Article

Impact of childhood trauma on treatment outcome in the Treatment for Adolescents with Depression Study (TADS).

Psychology Department, University of Oregon, Eugene, OR 97403, USA.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 6.97). 02/2010; 49(2):132-40. DOI: 10.1016/j.jaac.2009.10.007
Source: PubMed

ABSTRACT 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.

1 Bookmark
 · 
102 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Summary Objective: Aim of the study was to examine differences between the course of inpatient treatment in adolescents with different extents of trauma history. Methods: Using multilevel analysis, we investigated the differences between the course of inpatient treatment in adolescents without trauma history, with emotional trauma and complex trauma. Results: Regarding the GSI of the SCL-90-R, patients with trauma history showed significantly more symptom reduction than patients without trauma history. In terms of interpersonal problems (IIP) especially adolescents with emotional trauma seemed to benefit. Conclusions: Especially patients with trauma history benefited from the examined inpatient treatment concept. However, our results also show that the complex traumatized patients required longer treatment duration since they benefited particularly in the last phase of inpatient treatment.
    PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie 05/2014; 64:328-335. · 1.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Four clinical trials have shown that a history of interpersonal trauma is associated with diminished response to cognitive-behavioral therapy (CBT) for adolescent depression. An efficacious CBT protocol for adolescent depression was modified to address cognitive deficits and distortions associated with interpersonal trauma. Initial feasibility, acceptability, and treatment impact of the modified treatment (m-CBT) were evaluated in a randomized effectiveness trial conducted in community clinics. Clients were 43 referred adolescents with a depressive disorder and a history of interpersonal trauma. Adolescents either received m-CBT or usual care (UC) therapy. Results indicated that m-CBT was delivered with good fidelity by community clinicians, but that number of sessions completed was attenuated in both m-CBT and UC. Adolescents reported high levels of treatment satisfaction and acceptability for the new treatment. There were significant reductions in depressive symptoms over time, but no differences in outcomes between groups. Although the new treatment produced promising results, it did not outperform UC. Implications for treatment development are considered. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychotherapy Theory Research Practice Training 12/2013; · 0.84 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: The purpose of this study was to conduct a treatment development study to examine the feasibility, acceptability, and preliminary efficacy of treating depressed, suicidal adolescents and their depressed parent concurrently in a cognitive behavioral therapy (CBT) protocol (Parent-Adolescent-CBT [PA-CBT]). Methods: A randomized, controlled, repeated measures design was used to test the hypothesis that PA-CBT would lead to greater reductions in suicidality and depression compared with Adolescent Only CBT (AO-CBT). Participants included 24 adolescent and parent dyads in which the adolescent met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for current major depressive episode (MDE) and the parent met DSM-IV criteria for current or past MDE. Results: The concurrent protocol was found to be feasible to implement with most depressed adolescents and parents. Adolescent ratings of program satisfaction were somewhat lower in PA-CBT, suggesting that some teens view treatment negatively when they are required to participate with a parent. The concurrent treatment protocol was more effective in reducing depressed mood in the parent-adolescent dyad at the end of maintenance treatment (24 weeks) than treating an adolescent alone for depression; the largest effect was on parental depressed mood. This difference between dyads was no longer significant, however, at the 48 week follow-up. Adolescent and parent suicidal ideation improved equally in both groups during active and maintenance treatment, and remained low at follow-up in both groups. Conclusions: The PA-CBT protocol is feasible to conduct and acceptable to most but not all adolescents. The strongest effect was on parental depressed mood. A larger study that has sufficient power to test efficacy and moderators of treatment outcome is necessary to better understand which adolescents would benefit most from concurrent treatment with a parent.
    Journal of child and adolescent psychopharmacology 05/2014; · 2.59 Impact Factor