Article

The impact of perceived interpersonal functioning on treatment for adolescent depression: IPT-A versus treatment as usual in school-based health clinics.

Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, NY 10032, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 04/2010; 78(2):260-7. DOI: 10.1037/a0018935
Source: PubMed

ABSTRACT Aspects of depressed adolescents' perceived interpersonal functioning were examined as moderators of response to treatment among adolescents treated with interpersonal psychotherapy for depressed adolescents (IPT-A; Mufson, Dorta, Moreau, & Weissman, 2004) or treatment as usual (TAU) in school-based health clinics.
Sixty-three adolescents (12-18 years of age) participated in a clinical trial examining the effectiveness of IPT-A (Mufson, Dorta, Wickramaratne, et al., 2004). The sample was 84.1% female and 15.9% male (mean age = 14.67 years). Adolescents were 74.6% Latino, 14.3% African American, 1.6% Asian American, and 9.5% other. They came primarily from low-income families. Adolescents were randomly assigned to receive IPT-A or TAU delivered by school-based mental health clinicians. Assessments, completed at baseline and at Weeks 4, 8, and 12 (or at early termination), included the Hamilton Rating Scale for Depression (Hamilton, 1967), the Conflict Behavior Questionnaire (Robin & Foster, 1989), and the Social Adjustment Scale-Self-Report (Weissman & Bothwell, 1976).
Multilevel modeling indicated that treatment condition interacted with adolescents' baseline reports of conflict with their mothers and social dysfunction with friends to predict the trajectory of adolescents' depressive symptoms over the course of treatment, controlling for baseline levels of depression. The benefits of IPT-A over TAU were particularly strong for the adolescents who reported high levels of conflict with their mothers and social dysfunction with friends.
Replication with larger samples would suggest that IPT-A may be particularly helpful for depressed adolescents who are reporting high levels of conflict with their mothers or interpersonal difficulties with friends.

0 Bookmarks
 · 
71 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although interpersonal therapy (IPT) has demonstrated efficacy for mood and other disorders, little is known about how IPT works. We present interpersonal change mechanisms that we hypothesize account for symptom change in IPT. Integrating relational theory and insights based on research findings regarding stress, social support, and illness, IPT highlights contextual factors thought to precipitate and maintain psychiatric disorders. It frames therapy around a central interpersonal problem in the patient's life, a current crisis or relational predicament that is disrupting social support and increasing interpersonal stress. By mobilizing and working collaboratively with the patient to resolve this problem, IPT seeks to activate several interpersonal change mechanisms. These include: 1) enhancing social support, 2) decreasing interpersonal stress, 3) facilitating emotional processing, and 4) improving interpersonal skills. We hope that articulating these mechanisms will help therapists to formulate cases and better maintain focus within an IPT framework. Here we propose interpersonal mechanisms that might explain how IPT's interpersonal focus leads to symptom change. Future work needs to specify and test candidate mediators in clinical trials. We anticipate that pursuing this more systematic strategy will lead to important refinements and improvements in IPT and enhance its application in a range of clinical populations.
    Clinical psychology review 09/2013; 33(8):1134-1147. DOI:10.1016/j.cpr.2013.09.002 · 7.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Major Depressive Disorder (MDD) in children and adolescents is a common and impairing condition that is both recurrent and persistent into adulthood. In this article, a review of the literature regarding multimodal treatment is presented. The literature review process for this article included «adolescents», «children», «depression», «treatment», «antidepressants» and «psychotherapy» as key words. The initial Medline search covered a 10 year period dating back to 2001. Double blind randomized and meta-analysis studies were considered as gold standard to be included in the revision, but also experts' consensus were incorporated. Regarding pharmacological treatment, tricyclic-antidepressants did not show better efficacy against placebo in double blind controlled studies; selective serotonin reuptake inhibitors showed better efficacy against placebo in controlled studies, specifically fluoxetine and escitalopram, both approved to be used in pediatric population with MDD. Noradrenalin and serotonin reuptake inhibitors like venlafaxine or mirtazapine had not shown superior response than placebo. Comorbidity needs to be taken into account in the decisions of the pharmacological treatment; attention deficit hyperactivity disorder is the most frequent associated disorder and requires to add specific drug treatment like stimulants; if psychotic symptoms are present, atypical antipsychotics should be added. Regarding psychosocial treatment, psychoeducation is the first step in this treatment approach. Psychotherapy aims include decreasing symptoms severity by improving self esteem, increasing frustration tolerance and autonomy, as well as the ability to enjoy daily life activities, and establishing good relations with peers. Interpersonal and cognitive behavioral therapies are good options as psychotherapy for this age group. It is important to monitor patients to prevent relapses and complications of depression and suicidal behavior.
    Salud Mental 10/2011; 34(5):403-407. · 0.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    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 · 4.40 Impact Factor

Full-text (2 Sources)

Download
24 Downloads
Available from
May 22, 2014