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Blake JA, Thomas HJ, Pelecanos AM, Najman JM, Scott JG. The unique role of adolescent internalizing and externalizing problems, and maternal-adolescent communication in their association with attachment in early adulthood. Acta Psychol (Amst) 2024; 246:104273. [PMID: 38636402 DOI: 10.1016/j.actpsy.2024.104273] [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] [Received: 11/01/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
Attachment styles influence mental health and relationships through life. Few studies examine the adolescent factors associated with adult attachment styles. This paper examines the association between adolescent emotional and behavioral problems and maternal-adolescent communication with attachment style in early adulthood. Data from 3423 participants in a birth cohort study were examined. At 14-years, participants' mothers completed the Parent-Adolescent Communication Scale. Participants completed the Youth Self-Report at 14-years which measures internalizing and externalizing symptoms, and the Attachment Style Questionnaire (ASQ) at 21-years. The ASQ comprises five domains of internal working models of interpersonal relationships and attachment style: confidence (security), discomfort with closeness and relationships as secondary (avoidance), need for approval and preoccupation with relationships (anxiety). Associations were examined using general linear models. After adjustments, internalizing symptoms score was associated with all domains of attachment and externalizing symptoms score was associated with four domains of attachment insecurity, but not attachment security. Low openness in maternal-adolescent communication was most strongly associated with decreased confidence and high problem maternal-adolescent communication was associated with viewing relationships as secondary. Adolescents with emotional and behavioral problems and maternal-adolescent communication may benefit from attachment-based interventions to support the development of healthy relationships and attachments in young adulthood.
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Affiliation(s)
- Julie A Blake
- QIMR Berghofer Medical Research Institute of Herston, Queensland, Australia; Faculty of Medicine, University of Queensland, Queensland, Australia; Queensland Centre for Mental Health Research Queensland, Australia; Child and Youth Mental Health Service, Children's Health Queensland, South Brisbane, Queensland, Australia; Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia.
| | - Hannah J Thomas
- QIMR Berghofer Medical Research Institute of Herston, Queensland, Australia; Faculty of Medicine, University of Queensland, Queensland, Australia; Queensland Centre for Mental Health Research Queensland, Australia
| | - Anita M Pelecanos
- QIMR Berghofer Medical Research Institute of Herston, Queensland, Australia
| | - Jake M Najman
- Faculty of Medicine, University of Queensland, Queensland, Australia
| | - James G Scott
- QIMR Berghofer Medical Research Institute of Herston, Queensland, Australia; Faculty of Medicine, University of Queensland, Queensland, Australia; Queensland Centre for Mental Health Research Queensland, Australia; Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
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Jerome L, Ougrin D. Editorial: How Can We Best Support Suicidal Youth? New Evidence for Dialectical Behavior Therapy and Different Forms of Self-Harm. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00251-X. [PMID: 38762071 DOI: 10.1016/j.jaac.2024.05.009] [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] [Received: 01/17/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
Establishing effective treatments for youth at risk of suicide is one of the most pressing and important tasks within child and adolescent psychiatry. Self-harm, which includes suicide attempt (SA), nonsuicidal self-injury (NSSI), and nonsuicidal self-poisoning, is one of the strongest predictors of suicide.1 Youth who engage in self-harm or experience mental health crisis are becoming more and more common, at increasingly younger ages, and so confidence in treatments to successfully reduce self-harm and prevent relapse and recurrence is crucial.2 However, the evidence base for such treatments is severely lacking despite some progress in the field.3-5 Dialectical behavior therapy (DBT) is the most established treatment option, but even so, the evidence comes from just a handful of studies and primarily focuses on the ability of DBT to reduce the repetition of self-harm. Whether DBT is successful in supporting young people along their recovery journey and is equally effective at treating different forms of self-harm are yet to be properly explored.
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Affiliation(s)
- Lauren Jerome
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
| | - Dennis Ougrin
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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3
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Schaller S, Wiedicke A, Reifegerste D, Temmann LJ. (De)Stigmatizing Depression on Social Media: The Role of Responsibility Frames. JOURNAL OF HEALTH COMMUNICATION 2023; 28:757-767. [PMID: 37807757 DOI: 10.1080/10810730.2023.2266702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Responsibility frames on social media could shape recipients' responses toward people with depression, which is crucial for the public (de)stigmatization of the mental disorder. Thus, the present study examines the effects of different responsibility frames (individual, social, combination) in Instagram-posts about depression on respondents' related attributions as well as their emotional and behavioral reactions toward people suffering from the illness. Our online-experiment (N = 1,015) revealed that frames emphasizing the responsibility of one's social network (e.g. family, friends and professionals) for depression, i.e. social frames, strengthened participants' attributions to the social network, i.e. social attributions, most effectively. Individual frames, however, primarily intensified individual attributions to those affected by depression. Contrary to previous findings, a combination frame did not prove to increase recipients' social attributions more than a one-sided social frame. For emotional and behavioral responses, we did not find any effects of responsibility frames compared to the control group-possibly due to buffering effects of the narrative structure of the Instagram posts.
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Affiliation(s)
- Sophia Schaller
- Institute for Media and Communication Science, Technical University of Ilmenau, Ilmenau, Germany
| | - Annemarie Wiedicke
- Department of Media and Communication, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Doreen Reifegerste
- Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
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4
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Hong JS, Choi MJ, Wade RM, O'Donnell LA, Johns S. Racial/ethnic differences in parenting behaviors as protective factors in adolescent internalizing problems. THE JOURNAL OF GENERAL PSYCHOLOGY 2023; 150:467-484. [PMID: 36576224 DOI: 10.1080/00221309.2022.2152414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/17/2022] [Indexed: 12/29/2022]
Abstract
The current study explores variations among racially/ethnically diverse adolescents regarding parents' role in mitigating internalizing problems. Adolescents with a higher level of parental awareness, ease of talking to parents, and parental support were less likely to show internalizing problems. Parental awareness was negatively associated with internalizing problems among Whites and Hispanics. The ease of talking to parents was significant for all groups except for American Indians/Alaska Natives. These findings can inform culturally relevant treatments.
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Affiliation(s)
- Jun Sung Hong
- School of Social Work, Wayne State University, Detroit, MI, USA
- Department of Social Welfare, Ewha Womans University, Seoul, South Korea
| | - Mi Jin Choi
- School of Social Work, Texas State University, San Marcos, TX, USA
| | - Ryan M Wade
- School of Social Work, The University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Shantalea Johns
- School of Social Work, Wayne State University, Detroit, MI, USA
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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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Li Y, Shi DD, Wang Z. Adolescent nonpharmacological interventions for early-life stress and their mechanisms. Behav Brain Res 2023; 452:114580. [PMID: 37453516 DOI: 10.1016/j.bbr.2023.114580] [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] [Received: 04/18/2023] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
Those with a negative experience of psychosocial stress during the early stage of life not only have a high susceptibility of the psychiatric disorder in all phases of their life span, but they also demonstrate more severe symptoms and poorer response to treatment compared to those without a history of early-life stress. The interventions targeted to early-life stress may improve the effectiveness of treating and preventing psychiatric disorders. Brain regions associated with mood and cognition develop rapidly and own heightened plasticity during adolescence. So, manipulating nonpharmacological interventions in fewer side effects and higher acceptance during adolescence, which is a probable window of opportunity, may ameliorate or even reverse the constantly deteriorating impact of early-life stress. The present article reviews animal and people studies about adolescent nonpharmacological interventions for early-life stress. We aim to discuss whether those adolescent nonpharmacological interventions can promote individuals' psychological health who expose to early-life stress.
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Affiliation(s)
- Yi Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong-Dong Shi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
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7
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Seely HD, Gaskins J, Pössel P, Hautzinger M. Comprehensive Prevention: An Evaluation of Peripheral Outcomes of a School-based Prevention Program. Res Child Adolesc Psychopathol 2023; 51:921-936. [PMID: 36870013 DOI: 10.1007/s10802-023-01043-2] [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] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
By age 18, 22-27% of adolescents have experienced depressive symptoms increasing their risk of peripheral mental health and social issues. Despite the development of effective depression prevention programs, issues related to dissemination persist. This study aims to identify ways of increasing the likelihood of dissemination by a) investigating how prevention effects differ based on the professional background of the prevention program group leader and b) evaluating adolescent depression prevention in terms of comprehensive prevention - prevention with the breadth to reduce peripheral mental health and social issues. This cluster-randomized trial included 646 eighth-grade students recruited from German secondary schools. Adolescents were randomized into three conditions: teacher-led prevention, psychologist-led prevention, or school-as-usual. Results from hierarchical linear models reveal differences in effects based on implementation type and adolescent gender and provide preliminary evidence for a wider reach of depression prevention such that, regardless of implementation type or gender, the tested program was effective in reducing hyperactivity over time. Taken together, our findings warrant further research and suggest that depression prevention programs may have an effect on some peripheral outcomes, but not others, and that these effects may differ based on the profession of the group leader and adolescent gender. With continued empirical research investigating the efficaciousness of comprehensive prevention, this type of prevention has the potential to impact a larger proportion of the population and improve the cost-benefit ratio of prevention, thus increasing the likelihood of dissemination.
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Chiauzzi E, Robinson A, Martin K, Petersen C, Wells N, Williams A, Gleason MM. A Relational Agent Intervention for Adolescents Seeking Mental Health Treatment: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e44940. [PMID: 36867455 PMCID: PMC10024210 DOI: 10.2196/44940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Unmet pediatric mental health (MH) needs are growing as rates of pediatric depression and anxiety dramatically increase. Access to care is limited by multiple factors, including a shortage of clinicians trained in developmentally specific, evidence-based services. Novel approaches to MH care delivery, including technology-leveraged and readily accessible options, need to be evaluated in service of expanding evidence-based services to youths and their families. Preliminary evidence supports the use of Woebot, a relational agent that digitally delivers guided cognitive behavioral therapy (CBT) through a mobile app, for adults with MH concerns. However, no studies have evaluated the feasibility and acceptability of such app-delivered relational agents specifically for adolescents with depression and/or anxiety within an outpatient MH clinic, nor compared them to other MH support services. OBJECTIVE This paper describes the protocol for a randomized controlled trial evaluating the feasibility and acceptability of an investigational device, Woebot for Adolescents (W-GenZD), within an outpatient MH clinic for youths presenting with depression and/or anxiety. The study's secondary aim will compare the clinical outcomes of self-reported depressive symptoms with W-GenZD and a telehealth-delivered CBT-based skills group (CBT-group). Tertiary aims will evaluate additional clinical outcomes and therapeutic alliance between adolescents in W-GenZD and the CBT-group. METHODS Participants include youths aged 13-17 years with depression and/or anxiety seeking care from an outpatient MH clinic at a children's hospital. Eligible youths will have no recent safety concerns or complex comorbid clinical diagnoses; have no concurrent individual therapy; and, if on medications, are on stable doses, based on clinical screening and as well as study-specific criteria. RESULTS Recruitment began in May 2022. As of December 8, 2022, we have randomized 133 participants. CONCLUSIONS Establishing the feasibility and acceptability of W-GenZD within an outpatient MH clinical setting will add to the field's current understanding of the utility and implementation considerations of this MH care service modality. The study will also evaluate the noninferiority of W-GenZD against the CBT-group. Findings may also have implications for patients, families, and providers looking for additional MH support options for adolescents seeking help for their depression and/or anxiety. Such options expand the menu of supports for youths with lower-intensity needs as well as possibly reduce waitlists and optimize clinician deployment toward more severe cases. TRIAL REGISTRATION ClinicalTrials.gov NCT05372913; https://clinicaltrials.gov/ct2/show/NCT05372913. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44940.
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Affiliation(s)
| | | | - Kate Martin
- Woebot Health, San Francisco, CA, United States
| | - Carl Petersen
- Children's Hospital of The King's Daughters, Norfolk, VA, United States
| | - Nicole Wells
- Children's Hospital of The King's Daughters, Norfolk, VA, United States
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Qiu H, Liang K, Lu L, Gao Y, Li H, Hu X, Xing H, Huang X, Gong Q. Efficacy and safety of repetitive transcranial magnetic stimulation in children and adolescents with depression: A systematic review and preliminary meta-analysis. J Affect Disord 2023; 320:305-312. [PMID: 36174786 DOI: 10.1016/j.jad.2022.09.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/21/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) benefits adults with depression while its efficacy and safety in children and adolescents with major depressive disorder (MDD) remain unclear. We conducted a preliminary meta-analysis here to objectively appraise rTMS in the youth with MDD to inform future research and clinical practice. METHODS We searched Pubmed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials from their inception to December 1, 2021. Studies with a control group or self-controlled designs and evaluating the Hamilton Depression Scale (HAM-D) or the Children's Depression Rating Scale-Revised (CDRS-R) at baseline and post-rTMS treatment were included. Two reviewers independently selected eligible studies, retrieved data in a structured fashion and assessed studies' quality. Hedges'g with 95 % confidence intervals and withdrawal rate with 95 % confidential intervals were separately used to evaluate the efficacy and safety of rTMS. RESULTS Thirteen studies with six datasets (165 patients, 61.8 % female, age range from 10 to 25 years old) were included and our meta-analysis found children and adolescents with MDD benefited from rTMS treatment (Hedges'g 1.37, 95 % CI 0.85 to 1.90, P = 0.001). In addition, 4 % of patients (95 % CI 0.02 to 0.09) withdrew during rTMS treatment for reasons including fear, mood swings, suicide ideation and adverse events. LIMITATIONS This conclusion is tempered by a small number of studies included and a potentially existing placebo effect. CONCLUSIONS Our findings suggest rTMS could benefit children and adolescents with MDD in a relatively safe manner, and this result may help guide clinical practice.
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Affiliation(s)
- Hui Qiu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Kaili Liang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Lu Lu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Yingxue Gao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Hailong Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Xinyue Hu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Haoyang Xing
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; School of Physical Science and Technology, Sichuan University, Chengdu, PR China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, PR China.
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, PR China
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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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Hassan E, BK P, Magar J, Luitel N, Kohrt BA, Jordans M, Rose-Clarke K. Community perspectives on the implementation of a group psychological intervention for adolescents with depression: A qualitative study in rural Nepal. Front Psychiatry 2022; 13:949251. [PMID: 36339866 PMCID: PMC9634215 DOI: 10.3389/fpsyt.2022.949251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
Group-based psychological interventions could help to close the treatment gap for depression in low-resource settings, but implementation barriers exist. In Nepal we sought community members' perspectives on how to implement group interpersonal therapy for adolescents. We conducted qualitative interviews with 25 adolescents with depression (aged 13-18) and seven health and non-governmental organization workers, and four focus groups with non-depressed adolescents, four with parents/guardians, and two with teachers (126 participants total). Data were analyzed using the Framework Method. Participants recommended same-sex groups. School was the preferred location because it is accessible for adolescents and acceptable to parents. Adolescents wanted facilitators from their own community with good communication skills. They did not want parents or teachers to participate in groups but emphasized the need to inform parents and obtain their permission. Community members supported group psychological intervention. School-based psychological interventions facilitated by local people could be an acceptable option in rural Nepal.
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Affiliation(s)
- Eliz Hassan
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Prakash BK
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Jananee Magar
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Nagendra Luitel
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Brandon A. Kohrt
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Mark Jordans
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
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Tuijnman A, Kleinjan M, Olthof M, Hoogendoorn E, Granic I, Engels RC. A Game-Based School Program for Mental Health Literacy and Stigma on Depression (Moving Stories): Cluster Randomized Controlled Trial. JMIR Ment Health 2022; 9:e26615. [PMID: 35976200 PMCID: PMC9434393 DOI: 10.2196/26615] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/31/2021] [Accepted: 07/28/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Depressive symptoms are highly prevalent among adolescents in Western countries. However, although treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers to help-seeking among adolescents include low mental health literacy and high stigma. Therefore, we have developed a game-based school program, Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience both in the digital and nondigital world. OBJECTIVE The aim of this study is to conduct a first test of the effectiveness of the newly developed game-based program, Moving Stories, using a cluster randomized controlled trial. METHODS A total of 185 adolescents participated, divided over 10 classes from 4 schools. Half of the classes were randomly selected to follow the Moving Stories program, whereas the other half were in the control group, where no intervention was provided. The adolescents filled out digital questionnaires at 4 time points, with questions on mental health literacy, stigma, depressive symptoms, and the program itself (before the program, after the program, 3-month follow-up, and 6-month follow-up). Using R (R Foundation for Statistical Computing), we ran linear mixed-effects models for all continuous outcome variables and generalized linear mixed-effects models for all binary outcome variables. RESULTS Compared with the control group, participants in the Moving Stories group improved after the program in personal stigma (b=-0.53, 95% CI -1.02 to -0.03; t179.16=-2.08; P=.04). Effects on personal stigma lasted over time (3-month follow-up: b=-0.57, 95% CI -1.11 to -0.03; t174.39=-2.07; P=.04). Most adolescents in the Moving Stories group participated in the introduction (97/99, 98%) and contact session (93/99, 94%), played the game for 4 or 5 days (83/99, 83%), and indicated that they would recommend the game to their peers (90/98, 92%). CONCLUSIONS The results of this study show the potential of Moving Stories as a stigma reduction program. With changes in the program to improve its effects on mental health literacy, Moving Stories could be implemented in schools to improve help-seeking in adolescents and reduce the negative consequences and burden of depressive symptoms. TRIAL REGISTRATION Dutch Trial Register NTR7033; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7033. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11255.
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Affiliation(s)
- Anouk Tuijnman
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.,Trimbos-institute, Utrecht, Netherlands
| | - Marloes Kleinjan
- Trimbos-institute, Utrecht, Netherlands.,Department of Interdisciplinary Social Sciences, Youth Studies, Utrecht University, Utrecht, Netherlands
| | - Merlijn Olthof
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | | | - Isabela Granic
- Faculty of Social Sciences, McMaster University, Hamilton, ON, Canada
| | - Rutger Cme Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, Netherlands
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13
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Yang H, Gao S, Li J, Yu H, Xu J, Lin C, Yang H, Teng C, Ma H, Zhang N. Remission of symptoms is not equal to functional recovery: Psychosocial functioning impairment in major depression. Front Psychiatry 2022; 13:915689. [PMID: 35958633 PMCID: PMC9360322 DOI: 10.3389/fpsyt.2022.915689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
The ultimate goal of depression treatment is to achieve functional recovery. Psychosocial functioning is the main component of functional impairment in depressed patients. The concept of psychosocial functioning has an early origin; however, its concept and connotation are still ambiguous, which is the basic and key problem faced by the relevant research and clinical application. In this study, we start from the paradox of symptoms remission and functional recovery, describe the concept, connotation, and characteristics of psychosocial functioning impairment in depressed patients, and re-emphasize its importance in depression treatment to promote research and clinical applications related to psychosocial functioning impairment in depressed patients to achieve functional recovery.
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Affiliation(s)
- Hao Yang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shuzhan Gao
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiawei Li
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Haoran Yu
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jingren Xu
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chenchen Lin
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Hua Yang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Changjun Teng
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Ma
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ning Zhang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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14
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School-based group interpersonal therapy for adolescents with depression in rural Nepal: a mixed methods study exploring feasibility, acceptability, and cost. Glob Ment Health (Camb) 2022; 9:416-428. [PMID: 36618751 PMCID: PMC9806967 DOI: 10.1017/gmh.2022.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Adolescents with depression need access to culturally relevant psychological treatment. In many low- and middle-income countries treatments are only accessible to a minority. We adapted group interpersonal therapy (IPT) for adolescents to be delivered through schools in Nepal. Here we report IPT's feasibility, acceptability, and cost. METHODS We recruited 32 boys and 30 girls (aged 13-19) who screened positive for depression. IPT comprised of two individual and 12 group sessions facilitated by nurses or lay workers. Using a pre-post design we assessed adolescents at baseline, post-treatment (0-2 weeks after IPT), and follow-up (8-10 weeks after IPT). We measured depressive symptoms with the Depression Self-Rating Scale (DSRS), and functional impairment with a local tool. To assess intervention fidelity supervisors rated facilitators' IPT skills across 27/90 sessions using a standardised checklist. We conducted qualitative interviews with 16 adolescents and six facilitators post-intervention, and an activity-based cost analysis from the provider perspective. RESULTS Adolescents attended 82.3% (standard deviation 18.9) of group sessions. All were followed up. Depression and functional impairment improved between baseline and follow-up: DSRS score decreased by 81% (95% confidence interval 70-95); functional impairment decreased by 288% (249-351). In total, 95.3% of facilitator IPT skills were rated superior/satisfactory. Adolescents found the intervention useful and acceptable, although some had concerns about privacy in schools. The estimate of intervention unit cost was US $96.9 with facilitators operating at capacity. CONCLUSIONS School-based group IPT is feasible and acceptable in Nepal. Findings support progression to a randomised controlled trial to assess effectiveness and cost-effectiveness.
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15
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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: 8] [Impact Index Per Article: 2.7] [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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16
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Robertson L, Aboaja A, Walker DM, Vostanis P, Witt KG, Chakrabarti I, Perry AE, Townsend E. Interventions for mood, anxiety disorders or self-harm in young offenders. Hippokratia 2020. [DOI: 10.1002/14651858.cd013768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Lindsay Robertson
- Cochrane Common Mental Disorders; University of York; York UK
- Centre for Reviews and Dissemination; University of York; York UK
| | - Anne Aboaja
- Tees, Esk and Wear Valleys NHS Foundation Trust; Middlesbrough UK
| | | | - Panos Vostanis
- Department of Neurosciences, Psychology and Behaviour; University of Leicester; Leicester UK
| | - Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | | | - Amanda E Perry
- Department of Health Sciences; University of York; York UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology; University of Nottingham; Nottingham UK
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17
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Toth SL, Handley ED, Manly JT, Sturm R, Adams TR, Demeusy EM, Cicchetti D. The Moderating Role of Child Maltreatment in Treatment Efficacy for Adolescent Depression. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1351-1365. [PMID: 32696103 PMCID: PMC7484366 DOI: 10.1007/s10802-020-00682-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Adolescent girls are at heightened risk of depression, and because adolescent depression may initiate a negative developmental cascade, intervention early in adolescence has potential for altering a negative developmental trajectory. Identifying risk factors that impact response to intervention may inform decisions about the type of treatment to provide for adolescent girls with depression. Understanding moderators of outcomes in evidence-based treatment is critical to the delivery of timely and effective interventions. Matching patients effectively with optimal intervention will not only expedite the alleviation of patients' distress, but will also reduce unnecessary time and resources spent on less advantageous interventions. The current investigation examines the efficacy of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) in a racially and ethnically diverse sample of 120 low-income adolescent girls age 13-15 with and without histories of child maltreatment. Adolescent and parent report of depressive symptoms were assessed at the beginning and end of treatment and a diagnosis of subsyndromal symptoms of depression or depression were required for purposes of inclusion. Results indicated that among adolescent girls who had experienced two or more subtypes of maltreatment, IPT-A was found to be more efficacious than Enhanced Community Standard (ECS) treatment. Importantly, when the subtype of maltreatment experienced was further probed, among girls with a history of sexual abuse, we found preliminary evidence that IPT-A was significantly more effective than ECS in reducing depressive symptoms, and the effect size was large. Thus, if a history of maltreatment is present, especially including sexual abuse, specifically addressing the interpersonal context associated with depressive symptoms may be necessary.
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Affiliation(s)
- Sheree L Toth
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA.
| | - Elizabeth D Handley
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Jody Todd Manly
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Robin Sturm
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Tangeria R Adams
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Elizabeth M Demeusy
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Dante Cicchetti
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
- University of Minnesota, Minneapolis, MN, USA
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18
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Parr EJ, Shochet IM, Cockshaw WD, Kelly RL. General Belonging is a Key Predictor of Adolescent Depressive Symptoms and Partially Mediates School Belonging. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09371-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Ougrin D. Editorial: The job of an editor-one year on. Child Adolesc Ment Health 2019; 24:293-294. [PMID: 32677349 DOI: 10.1111/camh.12354] [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: 11/27/2022]
Abstract
Incredible as it still sounds to me, it has now been a year since I took over as the editor-in-chief of Child and Adolescent Mental Health. It is time to both look back and look forward. Over the past year, my approach remained unchanged: CAMH should grow to become a leading source of the most clinically relevant knowledge worldwide in our field. I would like you, our readers, to think of CAMH whenever you need clinical advice, a research update, or an innovative service development idea.
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Affiliation(s)
- Dennis Ougrin
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
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