suicidal Children and Adolescents (IPT-A-SCI) Pilot Study Results

In recent years, suicidal behaviors have shown substantial increase worldwide. This trend is also prominent in Israel and has led to a dramatic increase in mental health treatment demand resulting in long wait times and low treatment acceptance rate. To address the critical need in crisis intervention for children and adolescents at suicidal risk we developed an ultra-brief acute crisis intervention, based on Interpersonal Psychotherapy (IPT). IPT is an evidence-based intervention for various psychopathologies among different age groups. The current adaptation of IPT-A is comprised of five weekly sessions, followed by monthly follow-up caring email contacts to the patients and their parents, over a period of 3 months. This paper aims to review the theoretical foundation of this intervention, describe the research design, and present preliminary results of a pilot study. Preliminary Results from our samples of 26 adolescents indicate meaningful trends for both the suicidal ideation (SIQ) and depression (MFQ) outcome measures. Significant interaction was found concerning suicidal ideation but not for depression. Main limitations include small sample size and stratified controls. The treatment appears to be safe, feasible and acceptable and initial results show promising trends to support further study of the approach.

Mitigating depression among orphaned and vulnerable adolescents: a randomized controlled trial of interpersonal psychotherapy for groups in South Africa

BACKGROUND

Children and adolescents affected by HIV are at elevated risk of depression, yet research on related interventions in this population is scarce in sub-Saharan Africa. This study sought to examine the effects of interpersonal psychotherapy for groups (IPTG) on depressive symptomology among orphaned and vulnerable adolescents in South Africa.

METHOD

A cluster randomized controlled trial wherein adolescents ages 14-17 enrolled in community-based programming for HIV-affected and vulnerable families were randomly assigned by geographic cluster to participate in a 16-session IPTG intervention or the standard of care (n = 489). Baseline and postintervention surveys conducted with enrollees included standardized depression screening. Utilizing an intent-to-treat design, mixed effects models were performed to examine treatment effects for all participants and potential moderators including gender and baseline depression level (Clinical Trials registration: ClinicalTrials.gov NCT02386878).

RESULTS

While 23% of adolescents in the intervention group did not attend any IPTG sessions, average attendance was 12 out of 16 possible sessions among participants. The intervention was not associated with changes in depression symptomology.

CONCLUSIONS

Results underscore the importance of mitigating participation barriers prior to intervention roll-out and the need for increased evidence for psychological health interventions to mitigate depression among orphaned and vulnerable adolescents. This intervention and the study selectively targeted at-risk adolescents versus using diagnostic mental health criteria for enrollment; more research is needed to identify the potential benefits and disadvantages of these approaches.

Adapting to the changing needs of adolescents: parenting practices and challenges to sensitive attunement

Changes in adolescents' motivations and capabilities pose unique challenges to parents who play a continuing role in ensuring the youth's safety and well-being. We describe sensitively attuned parenting as an optimal response to this challenge and summarize practices of positive engagement, supervision/guidance and open communication that support sensitive attunement and facilitate the continuing development of the adolescent's self-confidence, autonomous decision-making, and communication skills. We then consider factors that require parents to adapt their practices to the particular needs and developmental level of the adolescent. Individual differences that may challenge parent's effectiveness in implementing these practices include: biological vulnerabilities, differential sensitivity to parenting, relationship history and temperament. Clinical interventions that seek to improve parenting offer an opportunity to test sensitive attunement as a mechanism for reducing adolescents' symptoms and problem behaviors.