Innovations in Practice: a pilot study of interpersonal psychotherapy for depressed adolescents and their parents

Parental Involvement in Adolescent Psychological Interventions: A Meta-analysis

Psychological interventions for adolescents have shown mixed efficacy, and including parents in interventions may be an important avenue to improve treatment outcomes. Evidence from meta-analyses examining the role of parents in interventions for youth is inconsistent and has typically combined findings for both children and adolescents together. No prior meta-analysis has examined the specific role of parents in adolescent interventions as compared with interventions focused solely on adolescents across several disorders. To address this gap, systematic literature reviews were conducted utilizing a combination of searches among keywords including (parent * OR family) AND (intervention OR therap * OR treatment OR prevent*) AND (adolescen*). Inclusion criteria were (1) a randomized controlled trial of an individual psychological intervention compared to the same intervention with a parental component, and (2) adolescents must have at least current symptoms or risk to be included. Literature searches identified 20 trials (N = 1251). Summary statistics suggested that interventions involving parents in treatment have a significantly greater impact on adolescent psychopathology when compared to interventions that targeted adolescents alone (g = - 0.18, p < .01, 95% CI [- 0.30, - 0.07]). Examination with symptom type (internalizing or externalizing) as a moderator found that the significant difference remained for externalizing (g = - 0.20, p = .01, 95% CI [- 0.35, - 0.05]) but not internalizing psychopathology (p = .11). Findings provide evidence of the importance of including parents in adolescent therapy, particularly for externalizing problems.

The impact of family interventions on communication in the context of anxiety and depression in those aged 14-24 years: systematic review of randomised control trials

BACKGROUND

The ability to communicate is integral to all human relationships. Previous research has specifically highlighted communication within families as both a risk and protective factor for anxiety disorders and/or depression. Yet, there is limited understanding about whether communication is amenable to intervention in the context of adolescent psychopathology, and whether doing so improves outcomes.

AIMS

The aim of this systematic review was to determine in which contexts and for whom does addressing communication in families appear to work, not work and why?

METHOD

We pre-registered our systematic review with PROSPERO (identifier CRD42022298719), followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and assessed study quality with the Risk of Bias 2 tool.

RESULTS

Seven randomised controlled trials were identified from a systematic search of the literature. There was significant heterogeneity in the features of communication that were measured across these studies. There were mixed findings regarding whether family-focused interventions led to improvements in communication. Although there was limited evidence that family-focused interventions led to improvements in communication relative to interventions without a family-focused component, we discuss these findings in the context of the significant limitations in the studies reviewed.

CONCLUSIONS

We conclude that further research is required to assess the efficacy of family-focused interventions for improving communication in the context of anxiety and depression in those aged 14-24 years.

Review: Adverse event monitoring and reporting in studies of pediatric psychosocial interventions: a systematic review

BACKGROUND

Adverse event monitoring in studies of psychotherapy is crucial to clinical decision-making, particularly for weighing of benefits and harms of treatment approaches. In this systematic review, we identified how adverse events are defined, measured, and reported in studies of psychosocial interventions for children with mental disorders.

METHOD

Medline, PsycINFO, Embase, ProQuest Dissertations and Theses Global, and the Cochrane Library were searched from January 2011-January 2023, and Google Scholar from January 2011-February 2023. English language experimental and quasi-experimental studies that evaluated the efficacy or effectiveness of psychosocial interventions for childhood mental disorders were included. Information on the definition, assessment, and report of adverse events was extracted using a checklist based on Good Clinical Practice guidelines.

RESULTS

In this review, 117 studies were included. Studies most commonly involved treating anxiety disorders or obsessive-compulsive disorder (32/117; 27%); 44% of the experimental interventions tested (52/117) were cognitive behavioral therapies. Adverse events were monitored in 36 studies (36/117; 31%) with a protocol used in 19 of these studies to guide monitoring (19/36; 53%). Twenty-seven different events were monitored across the studies with hospitalization the most frequently monitored (3/36; 8%). Event severity was fully assessed in 6 studies (17%) and partially assessed in 12 studies (33%). Only 4/36 studies (11%) included assessing events for cause.

CONCLUSIONS

To date, adverse events have been inconsistently defined, measured and reported in psychosocial intervention studies of childhood mental health disorders. Information on adverse events is an essential knowledge component for understanding the potential impacts and risks of therapeutic interventions.

[The German S3 guideline for depressive disorders in childhood and adolescence: new developments]

The German guideline for the treatment of depressive disorders in children and adolescents was first published in July 2013. Currently, this guideline is undergoing revision, in which the recommendations of the original version of the guideline are revisited and updated. This report aims to give an overview of the current status and the next steps for this revision.As part of the revision process, the key questions posited in the original version were expanded upon. In this, new questions were added regarding complementary therapies, that is, therapies meant to be administered in addition to the usual treatment, as well as regarding the transitionary period from adolescence into adulthood. For all key questions, new systematic literature searches were conducted in order to update the relevant evidence. For this, randomized controlled studies, systematic reviews, and non-controlled intervention studies were included and rated according to their relevance as well as possible risks of bias. Thus, all studies could be assigned a level of evidence that takes into account both the quality and the importance of the study to the guideline.This report will give a brief overview of the most important insights resulting from the new evidence base identified for the revision. While insights regarding psychotherapy are largely unchanged, there are changes in the evidence for certain antidepressants. In the field of complementary therapies, new evidence has been found for physical activity. In general, it is likely that most recommendations of the original guideline regarding first- and second-line treatments will be updated. The completion of the revision and the publishing of the revised guideline are expected to take until the end of 2023.

Interpersonal Psychotherapy-Adolescent Skills Training With Youth From Asian American and Immigrant Families: Cultural Considerations and Intervention Process

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.

Review: The effectiveness of interpersonal psychotherapy for adolescents with depression - a systematic review and meta-analysis

BACKGROUND

Interpersonal psychotherapy for adolescents (IPT-A) is a manualised, time-limited intervention for young people with depression. This systematic review aimed to determine the effectiveness of IPT-A for treating adolescent depression.

METHOD

A systematic search of relevant electronic databases and study reference lists was conducted. Any study investigating the effectiveness of IPT-A in 12- to 20-year-olds with a depressive disorder was eligible. Synthesis was via narrative summary and meta-analysis.

RESULTS

Twenty studies were identified (10 randomised trials and 10 open trials/case studies), many of which had small sample sizes and were of varying quality. Following IPT-A, participants experienced large improvements in depression symptoms (d = -1.48, p < .0001, k = 17), interpersonal difficulties with a medium effect (d = -0.68, p < .001, k = 8) and in general functioning with a very large effect (d = 2.85, p < .001, k = 8). When compared against control interventions, IPT-A was more effective than non-CBT active controls in reducing depression symptoms (d = -0.64, p < .001, k = 5) and was no different from CBT (d = 0.05, p = .88, k = 2). There was no difference between IPT-A and active control interventions in reducing interpersonal difficulties (d = -0.26, p = .25, k = 5).

CONCLUSIONS

Interpersonal psychotherapy for adolescents is an effective intervention for adolescent depression, improving a range of relevant outcomes. IPT-A is consistently superior to less structured interventions and performs similarly to CBT. However, these conclusions are cautious, as they are based on a small number of controlled studies, with minor adaptations to the standard IPT-A protocol, and/or were conducted by the intervention developers. Further robust RCTs are therefore required. The lack of superiority in IPT-A for improving interpersonal difficulties highlights a need for studies to explore the underpinning mechanisms of change.