Impact of Childhood Trauma on Treatment Outcome in the Treatment for Adolescents with Depression Study (TADS)
The impact of childhood trauma was examined in 427 adolescents (54% girls, 74% Caucasian, mean = 14.6, SD = 1.5) with major depressive disorder participating in the Treatment for Adolescents with Depression Study (TADS).
TADS compared the efficacy of cognitive behavioral therapy (CBT), fluoxetine (FLX), their combination (COMB), and placebo (PBO). Teens were separated into four trauma history groups: (1) no trauma; (2) trauma, no abuse; (3) physical abuse; (4), and sexual abuse. The effects of treatment and trauma history on depression severity across 12 weeks of acute treatment, as measured by the Children's Depression Rating Scale-Revised (CDRS-R), were examined.
A significant trauma-by-treatment-by-time interaction indicated that trauma history moderated treatment. The Week 12 primary efficacy findings previously reported by TADS were replicated in the no trauma group (n = 201): COMB = FLX > CBT = PBO. No significant differences in treatment arms were observed among the trauma, no abuse, or physical abuse group. Teens with a history of sexual abuse treated with COMB, FLX, and PBO showed significant and equivalent improvement on the CDRS-R (mean <45), whereas the mean CDRS-R for the CBT group tended to remain in the depressed range (mean >45). Baseline suicidality and self-reported depression were significantly related to a history of sexual abuse.
The study was limited by the level of detail regarding childhood traumatic experiences. Results are discussed in terms of the implications for treating depressed adolescents with traumatic backgrounds.Clinical Trials Registry Information: Treatment for Adolescents with Depression Study; http://www.clinicaltrials.gov, NCT00006286.
Available from: Cara C Lewis
- "Those who experienced HB traumas may require more extensive or tailored mental health treatment. Multiple studies have shown that depressed teens who have experienced traumas do not respond as well to cognitive– behavioral therapy targeting their depression as compared to depressed adolescents without a trauma history (e.g., Asarnow et al., 2009; Lewis et al., 2010), whereas targeting PTSD appears to alleviate both sets of symptoms. Interestingly, no studies have yet to analyze treatment effects using betrayal trauma category groupings , which may be a critical next step to personalizing psychiatric care. "
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ABSTRACT: The type and severity of traumatic events differentially predict negative posttraumatic outcomes, with betrayal traumas (in which the victim is perpetrated by someone s/he trusts) touted as the most harmful. Although disclosure is considered an important component of the "healing process," nondisclosure and delayed disclosure persist. This study explored factors predicting and the context surrounding disclosure as well as the link between disclosure timing and a trauma survivor's experience with depression. Participants (N = 124) were attendees of a Mental Health Awareness event who had experienced a traumatic event. Participant report of traumatic experiences revealed that 28.2%, 36.3%, and 35.5% of participants had experienced a low betrayal (LB), medium betrayal (MB), and high betrayal (HB) trauma, respectively. Almost half (43.5%) disclosed immediately after the trauma, 32.3% disclosed within a month, and 24.2% disclosed after 1 month or more. Betrayal trauma level significantly predicted disclosure timing with individuals who had experienced HB traumas significantly more likely to delay disclosure (HB:LB, odds ratio [OR] = 21.79; MB:LB, OR = 4.57). Trauma survivors predominantly first disclosed to informal support sources (e.g., friends, family), typically citing that they thought it would allow them to feel better or they perceived the other person to be concerned about their well-being as their reason for disclosing. Experiencing a HB trauma predicted subsequent depression severity, but disclosure status was not predictive of subsequent depression. Results will be discussed with respect to implications for assessment and interventions for trauma survivors. (PsycINFO Database Record
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Psychological Trauma Theory Research Practice and Policy 05/2015; DOI:10.1037/tra0000058 · 2.31 Impact Factor
- "However, effect sizes are modest (Weisz, McCarty, & Valeri, 2006) and residual symptoms remain problematic even among responders (Kennard et al., 2006; Kennard et al., 2009; Mufson, Dorta, Moreau, & Weissman, 2011; Mufson, Weissman, Moreau, & Garfinkel, 1999; Rosselló & Bernal, 1999; TADS [Treatment for Adolescents with Depression Study] Team, 2007). Furthermore, important subgroups of adolescents, such as those exposed to early life adversity, demonstrate poor response to existing treatments (Lewis et al., 2010; Nanni, Uher, & Danese, 2012). Treatment response for depressed adolescents may be improved by targeting specific functional deficits unique to some adolescents who present with depressive symptoms (Forbes, 2009; Forbes et al., 2006). "
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ABSTRACT: This study aimed to examine implementation feasibility and initial treatment outcomes of a behavioral activation (BA) based treatment for adolescent depression, the Adolescent Behavioral Activation Program (A-BAP). A randomized, controlled trial was conducted with 60 clinically referred adolescents with a depressive disorder who were randomized to receive either 14 sessions of A-BAP or uncontrolled evidenced-based practice for depression. The urban sample was 64% female, predominantly Non-Hispanic White (67%), and had an average age of 14.9 years. Measures of depression, global functioning, activation, and avoidance were obtained through clinical interviews and/or through parent and adolescent self-report at preintervention and end of intervention. Intent-to-treat linear mixed effects modeling and logistic regression analysis revealed that both conditions produced statistically significant improvement from pretreatment to end of treatment in depression, global functioning, and activation and avoidance. There were no significant differences across treatment conditions. These findings provide the first step in establishing the efficacy of BA as a treatment for adolescent depression and support the need for ongoing research on BA as a way to enhance the strategies available for treatment of depression in this population.
Journal of Clinical Child & Adolescent Psychology 01/2015; DOI:10.1080/15374416.2014.979933 · 1.92 Impact Factor
Available from: Assaf Oshri
- "Our results support the utilization of relational forms of therapy, such as IPT, for depressed women with significant past and current relationship impairments, including histories of maltreatment. This finding is consistent with emergent literature suggesting that cognitive approaches to intervention may be less effective with individuals with trauma histories (Lewis et al., 2010). Future research should investigate the potential differential efficacy of these two treatment models, particularly in racially and ethnically diverse populations with histories of trauma. "
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ABSTRACT: A randomized clinical trial was conducted to evaluate the efficacy of interpersonal psychotherapy (IPT) for ethnically and racially diverse, economically disadvantaged women with major depressive disorder. Non-treatment-seeking urban women (N = 128; M age = 25.40, SD = 4.98) with infants were recruited from the community. Participants were at or below the poverty level: 59.4% were Black and 21.1% were Hispanic. Women were screened for depressive symptoms using the Center for Epidemiologic Studies Depression Scale; the Diagnostic Interview Schedule was used to confirm major depressive disorder diagnosis. Participants were randomized to individual IPT or enhanced community standard. Depressive symptoms were assessed before, after, and 8 months posttreatment with the Beck Depression Inventory-II and the Revised Hamilton Rating Scale for Depression. The Social Support Behaviors Scale, the Social Adjustment Scale-Self-Report, and the Perceived Stress Scale were administered to examine mediators of outcome at follow-up. Treatment effects were evaluated with a growth mixture model for randomized trials using complier-average causal effect estimation. Depressive symptoms trajectories from baseline through postintervention to follow-up showed significant decreases among the IPT group compared to the enhanced community standard group. Changes on the Perceived Stress Scale and the Social Support Behaviors Scale mediated sustained treatment outcome.
Development and Psychopathology 11/2013; 25(4pt1):1065-1078. DOI:10.1017/S0954579413000370 · 4.89 Impact Factor
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