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Efficacy and acceptability of interpersonal psychotherapy for depression in adolescents: A meta-analysis of randomized controlled trials

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Abstract

In this study, we evaluate the efficacy and safety of interpersonal psychotherapy (IPT) for adolescents with depression. We searched our existing database and electronic databases, including PubMed, Cochrane, EMBASE, PsycINFO, Web of Science, and CINAHL databases (from inception to May 2016). We included randomized controlled trials comparing IPT with various control conditions, including waitlist, psychological placebo, treatment as usual, and no treatment, in adolescents with depression. Finally, we selected seven studies comprising 538 participants comparing IPT with three different control conditions. Pooled analyses suggested that IPT was significantly more effective than control conditions in reducing depressive symptoms at post-treatment and follow-up, and increasing the response/remission rate at post-treatment. IPT was also superior to control conditions for all-cause discontinuation and quality of life/functioning improvement outcomes. However, there was no evidence that IPT reduces the risk of suicide from these data. Meta-analysis demonstrated publication bias for primary efficacy, while the adjusted standardized mean difference using the trim-and-fill method indicated IPT was still significantly superior to the control conditions. Current evidence indicates IPT has a superior efficacy and acceptability compared with control conditions in treating adolescents with depression.

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... Variations of cognitive behavioral therapy (CBT) have been most extensively researched, identi ed as empirically supported psychotherapy approaches (8), and recommended as the rst-line treatment for adolescents with moderate to severe depression (9). With the accumulation of empirical data from randomized controlled trials (RCT) over the past decades, several meta-analyses on treatment of adolescents with depression indicate that Interpersonal therapy -Adolescents (IPT -A) with a considerably smaller evidence base, is a well-established treatment option, along with CBT (8,(10)(11)(12)(13)(14)(15)(16)(17)(18). A recent meta-analysis reported a small effect size (0.29) for CBT and IPT for adolescent depression when compared to active control groups (19) further, a substantial proportion of adolescents fail to remit (19,20). ...
... based on a two-way mixed consistency. GRID-HAMD scores are classi ed as no depression (0-7); mild depression (8)(9)(10)(11)(12)(13)(14)(15)(16); moderate depression (17)(18)(19)(20)(21)(22)(23); and severe depression (>24) (46). Clinical response is de ned as improvement in GRID-HAMD total score by ≥ 50% from baseline and remission from depression as GRID-HAMD score <5. ...
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Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. Objective: To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD. Method: Sixty adolescents (86.7% girls), aged 13-18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed by blinded evaluators at baseline and post-treatment with the Hamilton Depression Scale (HAMD). Self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks. Analyses were performed according to intent-to-treat principles. Results: At post-treatment, clinician-rated remission rates on the HAMD (5 % in ABFT and 3.33% in TAU, p =1, OR=1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X²[2, N = 60] =0.06 , p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3 %) of adolescents were still in the clinical range after 16 weeks of treatment. Conclusion: ABFT was not superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study’s small sample size, missing data, and implementation challenges. Continued efforts to improve treatment for MDD in outpatient clinics are warranted . Future research should examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings. Trial Registration: Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013
... Interpersonal therapy: Interpersonal therapy (IPT) is a structured, timelimited dynamically informed, and present-focused psychotherapy that was first developed to treat adult depression [44]. It has since been modified by Mufson and colleagues for use with adolescents [45]. ...
... Although there have been fewer randomized controlled trials examining IPT treatment of adolescent depression as there have been with CBT, the overall evidence of such trials has shown that IPT consistently separates from active control interventions and that the effects of IPT are similar to those of CBT in head-to-head trials [41•]. More specifically, both individual and group IPT have been found to have superior efficacy and acceptability compared with control conditions in treating adolescents with depression [44]. ...
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Purpose of review Adolescent depression is a prevalent condition that has been on the rise in recent years. The primary care setting is often the front line to mental health needs, specifically identifying and treating early depression. This review presents the current evidence base about adolescent depression, its identification, and treatment approaches. Recent findings The US Preventive Services Task Force and American Academy of Pediatrics recommend universal screening for depression in adolescents in primary care settings. There are several depression screening measures that could be useful in primary care. Recommended treatment approaches which include therapy, medication, or a combination of the two are based on an adolescent’s presentation and degree of impairment. There is sufficient empirical evidence supporting use of three therapies and two Selective Serotonin Reuptake Inhibitors for adolescent depression. Summary Currently, there are resources, screening measures, and research evidence available to adequately support pediatricians in the identification and treatment of adolescent depression.
... According to meta-analyses, cognitive behavioral therapy (CBT) and interpersonal psychotherapy for adolescents (IPT-A) are effective treatments for depression in adolescents (Pu et al., 2017;Weisz et al., 2013Weisz et al., , 2017Zhou et al., 2015). Although adaptations of these treatments have shown promise in reducing depressive symptoms in population-based student samples (Clarke et al., 1995;Horowitz, Garber, Ciesla, Young, & Mufson, 2007;La Greca, Ehrenreich-May, Mufson, & Chan, 2016;Ruffolo & Fischer, 2009;Young, Mufson, & Davies, 2006a;Young, Mufson & Gallop, 2010), more research is needed to establish the effectiveness of such treatments for adolescents with mild or moderate clinical depression in naturalistic settings (e.g., Arora, Collins, Dart, Hernández, Fetterman, & Doll, 2019;Mufson, 2010;Mufson, Pollack, Moreau, & Weissman, 2004a). ...
... Clinical response was defined as having at least 50% symptom reduction in the primary outcome measures (BDI and ADRSc). This definition of clinical response is the standard definition used in many psychiatric efficacy and effectiveness studies (e.g., Pu et al. 2017). Clinical recovery was defined as absence of depressive symptoms or the presence of minimal depressive symptoms (score < 10 in BDI; score < 15 in ADRSc). ...
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In order to offer early and accessible treatment for adolescents with depression, brief and effective treatments in adolescents’ everyday surroundings are needed. This randomized controlled trial studied the preliminary effectiveness, feasibility, and acceptability of interpersonal counseling (IPC) and brief psychosocial support (BPS) in school health and welfare services. The study was conducted in the 28 lower secondary schools of a large city in Southern Finland, randomized to provide either IPC or BPS. Help-seeking 12–16-year-old adolescents with mild-to-moderate depression, with and without comorbid anxiety, were included in the study. Fifty-five adolescents received either 6 weekly sessions of IPC or BPS and two follow-up sessions. Outcome measures included self- and clinician-rated measures of depression, global functioning, and psychological distress/well-being. To assess feasibility and acceptability of the treatments, adolescents’ and counselors’ treatment compliance and satisfaction with treatment were assessed. Both treatments were effective in reducing depressive disorders and improving adolescents’ overall functioning and well-being. At post-treatment, in both groups, over 50% of adolescents achieved recovery based on self-report and over 70% based on observer report. Effect sizes for change were medium or large in both groups at post-treatment and increased at 6-month follow-up. A trend indicating greater baseline symptom severity among adolescents treated in the IPC-providing schools was observed. Adolescents and counselors in both groups were satisfied with the treatment, and 89% of the adolescents completed the treatments and follow-ups. This trial suggests that both IPC and BPS are feasible, acceptable, and effective treatments for mild-to-moderate depression in the school setting. In addition, IPC seems effective even if comorbid anxiety exists. Our study shows that brief, structured interventions, such as IPC and BPS, are beneficial in treating mild-to-moderate depression in school settings and can be administered by professionals working at school.
... Variations of cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) have been most widely researched and identified as empirically supported psychotherapy approaches to treat adolescents with depression (7). With the accumulation of empirical data from randomized controlled trials (RCT) over the past decades, several meta-analyses on treatment of adolescents with depression suggest CBT and IPT to be efficacious treatments with moderate effect sizes (8)(9)(10)(11)(12)(13)(14). CBT and IPT are efficacious for adolescents with MDD when adequately implemented, but response rates are moderate (around 60% in clinical trials) and a substantial proportion of adolescents fail to remit (15). ...
... based on a two-way mixed consistency, average measures ICC. GRID-HAMD scores are classified as no depression (0-7); mild depression (8)(9)(10)(11)(12)(13)(14)(15)(16); moderate depression (17)(18)(19)(20)(21)(22)(23); and severe depression (>24) (31). Clinical response is defined as improvement in GRID-HAMD total score by ≥ 50% from baseline and remission from depression as GRID-HAMD score <5. ...
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Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. Objective: To study the efficacy of ABFT compared with Treatment as Usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD. Method: Sixty adolescents, aged 13-18 years, with MDD referred to two CAMHS were randomized to receive 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were clinician-rated (Hamilton Depression Scale, HAMD) and self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms assessed at baseline and post-treatment by blinded evaluators for HAMD and at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks for BDI-II. Analyses were performed according to intent-to-treat principles. Results: At post-treatment, clinician-rated remission rates on the HAMD (5 % in ABFT and 3.33% in TAU, p =1, OR=1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups ( X 2 [2, N = 60] =0.06 , p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority of adolescents were still in the clinical range after 16 weeks of treatment. Conclusion: In this sample of adolescents treated for MDD in community mental health clinics, ABFT was not associated with more favorable outcomes than TAU in terms of remission rates on clinician rated and self-reported depressive symptoms. Remission and response rates were low in both groups, suggesting a need for continued improvement of the treatment methods. Trial Registration: Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013 Keywords: Depression, Adolescents, Attachment Based Family Therapy, Efficacy trial
... Variations of cognitive behavioral therapy (CBT) have been most extensively researched, identi ed as empirically supported psychotherapy approaches (8), and recommended as the rst-line tratment for adolescents with moderate to severe depression (9). With the accumulation of empirical data from randomized controlled trials (RCT) over the past decades, several meta-analyses on treatment of adolescents with depression, suggest Interpersonal therapy -Adolescents (IPT -A) with a considerably smaller but strong evidence base, to be a well established treatment option, along with CBT (8,(10)(11)(12)(13)(14)(15)(16)(17). ...
... GRID-HAMD has been shown to have good psychometric properties as a measure of depression severity (37,42).The average Intraclass coffe cient (ICC) for GRID-HAMD scores in this study was .89, based on a two-way mixed consistency.GRID-HAMD scores are classi ed as no depression (0-7); mild depression (8)(9)(10)(11)(12)(13)(14)(15)(16); moderate depression (17)(18)(19)(20)(21)(22)(23); and severe depression (>24) (43). Clinical response is de ned as improvement in GRID-HAMD total score by ≥ 50% from baseline and remission from depression as GRID-HAMD score <5. ...
Preprint
Full-text available
Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. Objective: To study the effectiveness of ABFT compared with Treatment as Usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD. Method: Sixty adolescents (86.7% girls), aged 13-18 years (M = 14.9), with MDD referred to two CAMHS were randomized to receive 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were clinician-rated (Hamilton Depression Scale, HAMD) and self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms assessed at baseline and post-treatment by blinded evaluators for HAMD and at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks for BDI-II. Analyses were performed according to intent-to-treat principles. Results: At post-treatment, clinician-rated remission rates on the HAMD (5 % in ABFT and 3.33% in TAU, p =1, OR=1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X²[2, N = 60] =0.06 , p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority(63.3 %) of adolescents were still in the clinical range after 16 weeks of treatment. Conclusion: ABFT was not associated with more favorable outcomes than TAU Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. These findings call for continued efforts to improve treatment for MDD in outpatient clinics. Policies on implementation of evidence based treatments already available are essential. Future research may focus on moderators of and mechanisms for individual differences to treatment response. Trial Registration: Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013
... The efficacy of IPT-A is supported by multiple metaanalyses [67][68][69][70][71] . These meta-analyses report on different outcomes, but it is important to acknowledge the overlap of included studies across them (i.e., of the five metaanalyses reported on below, 22 studies were included in total and 12 were included in more than one meta-analysis). ...
... Further evidence suggests that IPT-A is well suited and acceptable to young people. Meta-analyses show that IPT-A is associated with significantly fewer dropouts than IPT for adults (13.0 vs. 22.6%) 73 , and is either superior or noninferior to active and non-active controls in terms of its all-cause discontinuation rate 67,70,71 . Although IPT-A trials have been predominantly conducted in the United States (k = 14), efficacy is also supported in low socioeconomic groups 74 , and in samples from Australia (k = 1), Canada (k = 1), Puerto Rico (k = 2), Uganda (k = 1) and Taiwan (k = 1) 67 . ...
Article
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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.
... Variations of cognitive behavioral therapy (CBT) have been most extensively researched, identi ed as empirically supported psychotherapy approaches (8), and recommended as the rst-line tratment for adolescents with moderate to severe depression (9). With the accumulation of empirical data from randomized controlled trials (RCT) over the past decades, several meta-analyses on treatment of adolescents with depression, suggest Interpersonal therapy -Adolescents (IPT -A) with a considerably smaller but strong evidence base, to be a well established treatment option, along with CBT (8,(10)(11)(12)(13)(14)(15)(16)(17). ...
... GRID-HAMD has been shown to have good psychometric properties as a measure of depression severity (37,42).The average Intraclass coffe cient (ICC) for GRID-HAMD scores in this study was .89, based on a two-way mixed consistency.GRID-HAMD scores are classi ed as no depression (0-7); mild depression (8)(9)(10)(11)(12)(13)(14)(15)(16); moderate depression (17)(18)(19)(20)(21)(22)(23); and severe depression (>24) (43). Clinical response is de ned as improvement in GRID-HAMD total score by ≥ 50% from baseline and remission from depression as GRID-HAMD score <5. ...
Preprint
Full-text available
Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. Objective: To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD. Method: Sixty adolescents (86.7% girls), aged 13-18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to receive 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed clinician-rated by blinded evaluators (Hamilton Depression Scale, HAMD)at baseline and post-treatment with the Hamilton Depression Scale (HAMD).and Sself-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline and post-treatment by blinded evaluators for HAMD and at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks for BDI-II. Analyses were performed according to intent-to-treat principles. Results: At post-treatment, clinician-rated remission rates on the HAMD (5 % in ABFT and 3.33% in TAU, p =1, OR=1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X²[2, N = 60] =0.06 , p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3 %) of adolescents were still in the clinical range after 16 weeks of treatment. Conclusion: ABFT was not associated with more favorable outcomes thannot superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study’s limitations and implementation challenges. These finding scall forContinued efforts to improve treatment for MDD in outpatient clinics are warranted . Policies on implementation of evidence based treatments already available are essential. Future research may focus onshould examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings. Trial Registration: Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013
... Variations of cognitive behavioral therapy (CBT) have been most extensively researched, identified as empirically supported psychotherapy approaches [8], and recommended as the first-line treatment for adolescents with moderate to severe depression [9]. With the accumulation of empirical data from randomized controlled trials (RCT) over the past decades, several meta-analyses on treatment of adolescents with depression indicate that Interpersonal therapy-Adolescents (IPT-A) with a considerably smaller evidence base, is a well-established treatment option, along with CBT [8,[10][11][12][13][14][15][16][17][18]. A recent meta-analysis reported a small effect size (0.29) for CBT and IPT for adolescent depression when compared to active control groups [19] further, a substantial proportion of adolescents fail to remit [19,20]. ...
... The average Intraclass correlation coefficient (ICC) for GRID-HAMD scores in this study was 0.89, based on a two-way mixed consistency. GRID-HAMD scores are classified as no depression (0-7); mild depression (8)(9)(10)(11)(12)(13)(14)(15)(16); moderate depression (17)(18)(19)(20)(21)(22)(23); and severe depression (> 24) [47]. Clinical response is defined as improvement in GRID-HAMD total score by ≥ 50% from baseline and remission from depression as GRID-HAMD score < 5. Suicidal ideation was measured with the Suicidal Ideation Questionnaire-Junior (SIQ-Jr) [48], and was used in this study in the multiple imputation process. ...
Article
Full-text available
Background Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent–child relationship. Objective To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD. Method Sixty adolescents (86.7% girls), aged 13–18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed by blinded evaluators at baseline and post-treatment with the Hamilton Depression Scale (HAMD). Self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks. Analyses were performed according to intent-to-treat principles. Results At post-treatment, clinician-rated remission rates on the HAMD (5% in ABFT and 3.33% in TAU, p = 1, OR = 1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups ( X 2 [2, N = 60] = 0.06, p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3%) of adolescents were still in the clinical range after 16 weeks of treatment. Conclusion ABFT was not superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study’s small sample size, missing data, and implementation challenges. Continued efforts to improve treatment for MDD in outpatient clinics are warranted. Future research should examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings. Trial registration Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013
... It is currently believed that cognitive training (164,165) and cognitive remediation (166) influence psychosocial functioning by improving cognitive functioning. Interpersonal therapy (IPT) is prominent in adolescent depression (167,168) and has a long-lasting effect, with some studies showing that such improvements last at least 1 year (168). However, older individuals find it difficult to show the advantages of psychotherapy alone (99) because of complex age-related problems (physical illness, loneliness, and grief), and collaborative care is more effective in restoring psychosocial functioning in such individuals (169). ...
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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.
... There are no current studies that evaluate the effects of IPT-A on suicidality. 45 This case demonstrates the increased risk of suicidality with the initiation of antidepressant medications and the need to consider a change in antidepressant medication. It also illustrates some risk factors that are predictive of suicide, including female sex, baseline self-injury, increased number of previous suicide attempts, and history of family conflict. ...
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Major depressive disorder (MDD) is one of the most common psychiatric disorders of childhood and adolescence, but because of symptom variation from the adult criteria, it is often unrecognized and untreated. Symptom severity predicts the initial mode of treatment ranging from psychotherapy to medications to combination treatment. Several studies have assessed the efficacy of treatment in children and adolescents, and others have evaluated the risk of developing adverse effects and/or new or worsening suicidal thoughts and behaviors. Optimal treatment often includes a combination of therapy and antidepressant medication. The most studied combination includes fluoxetine with cognitive behavioral therapy. Once symptom remission is obtained, treatment should be continued for 6 to 12 months before a slow taper is initiated. Although most children and adolescents recover from their first depressive episode, a large number will continue to present with MDD in adulthood. Untreated depression in children and adolescents may increase the risk of substance abuse; poor work, academic, and social functioning; and risk of suicidal behaviors.
... Children, adolescents and young adults Eight reviews 90-97 examined interventions grouping children, adolescents and young adults (≤24 years). One SR 96 found that interpersonal psychotherapy reduced depressive symptoms in adolescents, but did not impact suicide. Three reviews 90 91 94 examined school-based interventions for suicide reduction; two overviews 90 91 found some benefit to school-based strategies, while one SR 94 found few studies examining this type of intervention and was unable to draw conclusions. ...
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Objectives Patient priority setting projects (PPSPs) can reduce research agenda bias. A key element of PPSPs is a review of available literature to determine if the proposed research priorities have been addressed, identify research gaps, recognise opportunities for knowledge translation (KT) and avoid duplication of research efforts. We conducted rapid responses for 11 patient-identified priorities in depression to provide a map of the existing evidence. Design Eleven rapid responses. Data sources Single electronic database (PubMed). Eligibility criteria Each rapid response had unique eligibility criteria. For study designs, we used a stepwise inclusion process that started with systematic reviews (SRs) if available, then randomised controlled trials and observational studies as necessary. Results For all but one of the rapid responses we identified existing SRs (median 7 SRs per rapid response, range 0–179). There were questions where extensive evidence exists (ie, hundreds of primary studies), yet uncertainties remain. For example, there is evidence supporting the effectiveness of many non-pharmacological interventions (including psychological interventions and exercise) to reduce depressive symptoms. However, targeted research is needed that addresses comparative effectiveness of promising interventions, specific populations of interest (eg, children, minority groups) and adverse effects. Conclusions We identified an extensive body of evidence addressing patient priorities in depression and mapped the results and limitations of existing evidence, areas of uncertainty and general directions for future research. This work can serve as a solid foundation to guide future research in depression and KT activities. Integrated knowledge syntheses bring value to the PPSP process; however, the role of knowledge synthesis in PPSPs and methodological approaches are not well defined at present.
... 30 2017 yılında yayınlanan bir meta-analizde, KİPT'in majör depresyon tanılı ergen hastalarda etkili bir tedavi yöntemi olduğu, yaşam kalitesinde ve işlevsellikte iyileşmeye yardımcı olduğu, ancak intihar riskini azalttığına dair kanıt bulunmadığı bildirilmiştir. 31 ...
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ABS TRACT Interpersonal Psychotherapy (IPT) was developed in the 1970s as a treatment for depression and for many years was used mainly by investigators in clinical trials. It’s demonstrated efficacyin multiple studies eventually led clinicians to proposeIPT as a treatment for different types of depressed patients, including pregnant, postpartum, and primary care patients. Clinical guidelines endorse IPT monotherapy for treatment of mild to moderate depression. In addition, IPT is used to treat other psychiatric illnesses, including bipolar disorder, eating disorders, anxiety disorders and postraumatic stress disorder. In this review, we will summarize the efficacy of IPT in an evidencebased manner
... While there are components of evidence-based treatments that can assist young people with depression or anxiety arising from interpersonal conflict (e.g. Cognitive Behavioural Therapy, Interpersonal Therapy), such treatments were developed for youth with clinical disorders (Klein, Jacobs, & Reinecke, 2007;Oud et al., 2019;Pu et al., 2017). Many of these treatments are administered face-to-face by trained clinicians, limiting uptake and access among youth. ...
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Background: This study evaluated the acceptability and effectiveness of a relationship-focussed mobile phone application (WeClick) for improving depressive symptoms and other mental health outcomes in adolescents. Methods: A randomised controlled trial involving 193 youth (M age: 14.82, SD: 0.94, 86.5% female) from Australia was conducted. Youth were recruited via the Internet and randomly allocated to the intervention or a 4-week wait list control condition, stratified for age and gender. The primary outcome was change in depressive symptom scores measured using the Patient Health Questionnaire for Adolescents (PHQ-A) at baseline, 4-week post-test and 12-week follow-up. Secondary outcomes included anxiety, psychological distress, wellbeing, help-seeking intentions for mental health, social self-efficacy and social support. Participants in the intervention condition received access to the intervention for four weeks. Thematic analysis was utilised to identify and examine acceptability. Results: The change in PHQ-A scores from baseline to 4-week post-test did not differ significantly (d = 0.26, p = .138) between the intervention (Mchange = -2.9, SD = 5.3) and wait list control conditions (Mchange = -1.7, SD = 4.3). However, significant between-group improvements were observed in wellbeing (d = 0.37, p = .023), help-seeking intentions (d = 0.36, p = .016) and professional help-seeking intentions for mental health problems (d = 0.36, p = .008). Increases in help-seeking intentions were sustained at follow-up in the intervention condition. No differential effects were found for generalised anxiety, separation anxiety, social self-efficacy or for any social support outcomes. Over 90% of participants indicated the app was enjoyable, interesting and easy to use. The app provided 'advice and direction' (n = 42; 46.15%), an 'opportunity for self-reflection' (n = 33; 36.3%) and 'normalised experiences' (n = 21; 23.1%). Conclusions: The WeClick app was found to be effective for improving wellbeing and help-seeking intentions for mental health in adolescents. A larger, adequately powered trial is now required to establish differential effects on depressive symptoms. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001982202.
... Effectiveness for depression treatment in youth has been demonstrated for several therapy modalities. Interpersonal psychotherapy (IPT) and Cognitive Behavioural Therapy (CBT) have been found to be more effective than control conditions in meta-analyses (Arnberg & Ost, 2014;Pu et al., 2017;Zhou et al., 2015). A systematic review found preliminary evidence that computerised CBT is acceptable and effective for the treatment of depression in children and adolescents (Richardson, Stallard, & Velleman, 2010). ...
Article
Background: Depression is a prevalent and disabling condition in youth. Treatment efficacy has been demonstrated for several therapeutic modalities. Acceptability of treatments is also important to explore and was addressed by investigating treatment dropout using meta-analyses. Methods: A systematic search was conducted using MEDLINE, CINAHL and PsycARTICLES databases. Peer-reviewed randomised controlled trials investigating psychotherapy treatment of depression in children and youth (aged up to and including 18 years) were included. Proportion meta-analyses were used to calculate estimated dropout rates; odds ratios assessed whether there was greater dropout from intervention or control arms and meta-regressions investigated for associations between dropout, study and treatment characteristics. Results: Thirty-seven studies were included (N=4343). Overall estimate of dropout from active interventions was 14.6% (95% CI 12.0-17.4%). Dropout was equally likely from intervention and control conditions, aside from family/dyadic interventions (where dropout was more likely from control arms). There was some suggestion that interventions offering more sessions and longer duration had less dropout and of less dropout from IPT than other interventions. There were no significant associations between dropout and study quality, CBT, family or individual versus other approaches. Limitations: Lack of consistent reporting decreased the factors which could be analysed. Conclusions: Dropout from depression treatment in children and youth was similar across different types of intervention and control conditions. Future treatment trials should specify minimum treatment dose, define dropout and provide information about participants who dropout. This may inform treatment choice and modification of treatments.
... A meta-analysis (k ¼ 7) reported that IPT, compared to control conditions, was more effective in reducing symptoms of depression at posttreatment and follow-up in adolescents [80]. Moreover, IPT improved their quality of life. ...
... based on a two-way mixed consistency. GRID-HAMD scores are classi ed as no depression (0-7); mild depression (8)(9)(10)(11)(12)(13)(14)(15)(16); moderate depression (17)(18)(19)(20)(21)(22)(23); and severe depression (>24) (46). Clinical response is de ned as improvement in GRID-HAMD total score by ≥ 50% from baseline and remission from depression as GRID-HAMD score <5. ...
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Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. Objective: To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD. Method: Sixty adolescents (86.7% girls), aged 13-18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed by blinded evaluators at baseline and post-treatment with the Hamilton Depression Scale (HAMD). Self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks. Analyses were performed according to intent-to-treat principles. Results: At post-treatment, clinician-rated remission rates on the HAMD (5 % in ABFT and 3.33% in TAU, p =1, OR=1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X²[2, N = 60] =0.06 , p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3 %) of adolescents were still in the clinical range after 16 weeks of treatment. Conclusion: ABFT was not superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study’s limitations and implementation challenges. Continued efforts to improve treatment for MDD in outpatient clinics are warranted . Future research should examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings. Trial Registration: Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013
... The authors conclude that "on the basis of currently available evidence, the effectiveness of these interventions for treating depressive disorders in children and adolescents cannot be established" (6). Findings from several large meta-analyses conducted since then have been consistent with this conclusion (7)(8)(9)(10)(11). ...
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Depression in adolescents and young adults is an increasing global health concern. Available treatments are not sufficiently effective and relapse rates remain high. The novel group-treatment program “Training for Awareness, Resilience and Action” (TARA) targets specific mechanisms based on neuroscientific findings in adolescent depression. TARA is framed within the National Institute of Mental Health's Research Domain Criteria and has documented feasibility and preliminary efficacy in the treatment of adolescent depression. Since neurodevelopment continues well into the mid-twenties, age-adapted treatments are warranted also for young adults. Patients 15–22 years old, with either major depressive disorder (MDD) or persistent depressive disorder (PDD) according to the DSM-IV/5 or a rating >40 on the clinician rating scale Children's Depression Rating Scale—Revised (CDRS-R), will be recruited from specialized Child and Adolescent Psychiatry and local Youth-Clinics and randomized to either TARA or standard treatment, including but not limited to antidepressant medication and/or psychotherapy. Outcome measures will be obtained before randomization (T0), after 3 months of treatment (T1) and at 6-months- (T2) and 24-months- (T3) follow-up. Additionally, dose-response measures will be obtained weekly in the TARA-arm and measures for mediation-analysis will be obtained halfway through treatment (T0.5). Primary outcome measure is Reynolds Adolescent Depression Scale (RADS-2) score at T1. Secondary outcome measures include RADS-2 score at T2, Multidimensional Anxiety Scale for Children at T1 and T2, and CDRS-R at T1. Additional outcome measures include self-report measures of depression-associated symptoms, systemic bio-indicators of depression from blood and hair, heartrate variability, brain magnetic resonance imaging, as well as three-axial accelerometry for sleep-objectivization. Qualitative data will be gathered to reach a more comprehensive understanding of the factors affecting adolescents and young adults with depression and the extent to which the different treatments address these factors. In summary, this article describes the design, methods and statistical analysis plan for pragmatically evaluating the clinical effectiveness of TARA. This will be the first RCT to examine the effects of TARA compared to standard treatment for adolescents and young adults with MDD or PDD. We argue that this study will extend the current knowledgebase regarding the treatment of depression. NCT Registration: identifier [NCT04747340].
... based on a two-way mixed consistency. GRID-HAMD scores are classi ed as no depression (0-7); mild depression (8)(9)(10)(11)(12)(13)(14)(15)(16); moderate depression (17)(18)(19)(20)(21)(22)(23); and severe depression (>24) (46). Clinical response is de ned as improvement in GRID-HAMD total score by ≥ 50% from baseline and remission from depression as GRID-HAMD score <5. ...
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Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. Objective: To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD. Method: Sixty adolescents (86.7% girls), aged 13-18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed by blinded evaluators at baseline and post-treatment with the Hamilton Depression Scale (HAMD). Self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks. Analyses were performed according to intent-to-treat principles. Results: At post-treatment, clinician-rated remission rates on the HAMD (5 % in ABFT and 3.33% in TAU, p =1, OR=1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X2[2, N = 60] =0.06 , p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3 %) of adolescents were still in the clinical range after 16 weeks of treatment. Conclusion: ABFT was not superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study’s small sample size, missing data, and implementation challenges. Continued efforts to improve treatment for MDD in outpatient clinics are warranted . Future research should examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings. Trial Registration: Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013
... This finding is consistent with previous studies where most adolescents showed significant improvement in symptoms of depression and social functioning after receiving IPT intervention [40,43,56]. Another studies also reported that adolescents who received IPT showed a reduction of depression symptoms as compared to a control group [59,60]. Similarly, a study in a higher education institution reported that students who received IPT had significantly reduced symptoms of depression compared to a control group [42]. ...
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Background The prevalence of mental distress among university students in low- and middle-income countries (LMICs) is increasing; however, the majority do not receive evidence-based psychological intervention. This calls for the provision of culturally adapted psychological therapy in higher education institutions in LMICs. The aim of this pilot study is to evaluate the feasibility and acceptability of Interpersonal Psychotherapy adapted for Ethiopia (IPT-E) among Wolaita Sodo University students and to assess the preliminary outcomes of IPT-E in reducing symptoms of mental distress and in improving functioning. Methods We used a quasi-experimental single-group pre-post-test study design. As indicators of feasibility of IPT-E, we used consent, treatment completion and attrition. We used Client Satisfaction Questionnaire and semi-structured interview to measure the acceptability of the intervention, self-reporting IPT-E checklist to assess treatment adherence and World Health Organization Disability Assessment and Self-Reporting Questionnaire-20 tools to assess functional impairment and mental distress, respectively. We used percentage, frequency, mean and standard deviation to summarize the demographic variables, feasibility and acceptability of IPT-E. We analyzed changes from pre- to post-tests of mental distress and functioning results using paired t-test and Wilcoxon signed-rank tests. Independent sample t-test and one way-ANOVA used to assess the difference in mean score of in demographic variables at baseline and eight weeks. The qualitative data was analyzed with the support of open code 4.02. Results IPT-E was feasible (consent rate = 100%; completion rate = 92.31%; attrition rate = 7.69%; mean score of the sessions = 8 and mode of the session = 8). The total mean score of treatment satisfaction was 27.83 (SD = 4.47). After the delivery of IPT-E, symptoms of mental distress were decreased, functioning was improved and therapist adherence to the treatment model was 100% (i.e. treatment delivered according to the IPT-E guideline). Conclusion IPT-E was feasible and acceptable to treat university students with mental distress in low-income country setting. The preliminary results also suggest promising viability of IPT-E in higher education institutions of low-income country setting for students with symptoms of anxiety and depression.
... These findings suggest that there is a strong need for effective treatment of depression in these age groups through early and evidence-based interventions [7,15]. There is growing research on the psychotherapy of depression in children and adolescents, but recent studies have delivered heterogeneous results and only low to medium effect sizes [16][17][18][19][20]. Reviews focusing exclusively on the psychotherapy of depression in childhood and adolescence [16,21] reported an overall effect size (g) of 0.36 at post-treatment and 0.21 at follow-up. ...
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Background Depression is a serious disorder in childhood and adolescence. Affected children and adolescents show significant impairments in various aspects of life. Studies on the effectiveness or efficacy of psychotherapy in depressed children and adolescents are qualitatively very heterogeneous and reveal small effect sizes. There is thus a need to better tailor psychotherapy approaches to these age groups to improve outcomes like parent-child relationship, symptomatology, or quality of life. To address this gap, we designed a modular, individualized treatment program for children and adolescents based on the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) including caregiver involvement. Method This quasi-experimental pilot feasibility trial is a phase 1 to phase 2 study investigating the feasibility and effectiveness of CBASP@YoungAge by including an intervention group (CBASP@YoungAge) and a treatment-as-usual control group. The treatment of depressive symptoms as well as interpersonal problems with primary caregivers are the main targets of CBASP@YoungAge. Personalization is ensured concerning the treatment course, caregivers’ involvement, and the patient’s age. The primary outcome relates to two areas: the feasibility of the CBASP@YoungAge treatment program in an outpatient context and a change in patients' depressive symptomatology from before to after treatment. We conduct a brief process evaluation after each session in the intervention group to closely monitor the treatment process and examine feasibility from the therapists' and patients' perspectives and mechanisms of symptom change. In addition, we consider interpersonal behavior between children and caregivers, parenting behavior, and monitor the global-health-index in children and parents as secondary outcomes. Pre-, post-, and follow-up data are evaluated. Discussion This is the first study of a modular-based intervention program for children and adolescents with depression and a clear focus on the interpersonal problems between the depressed young patient and her/his caregiver. It will provide important knowledge on the feasibility and effectiveness of the program and potential benefits of including caregivers in psychotherapy. Based on this study’s results, we plan a multicenter, randomized, controlled trial whose long-term aim is to improve the psychotherapeutic care of young patients with depression while preventing persistent courses of depressive disorders. Trial registration German Clinical Trials Register, DRKS (identifier DRKS00023281 ). Registered 17 November 2020–Retrospectively registered
... It is difficult for medical students who do not have interpersonal communication skills to establish a good doctor-patient relationship [35]. On the other hand, the main influencing factor of self-efficacy is the experience of success or failure, and considerable experience with regulating emotions is acquired through interpersonal interaction, so individuals with a high level of self-efficacy experience more harmonious interpersonal relationships [36,37]. It has also been found that regulatory emotional self-efficacy can predict interpersonal adaptation, and people who are confident in their emotional regulation capacities have stronger communication skills [38]. ...
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Background Psychological distress (depression, anxiety and stress) is more common among medical students than in the general population, and is an important cause of insomnia, internet addiction, substance abuse, decreased academic performance and increased suicidality in medical students. Methods To examine the mechanism by which regulatory emotional self-efficacy affects medical students' psychological distress, a questionnaire of 539 medical students using an interpersonal adaptability scale, regulatory emotional self-efficacy scale, self-acceptance scale and depression-anxiety-stress scale was conducted. Results ① Regulatory emotional self-efficacy, interpersonal adaptability and self-acceptance are positively correlated, but they are negatively correlated with psychological distress. ② The mediation model shows that interpersonal adaptation and self-acceptance are the mediation variables of the effect of regulatory emotional self-efficacy on psychological distress, and the total mediation effect value is -0.37, accounting for 86.05% of the total effect (-0.43). Specifically, the effect involves three paths: first, regulatory emotional self-efficacy indirectly affects psychological distress through interpersonal adaptation (effect value-0.24); second, regulatory emotional self-efficacy indirectly affects psychological distress through interpersonal adaptation and self-acceptance (effect value-0.08); and third, regulatory emotional self-efficacy indirectly affects psychological distress through self-acceptance (effect value -0.05). Conclusions Interpersonal adaptation and self-acceptance have a significant mediating effect between regulatory emotional self-efficacy and psychological distress, and the chain mediating effect of interpersonal adaptation and self-acceptance is also significant.
... The figure shows an example of a SMART design for a trial enrolling adolescents with type 2 diabetes treated with metformin ± insulin, positive for depressive or diabetes distress symptoms, and HbA 1c > 47.5 mmol/mol (>6.5%). Interpersonal therapy (IPT) is effective for treatment of depression [62] and is particularly suitable for individuals from historically disadvantaged racial/ethnic groups [63]. Add-on pharmacological therapy (Add pharmaRx) involves the addition of a newer diabetes treatment agent (e.g., GLP-1 agonist, SGLT2 inhibitor), individualised based on patient characteristics. ...
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Globally, the proportion of new diagnoses of youth-onset diabetes represented by type 2 diabetes is increasing, and youth with type 2 diabetes commonly have complications and comorbidities, as well as a higher rate of mortality. In this review, we summarise what is known about the natural progression of youth-onset type 2 diabetes from published clinical trials and large-scale prospective epidemiological studies. It is important to note that the robust pathophysiological and treatment data specifically related to individuals with a diabetes onset at ≤20 years of age largely hails from the USA. Youth-onset type 2 diabetes is characterised by pathophysiological heterogeneity and inadequate glycaemic control, highlighting the need for new treatment approaches and innovative study designs in populations of varied genetic and cultural backgrounds. Graphical abstract
... Evidence showed the effectiveness of several psychological therapies to reduce depression, such as Cognitive Behavioral Therapy (Nieuwsma et al., 2012), Dialectical Behavior Therapy (Goodman et al., 2016), Interpersonal Psychotherapy (Pu et al., 2017), Psychodynamic Psychotherapy (Bressi et al., 2016), and Transpersonal Psychotherapy (Boorstein, 2000;Llabres, 2003). ...
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Female victims of domestic violence often experience depression. This research used Empathic Love Therapy (ELT) to reduce depressive symptoms, by enabling individual to understand one-self deeper by realizing, understanding, accepting, and loving all aspects of the self, which is the early process of healing. This research is quasi-experiment research using a single group simple interrupted time series design. Five women aged 30-60 years old who experience depression, based on BDI (Beck Depression Inventory) score, participated in an eight-session therapy. Participants were recruited purposively based on theory-based or operational construct sampling. Data analysis combined quantitative and qualitative methods, of which Wilcoxon Signed Ranks Test was used for quantitative analysis, whereas qualitative analysis adopted a descriptive analysis. Quantitative findings significant difference in BDI score between before and after treatment (Z = -2.023 with p= 0.043<0.05). Qualitative findings showed that participants were able to find survival personality that emerged from past painful experiences and plays a role in the depression symptoms they are currently experiencing. With the power of love they find from God, they are able to accept themselves, and focus their lives on their potential and positive future plans. Therefore, it can be concluded that Empathic Love Therapy is effective to be used to reduce depressive symptoms.
... based on a two-way mixed consistency. GRID-HAMD scores are classi ed as no depression (0-7); mild depression (8)(9)(10)(11)(12)(13)(14)(15)(16); moderate depression (17)(18)(19)(20)(21)(22)(23); and severe depression (>24) (46). Clinical response is de ned as improvement in GRID-HAMD total score by ≥ 50% from baseline and remission from depression as GRID-HAMD score <5. ...
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Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. Objective: To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD. Method: Sixty adolescents (86.7% girls), aged 13-18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed by blinded evaluators at baseline and post-treatment with the Hamilton Depression Scale (HAMD). Self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks. Analyses were performed according to intent-to-treat principles. Results: At post-treatment, clinician-rated remission rates on the HAMD (5 % in ABFT and 3.33% in TAU, p =1, OR=1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X2[2, N = 60] =0.06 , p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3 %) of adolescents were still in the clinical range after 16 weeks of treatment. Conclusion: ABFT was not superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study’s small sample size, missing data, and implementation challenges. Continued efforts to improve treatment for MDD in outpatient clinics are warranted . Future research should examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings. Trial Registration: Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013
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Background: Mental health problems are a major health issue for children and adolescents around the world. The school environment allows adolescents to be reached comprehensively and on a low threshold, making it a potential environment for mental health interventions. The aim of this review was to describe interventions delivered by health-care workers in school environment for individual adolescents aged 12–18 with mental health problems and to assess the effectiveness of these interventions. Methods: This systematic review was conducted in adherence with the PRISMA guidelines. Altogether 349 studies were screened and 24 of them were included in full text assessment. Eight studies were included in the qualitative synthesis. Only in three studies the intervention was compared to another intervention or the study setting included a control group. Five of the interventions were based on cognitive-behavioral therapy and three on other approaches. In seven studies, one of the main response variables was based on assessment of depressive symptoms and/or a depressive disorder. The quality of the studies was limited with notable risk for bias for some studies. Results: Based on reported symptom reductions, for most of the interventions, the results were good. Symptom reductions were also typically achieved in a rather low number of sessions (12 or less) supporting the feasibility of these type of interventions in school environment. However, the lack of use of control groups and actual comparisons between the interventions, limit the possibility to draw firm conclusions regarding their effectiveness and thus, the results should be interpreted with caution. Confirming the effectiveness of the studied interventions requires more robust evidence and thus, improving the quality of studies in the school environment is encouraged.
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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.
Chapter
Substantively as well as symbolically, psychotherapy for depression and addiction repeats the clinical record of post-traumatic stress disorder. The best of the best studies of psychotherapy for depression fails as science, lacking true tests of treatment while routinely exaggerating the effectiveness of psychotherapy. The research does not dispel the likelihood that psychotherapy for depression fails to improve on the processes that account for natural remission. Psychotherapy offers no apparent cure for drug addiction. The variation in reported addiction rates from year to year, suspect in itself, may be due to generational learning and changing fashions in social attitudes to illicit drug use more than to any form of treatment. The small amount of remission and true long-term abstinence reported in psychotherapy trials are likely determined by rare patient motivation and their situations rather than treatment itself.
Chapter
This chapter presents the evidence-base for family-based psychological interventions (FBPI), and the clinical implications of this for the treatment of (1) child-focused problems, (2) adult focused problems, and (3) difficulties that may occur across the life-cycle. Child-focused problems include attachment problems in infancy, child abuse, disruptive behavior disorders, and adolescent eating disorders. Adult focused problems include relationship distress, psychosexual problems, and intimate partner violence. Difficulties that may occur across the life-cycle include alcohol and substance use disorders, mood disorders, anxiety disorders, psychosis, and adjustment to illness and disability. FBPIs may be effective either alone or as part of multimodal programs for all of these types of problems. Treatment manuals for a range of FBPIs are available to inform clinical practice in this field. Further research on FBPIs is required to address issues such as transportability to community settings, cost-effectiveness, protocol enhancement for non-responders and those who experience negative treatment effects, the contribution of common factors and specific techniques to treatment effectiveness and adverse reactions to treatment, inclusion of FBPIs in multimodal programs, information technology supported FBPIs, and under-researched problems, populations, and FBPI practice models.
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Se analiza la veracidad de cinco ideas muy populares sobre la naturaleza y el tratamiento de la depresión infantojuvenil que dificultan que los niños y adolescentes reciban un tratamiento apropiado y que favorecen la farmacoterapia en perjuicio de la psicoterapia. Esas ideas se contrastan con los resultados de los metaanálisis y estudios más recientes localizados en PsycINFO y MEDLINE, que contrariamente a esas ideas indican que: 1) la psicoterapia cura la depresión infantojuvenil, 2) la psicoterapia, especialmente la terapia cognitivo-conductual para niños y adolescentes y la terapia interpersonal para adolescentes, es el tratamiento de primera elección tanto para la depresión leve como para la moderada o grave y por delante de la medicación antidepresiva, 3) la psicoterapia para la depresión infantojuvenil suele ser un tratamiento de corta duración, 4) la depresión infantojuvenil se considera un trastorno mental, no una enfermedad mental y 5) no se ha demostrado empíricamente que la causa principal de la depresión infantojuvenil sea biológica, sino que esta es solamente una hipótesis más.
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Objectives To describe the results of a mapping review exploring the coverage of unwanted treatment effects in systematic reviews of the effects of various treatments for moderate to severe depression in children and adolescents. Setting Any context or service providing treatment for depression, including interventions delivered in local communities and school settings, as well as services provided in primary or specialist care. Participants Children and young people with moderate to severe depression (<18 years). Interventions Systematic reviews published in 2011 or later comparing the effects of any treatment for children and adolescents with moderate to severe depression meeting the Database of Abstracts of Reviews of Effects criteria. The systematic search was performed in April 2018 and updated in December 2018. Primary outcomes Any unwanted effects of treatments as defined in the systematic review. Results We included 10 systematic reviews covering 19 treatment comparisons. Unwanted effects were assessed for seven of 19. Three comparisons were evaluations of pharmaceutical interventions or combination therapy, reporting effects on ‘suicidal ideation’ and ‘suicide risk’. Two included therapy, reporting ‘self-harm’, and ‘suicidal ideation’, and two comparisons included transcranial magnetic stimulation and electroconvulsive treatment. Unwanted effects evaluated for these treatments were mostly symptoms of physical discomfort such as headache or cramps. For the remaining treatment comparisons evaluating psychological and psychosocial therapies, unwanted effects were not evaluated or found. A limitation of overviews of systematic reviews such as this mapping study is that data extraction is done based on the reporting of results by the review authors and not on the primary studies. Conclusion The unwanted effects of widely used treatments for children and young people with depression is unknown. This is a major barrier for evidence informed decision making about treatment choices for children and young people. We suggest that unwanted effects should be a reporting standard in all protocols describing evaluations of treatments, including primary studies as well as systematic reviews.
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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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The Republic of Croatia holds the Presidency of the Council of the European Union from 1st January 2020 to 30rd June 2020. During its presidency, Croatia set its health priorities, in accordance with the health policies advocated by the EU. (Taking forward the Strategic Agenda - 18-month Program of the Council (January 1st 2019 - June 30th 2020 Available on https://www.consilium.europa.eu/en/council-eu/presidency-council-eu/). One of the health priorities that the Republic of Croatia singled out during its presidency is: the promotion of lifelong care for the health of the individual. As part of this priority, the protection of mental health is one of the most important priorities in public health care to ensure optimal access to health care for all EU citizens. Health is of particular importance, especially in the circumstances that marked Croatia's presidency of the EU Council, such as the COVID19 pandemic and the earthquake in Zagreb on March 22nd, 2020. During its presidency, Croatia decided on the topic of mental health in order to emphasize the importance of mental health as a public good and to encourage the implementation of EU strategies and recommendations in the field of mental health. The Mental health as public good – Psychosocial interventions in mental health booklet was created by mental and public health experts during the Croatian presidency of the Council of the European Union as Croatian contribution to the European path to mental health. The purpose of the booklet is to encourage EU member states to view mental health as a public good, a key part of sustainable development, stability, and social capital that builds communities of satisfied citizens who in return contribute to the development of society as a whole by taking appropriate actions. The main goal is to encourage the setup of mental health care through the implementation of various psychosocial programs and interventions that contribute to better mental health, prevention and treatment of mental disorders, and encourage the development of new programs and interventions. In order to encourage governments, experts and all relevant stakeholders in the field of mental health care to analyze the VI current situation and encourage positive changes, but aware of the fact that there are significant differences among EU Member States, we have listed evidence-based and/or good practice psychosocial interventions which can be useful in both analyzing the current situation and creating action plans that will result in improvements in the promotion, prevention and treatment outcomes, as well as the implementation of good practices that can change the lives of many people. In the selection of psychosocial interventions we used sources cited in the publications of the EU Commission, EU – Compass for Action on Mental Health and Wellbeing, WHO, Lancet committees, international guidelines for the treatment of mental disorders in clinical practice, scientific publications that include meta-analyses, randomized and control studies and other sources. Editors: Prof. Slađana Štrkalj-Ivezić, MD, PhD, University Clinical Hospital Vrapče, School of Medicine, University of Zagreb Marija Kušan Jukić, MD, PhD, Andrija Stampar Teaching Institute of Public Health, Zagreb Assoc. Prof. Danijela Štimac Grbić, Croatian Institute of Public Health, Andrija Štampar School of Public Health, School of Medicine, University of Zagreb
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Evidence confirms that children and adolescents can experience the whole spectrum of mood disorders and suffer from the significant morbidity and mortality associated with them. Effective treatment often relies on physicians developing advanced communication skills with their patients. Enhanced communication will help decipher the etiology of the patient’s depression and, in addition to serotonin-regulating medications, will optimize treatment. Osteopathic medicine offers an effective treatment model through osteopathic manipulative treatment (OMT) because of the inseparability of physical and mental health. Osteopathic medicine takes a holistic view in which somatic, visceral and psychological dysfunction are united. Thus, physicians who incorporate OMT into their practice will help treat psychopathologies, such as depression and its accompanying somatic dysfunctions. This paper discusses the epidemiology of depression, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) depression criteria, screening algorithms, current treatment protocols, osteopathic considerations to treating depression, and lastly, OMT and its role in treatment.
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en This review updates previous similar papers published in JFT in 2000, 2009 and 2014. It presents evidence from meta‐analyses, systematic literature reviews, narrative literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with common mental health problems and other difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training, or parent implemented behavioural programmes. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; recovery from child abuse and neglect; conduct problems, emotional problems, eating disorders, somatic problems, and first episode psychosis. 抽象 zh 针对儿童问题的家庭治疗和系统干预:当前的实证基础 本文对2000年、2009年和2014年发表在JFT上的相似综述进行了更新。本文提供了统合分析、系统文献综述、叙事文献综述和对有常见心理健康问题以及其他障碍的青少年儿童进行系统干预有效性的对照试验的实证数据。在本文中,系统性干预包括家庭治疗和其他家庭为基础的方法,如家长培训或家长实施的行为计划。数据支持单独使用或作为多模式计划一部分的系统性干预措施对于婴儿期睡眠、喂养和依恋问题;儿童虐待和忽视的恢复;行为问题、情绪问题、饮食失调、躯体问题和首发精神病的有效性。 Abstracto es Terapia familiar e intervenciones sistémicas para problemas centrados en los niños: revisión actualizada de la evidencia de resultados Esta revisión actualiza artículos similares anteriores publicados en JFT en 2000, 2009 y 2014. Presenta evidencia de meta‐análisis, revisiones sistemáticas de literatura, revisiones de literatura narrativa y ensayos controlados para la efectividad de intervenciones sistémicas para familias de niños y adolescentes con problemas habituales de salud mental y otras dificultades. En este contexto, las intervenciones sistémicas incluyen tanto la terapia familiar como otros enfoques basados en la familia, como la capacitación de los padres o los programas conductuales implementados por los padres. La evidencia apoya la efectividad de las intervenciones sistémicas, ya sea de forma independiente o como parte de programas multimodales para el sueño, la alimentación y los problemas de apego en la infancia; recuperación del abuso y negligencia infantil; problemas de conducta, problemas emocionales, trastornos alimenticios, problemas somáticos y primer episodio de psicosis.
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Previous meta-analyses of atypical antipsychotics for depression were limited by few trials with direct comparisons between two treatments. We performed a network meta-analysis, which integrates direct and indirect evidence from randomized controlled trials (RCTs), to investigate the comparative efficacy and tolerability of adjunctive atypical antipsychotics for treatment-resistant depression (TRD). Systematic searches resulted in 18 RCTs (total N=4422) of seven different types and different dosages of atypical antipsychotics and placebo that were included in the review. All standard-dose atypical antipsychotics were significantly more efficacious than placebo in the efficacy (SMDs ranged from -0.27 to -0.43). There were no significant differences between these drugs. Low-dose atypical antipsychotics were not significantly more efficacious than placebo. In terms of tolerability, all standard-dose atypical antipsychotics, apart from risperidone, had significantly more side-effect discontinuations than placebo (ORs ranged from 2.72 to 6.40). In terms of acceptability, only quetiapine (mean 250-350 mg daily) had a significantly more all-cause discontinuation than placebo (OR = 1.89). In terms of quality of life/functioning, standard-dose risperidone and standard-dose aripiprazole were more beneficial than placebo (SMD = -0.38; SMD = -0.26, respectively), and standard-dose risperidone was superior to quetiapine (mean 250-350 mg daily). All standard-dose atypical antipsychotics for the adjunctive treatment of TRD are efficacious in reducing depressive symptoms. Risperidone and aripiprazole also showed benefits in improving the quality of life of patients. Atypical antipsychotics should be prescribed with caution due to abundant evidence of side effects. © The Author 2015. Published by Oxford University Press on behalf of CINP.
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This study adds to the limited evidence concerning the benefits of Interpersonal Psychotherapy (IPT) with depressed adolescents. It evaluates the long-term effects of group versus individual delivery of this treatment approach. To conduct a small-scale examination of the long-term efficacy of group versus individual delivery of IPT for depressed adolescents. Thirty-nine adolescents, aged 13-19 years, with a primary diagnosis of Major Depressive Disorder, were randomly assigned in blocks to either group or individual delivery of IPT. Standardized clinical interview and questionnaire assessments were conducted at pre- and posttreatment, and 12-month follow-up. Intent-to-treat (ITT) analyses indicated significant improvements in depression, anxiety, youth-reported internalizing problems, and global functioning from pre- to posttreatment for those receiving IPT, with no significant differences in outcome between group and individual formats of delivery. Improvements were maintained at 12-month follow-up. Completer analyses also revealed significant and sustained improvements on these measures for those receiving IPT, with no differences in outcome between therapy formats for most measures. Individual IPT showed significantly greater improvements than group IPT in parent-reported internalizing problems for the completer but not the ITT analyses. Both individual and group formats of IPT offer promise in producing long-term benefits in the treatment of depression among adolescents.
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Background Current guidelines for treatment-resistant depression in adolescents remain inadequate. This study aimed to systematically review the management of treatment-resistant depression in adolescent patients.Methods We conducted an electronic database search of PUBMED, EMBASE, Cochrane, Web of Science and PsycINFO for studies with adolescent treatment-resistant depression published up to January 2014. Treatment-resistant depression was defined as failure to respond to at least one course of psychological or pharmacological treatment for depression with an adequate dosage, duration, and appropriate compliance during the current illness episode. The Cochrane risk-of-bias method was used to assess the quality of randomized controlled trials. A meta-analysis of all active treatments was conducted.ResultsEight studies with 411 depressed adolescents that fit predetermined criteria investigated pharmacological treatments and psychotherapies. Six were open-label studies, and two were randomized controlled trials. The overall response rate for all active treatments investigated was 46% (95% CI 33 to 59; N¿=¿411) with a moderately high degree of heterogeneity (I2¿=¿76.1%, 95% CI¿=¿47%-86%). When only the two randomized trials were included, the overall response rate of active treatment was 53% (95% CI¿=¿38-67; N¿=¿347). In these randomized trials, SSRI therapy plus CBT was significantly more effective than SSRI therapy alone, while amitriptyline was not more effective than placebo.Conclusions Approximately half of the adolescents who presented with treatment-refractory depression responded to active treatment, which suggests that practitioners should remain persistent in managing these challenging cases. The combination of antidepressant medication and psychotherapy should be recommended for adolescents who present with treatment-resistant depression.
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AimsTo measure the effectiveness of antidepressants for adolescents and young adults with co-occurring depression and substance use disorder.Design, setting, participantsMeta-analysis of randomized controlled clinical trials. A comprehensive literature search of PubMed, Cochrane, Embase, Web of Science and PsychINFO was conducted (from 1970 to 2013). Prospective, parallel groups, double-blind, controlled trials with random assignment to an antidepressant or placebo on young patients (age ≤25 years) who met diagnostic criteria of both substance use and unipolar depressive disorder were included. Five trials were selected for this analysis and included 290 patients.MeasurementsOur efficacy outcome measures were depression outcomes (dichotomous and continuous measures) and substance-use outcomes (change of frequency or quantity of substance-use). Secondary analysis was conducted to access the tolerability of antidepressants treatment.FindingsFor dichotomous depression outcome, antidepressants group was significantly more effective than placebo group (RR=1.21; 95% CI 1.01 to 1.45) with low heterogeneity (I2=0%). Although no statistically significant effects for continuous depression outcome (SMD=-0.13; 95% CI, -0.55 to 0.30) were found with moderate heterogeneity (I2=63%), subgroup analysis showed medicine group with sample size of more than 50 showed a statistically significant efficacy compared with the placebo group (SMD -0.53, 95% CI -0.82 to -0.25). Moreover, there was no significant difference for substance-use outcomes and tolerability outcomes between medication group and placebo group.Conclusions Antidepressant medication has a small overall effect in reducing depression in young patients with combined depressive and substance-use disorders but does not appear to improve substance use outcomes.
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Interpersonal psychotherapy (IPT) is a dynamically informed and present-focused psychotherapy originally conceived for patients with unipolar depression and subsequently modified for other disorders, including postpartum depression (PPD). The aim of this paper is to review the evidence on the efficacy of IPT for PPD. We conducted a systematic review of studies published between 1995 and April 2013 assessing the efficacy of IPT for PPD using PubMed and PsycINFO. We included the following: (i) articles that presented a combination of at least two of the established terms in the abstract, namely, interpersonal [all fields] and ("psychotherapy" [MeSH terms] or psychotherapy [all fields]) and (perinatal [all fields] or postpartum [all fields]) and ("depressive disorder" [MeSH terms] or ("depressive" [all fields] and "disorder" [all fields]) or depressive disorder [all fields] or "depression" [all fields] or depression [MeSH terms]); (ii) manuscripts in English; (iii) original articles; and (iv) prospective or retrospective observational studies (analytical or descriptive), experimental, or quasi-experimental. Exclusion criteria were as follows: (i) other study designs, such as case reports, case series, and reviews; (ii) non-original studies including editorials, book reviews, and letters to the editor; and (iii) studies not specifically designed and focused on IPT. We identified 11 clinical primary trials assessing the efficacy of IPT for PPD, including 3 trials with group interventions (G-IPT) and one that required the presence of the partner (PA-IPT). We also identified six studies interpersonal-psychotherapy-oriented preventive interventions for use in pregnancy. IPT studies showed overall clinical improvement in the most commonly used depression measures in postpartum depressed women (EPDS, HDRS, BDI) and often-full recovery in several cases of treated patients. Evidence from clinical trials indicates that, when administered in monotherapy (or in combination with antidepressants), IPT may shorten the time to recovery from PPD and prolong the time spent in clinical remission.
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Background This systematic review describes a comparison between several standard treatments for major depressive disorder (MDD) in adult outpatients, with a focus on interpersonal psychotherapy (IPT). Methods Systematic searches of PubMed and PsycINFO studies between January 1970 and August 2012 were performed to identify (C-)RCTs, in which MDD was a primary diagnosis in adult outpatients receiving individual IPT as a monotherapy compared to other forms of psychotherapy and/or pharmacotherapy. Results 1233 patients were included in eight eligible studies, out of which 854 completed treatment in outpatient facilities. IPT combined with nefazodone improved depressive symptoms significantly better than sole nefazodone, while undefined pharmacotherapy combined with clinical management improved symptoms better than sole IPT. IPT or imipramine hydrochloride with clinical management showed a better outcome than placebo with clinical management. Depressive symptoms were reduced more in CBASP (cognitive behavioral analysis system of psychotherapy) patients in comparison with IPT patients, while IPT reduced symptoms better than usual care and wait list condition. Conclusions The differences between treatment effects are very small and often they are not significant. Psychotherapeutic treatments such as IPT and CBT, and/or pharmacotherapy are recommended as first-line treatments for depressed adult outpatients, without favoring one of them, although the individual preferences of patients should be taken into consideration in choosing a treatment.
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Background Substantial data indicate potential health consequences of untreated postpartum depression (PPD) on the mother, infant, and family. Studies have evaluated interpersonal psychotherapy (IPT) as treatment for PPD; however, the results are questionable due to methodological limitations. A comprehensive review of maternal treatment preferences suggests that mothers favor ‘talking therapy’ as a form of PPD treatment. Unfortunately, IPT is not widely available, especially in rural and remote areas. To improve access to care, telepsychiatry has been introduced, including the provision of therapy via the telephone. Methods/Design The purpose of this randomized controlled trial is to evaluate the effect of telephone-based IPT on the treatment of PPD. Stratification is based on self-reported history of depression and province. The target sample is 240 women. Currently, women from across Canada between 2 and 24 weeks postpartum are able to either self-identify as depressed and refer themselves to the trial or they may be referred by a health professional based on a score >12 on the Edinburgh Postnatal Depression Scale (EPDS). Following contact by the trial coordinator, a detailed study explanation is provided. Women who fulfill the eligibility criteria (including a positive diagnostic assessment for major depression) and consent to participate are randomized to either the control group (standard postpartum care) or intervention group (standard postpartum care plus 12 telephone-based IPT sessions within 12 to 16 weeks, provided by trained nurses). Blinded research nurses telephone participants at 12, 24, and 36 weeks post-randomization to assess for PPD and other outcomes including depressive symptomatology, anxiety, couple adjustment, attachment, and health service utilization. Results from this ongoing trial will: (1) develop the body of knowledge concerning the effect of telephone-based IPT as a treatment option for PPD; (2) advance our understanding of training nurses to deliver IPT; (3) provide an economic evaluation of an IPT intervention; (4) investigate the utility of the EPDS in general clinical practice to identify depressed mothers; and (5) present valuable information regarding PPD, along with associated couple adjustment, co-morbid anxiety and self-reported attachment among a mixed rural and urban Canadian population. Trial registration Current Controlled Trials Ltd. ISRCTN88987377.
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Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30
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Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Cognitive therapy may be an effective treatment option for major depressive disorder, but the effects have only had limited assessment in systematic reviews. Cochrane systematic review methodology, with meta-analyses and trial sequential analyses of randomized trials, are comparing the effects of cognitive therapy versus 'treatment as usual' for major depressive disorder. To be included the participants had to be older than 17 years with a primary diagnosis of major depressive disorder. Altogether, we included eight trials randomizing a total of 719 participants. All eight trials had high risk of bias. Four trials reported data on the 17-item Hamilton Rating Scale for Depression and four trials reported data on the Beck Depression Inventory. Meta-analysis on the data from the Hamilton Rating Scale for Depression showed that cognitive therapy compared with 'treatment as usual' significantly reduced depressive symptoms (mean difference -2.15 (95% confidence interval -3.70 to -0.60; P<0.007, no heterogeneity)). However, meta-analysis with both fixed-effect and random-effects model on the data from the Beck Depression Inventory (mean difference with both models -1.57 (95% CL -4.30 to 1.16; P = 0.26, I(2) = 0) could not confirm the Hamilton Rating Scale for Depression results. Furthermore, trial sequential analysis on both the data from Hamilton Rating Scale for Depression and Becks Depression Inventory showed that insufficient data have been obtained. Cognitive therapy might not be an effective treatment for major depressive disorder compared with 'treatment as usual'. The possible treatment effect measured on the Hamilton Rating Scale for Depression is relatively small. More randomized trials with low risk of bias, increased sample sizes, and broader more clinically relevant outcomes are needed.
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Interpersonal psychotherapy (IPT), a structured and time-limited therapy, has been studied in many controlled trials. Numerous practice guidelines have recommended IPT as a treatment of choice for unipolar depressive disorders. The authors conducted a meta-analysis to integrate research on the effects of IPT. The authors searched bibliographical databases for randomized controlled trials comparing IPT with no treatment, usual care, other psychological treatments, and pharmacotherapy as well as studies comparing combination treatment using pharmacotherapy and IPT. Maintenance studies were also included. Thirty-eight studies including 4,356 patients met all inclusion criteria. The overall effect size (Cohen's d) of the 16 studies that compared IPT and a control group was 0.63 (95% confidence interval [CI]=0.36 to 0.90), corresponding to a number needed to treat of 2.91. Ten studies comparing IPT and other psychological treatments showed a nonsignificant differential effect size of 0.04 (95% CI=-0.14 to 0.21; number needed to treat=45.45) favoring IPT. Pharmacotherapy (after removal of one outlier) was more effective than IPT (d=-0.19, 95% CI=-0.38 to -0.01; number needed to treat=9.43), and combination treatment was not more effective than IPT alone, although the paucity of studies precluded drawing definite conclusions. Combination maintenance treatment with pharmacotherapy and IPT was more effective in preventing relapse than pharmacotherapy alone (odds ratio=0.37; 95% CI=0.19 to 0.73; number needed to treat=7.63). There is no doubt that IPT efficaciously treats depression, both as an independent treatment and in combination with pharmacotherapy. IPT deserves its place in treatment guidelines as one of the most empirically validated treatments for depression.
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Interpersonal psychotherapy is regarded as an effective psychotherapy particularly in the treatment of depression and has been around for more than 20 years. However, there is a paucity of information and discussion in the nursing literature. This article provides an overview of interpersonal psychotherapy, including its origins and historical background. This is followed by a description of the model and its application in patients with major depression.
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We evaluated the Children's Global Assessment Scale (CGAS), an adaptation of the Global Assessment Scale for adults. Our findings indicate that the CGAS can be a useful measure of overall severity of disturbance. It was found to be reliable between raters and across time. Moreover, it demonstrated both discriminant and concurrent validity. Given these favorable psychometric properties and its relative simplicity, the CGAS is recommended to both clinicians and researchers as a complement to syndrome-specific scales.
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Psychotherapy is widely used for depressed adolescents, but evidence supporting its efficacy is sparse. In a controlled, 12-week, clinical trial of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), 48 clinic-referred adolescents (aged 12-18 years) who met the criteria for DSM-III-R major depressive disorder were randomly assigned to either weekly IPT-A or clinical monitoring. Patients were seen biweekly by a "blind" independent evaluator to assess their symptoms, social functioning, and social problem-solving skills. Thirty-two of the 48 patients completed the protocol (21 IPT-A-assigned patients and 11 patients in the control group). Patients who received IPT-A reported a notably greater decrease in depressive symptoms and greater improvement in overall social functioning, functioning with friends, and specific problem-solving skills. In the intent-to-treat sample, 18 (75%) of 24 patients who received IPT-A compared with 11 patients (46%) in the control condition met recovery criterion (Hamilton Rating Scale for Depression score < or =6) at week 12. These preliminary findings support the feasibility, acceptability, and efficacy of 12 weeks of IPT-A in acutely depressed adolescents in reducing depressive symptoms and improving social functioning and interpersonal problem-solving skills. Because it is a small sample consisting largely of Latino, low socioeconomic status adolescents, further studies must be conducted with other adolescent populations to confirm the generalizability of the findings.
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This study evaluated the efficacy of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) with depressed adolescents in Puerto Rico. Seventy-one adolescents meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria for a diagnosis of depression were randomly assigned to 1 of 3 conditions: CBT, IPT, or wait list (WL). Pretreatment, posttreatment, and 3-month follow-up measures of depression symptoms, self-esteem, social adjustment, family emotional involvement and criticism, and behavioral problems were completed. Results suggest that IPT and CBT significantly reduced depressive symptoms when compared with the WL condition. IPT was superior to the WL condition in increasing self-esteem and social adaptation. Clinical significance tests suggested that 82% of adolescents in IPT and 59% of those in CBT were functional after treatment. The results suggest that both IPT and CBT are efficacious treatments for depressed Puerto Rican adolescents. IPT's impact in other levels of outcome is discussed in terms of its consonance with Puerto Rican cultural values.
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We study recently developed nonparametric methods for estimating the number of missing studies that might exist in a meta-analysis and the effect that these studies might have had on its outcome. These are simple rank-based data augmentation techniques, which formalize the use of funnel plots. We show that they provide effective and relatively powerful tests for evaluating the existence of such publication bias. After adjusting for missing studies, we find that the point estimate of the overall effect size is approximately correct and coverage of the effect size confidence intervals is substantially improved, in many cases recovering the nominal confidence levels entirely. We illustrate the trim and fill method on existing meta-analyses of studies in clinical trials and psychometrics.
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Cochrane Reviews have recently started including the quantity I 2 to help readers assess the consistency of the results of studies in meta-analyses. What does this new quantity mean, and why is assessment of heterogeneity so important to clinical practice? Systematic reviews and meta-analyses can provide convincing and reliable evidence relevant to many aspects of medicine and health care.1 Their value is especially clear when the results of the studies they include show clinically important effects of similar magnitude. However, the conclusions are less clear when the included studies have differing results. In an attempt to establish whether studies are consistent, reports of meta-analyses commonly present a statistical test of heterogeneity. The test seeks to determine whether there are genuine differences underlying the results of the studies (heterogeneity), or whether the variation in findings is compatible with chance alone (homogeneity). However, the test is susceptible to the number of trials included in the meta-analysis. We have developed a new quantity, I 2, which we believe gives a better measure of the consistency between trials in a meta-analysis. Assessment of the consistency of effects across studies is an essential part of meta-analysis. Unless we know how consistent the results of studies are, we cannot determine the generalisability of the findings of the meta-analysis. Indeed, several hierarchical systems for grading evidence state that the results of studies must be consistent or homogeneous to obtain the highest grading.2–4 Tests for heterogeneity are commonly used to decide on methods for combining studies and for concluding consistency or inconsistency of findings.5 6 But what does the test achieve in practice, and how should the resulting P values be interpreted? A test for heterogeneity examines the null hypothesis that all studies are evaluating the same effect. The usual test statistic …
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Interpersonal psychotherapy (IPT) is a time-limited psychotherapy for major depression. The aim of this study is to summarize findings from controlled trials of the efficacy of IPT in the treatment of depressive spectrum disorders (DSD) using a meta-analytic approach. Studies of randomized clinical trials of IPT efficacy were located by searching all available data bases from 1974 to 2002. The searches employed the following MeSH categories: Depression/ Depressive Disorder; Interpersonal therapy; Outcome/Adverse Effects/Efficacy; in the identified studies. The efficacy outcomes were: remission; clinical improvement; the difference in depressive symptoms between the two arms of the trial at endpoint, and no recurrence. Drop out rates were used as an index of treatment acceptability. Thirteen studies fulfilled inclusion criteria and four meta-analyses were performed. IPT was superior in efficacy to placebo in nine studies (Weight Mean Difference (WMD) - 3.57 [-5.9, -1.16]). The combination of IPT and medication did not show an adjunctive effect compared to medication alone for acute treatment (RR 0.78 [0.30, 2.04]), for maintenance treatment (RR 1.01 [0.81, 1.25]), or for prophylactic treatment (RR 0.70 [0.30, 1.65]). IPT was significantly better than CBT (WMD -2.16 [-4.16,-0.15]). The efficacy of IPT proved to be superior to placebo, similar to medication and did not increase when combined with medication. Overall, IPT was more efficacious than CBT. Current evidence indicates that IPT is an efficacious psychotherapy for DSD and may be superior to some other manualized psychotherapies.
Article
Background: Few meta-analyses have focused on the effect of cognitive behavioral therapy (CBT) for depression in children. Study selection: Randomized controlled trials comparing CBT with control conditions for depression in children (≤13 years old) were included. Data sources: Seven electronic databases (PubMed, Embase, CENTRAL, Web of Science, PsycINFO, CINAHL, and LiLACS) were searched from inception to September 2015. Data extraction and synthesis: The primary efficacy was defined as mean change scores in depressive symptoms, and the second efficacy (remission) was a score below the threshold for a diagnosis of depression, both after treatment and at the end of follow-up. We also measured acceptability by the proportion of participants who discontinued treatment up to posttreatment. Results: Nine studies with 306 participants were selected for this analysis. At posttreatment, CBT was significantly more effective than control conditions in terms of primary efficacy (standardized mean difference, -0.41; 95% confidence interval [CI], -0.64 to -0.18) and secondary efficacy (odds ratio [OR], 2.16; 95% CI, 1.24 to 3.78). At follow-up, the results were consistent with those of efficacy outcomes at posttreatment, with a standardized mean difference of -0.34 and an OR of 2.04. CBT had no statistical more all-cause discontinuations than the control group (OR, 0.69; 95% CI, 0.26 to 1.82). However, subgroup analyses found that CBT was only significantly more effective than nontreatment, while it was not better than wait list or psychological placebo. Conclusions: CBT seems to be more beneficial in the treatment of depression in children than nontreatment; however, this finding is limited by the small size of the trials and low literature quality.
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The aim of this study was to explore the change and associated risk and protective factors of social anxiety symptoms among Chinese children. A 2-year longitudinal study was performed in a general primary and secondary school population in Anhui Province, China including 816 children in grades 3, 4, and 7. Children's social anxiety symptoms were assessed using the Social Anxiety Scales for Children (SASC) at three assessments. The overall prevalence of children's elevated social anxiety symptoms ranged from 15.2% to 16.4% across three assessments. Children's overall mean SASC scores were 5.6 (SD =3.7), 5.3 (SD =3.8), and 5.3 (SD =4.1) at three assessments, respectively, but the difference was not statistically significant. However, children's social anxiety symptom levels and change among different subgroups was not stable across 2-year follow-up. Multivariable logistic regression analysis indicated that age, severe family dysfunction, quality of life, positive coping, negative coping, depressive symptoms and self-esteem were predictive factors for childhood elevated social anxiety symptoms. The findings suggested that the overall social anxiety symptoms showed a relatively stable pattern over time. The identified risk and protective factors may provide scientific evidence for school, family, and health authorities to conduct necessary intervention.
Article
The main aim of the study was to investigate the effectiveness of two psychotherapeutic approaches, cognitive behavioral therapy (CBT) and a complementary medicine method Reiki, in reducing depression scores in adolescents. We recruited 188 adolescent patients who were 12–17 years old. Participants were randomly assigned to CBT, Reiki or wait-list. Depression scores were assessed before and after the 12 week interventions or wait-list. CBT showed a significantly greater decrease in Child Depression Inventory (CDI) scores across treatment than both Reiki (p<.001) and the wait-list control (p<.001). Reiki also showed greater decreases in CDI scores across treatment relative to the wait-list control condition (p=.031). The analyses indicated a significant interaction between gender, condition and change in CDI scores, such that male participants showed a smaller treatment effect for Reiki than did female participants. Both CBT and Reiki were effective in reducing the symptoms of depression over the treatment period, with effect for CBT greater than Reiki. These findings highlight the importance of early intervention for treatment of depression using both cognitive and complementary medicine approaches. However, research that tests complementary therapies over a follow-up period and against a placebo treatment is required.
Article
Major depressive disorder (MDD) is a prevalent and frequently comorbid psychiatric disorder. This study evaluates the development of depressive symptoms, MDD diagnosis, and suicidal ideation in a high-risk sample (N=524) diagnosed with conduct disorder (CD) and substance use disorder (SUD) symptoms as youth and re-assessed approximately 6.5 years later. Dual trajectory classes of both alcohol and other drug use (AOD) and antisocial behavior (ASB), previously identified using latent class growth analyses (LCGA), were used to predict depression outcomes. The Dual Chronic, Increasing AOD/Persistent ASB, and Decreasing Drugs/Persistent ASB classes had higher past-week depression scores, more past-year MDD symptoms, and were more likely to have past-year MDD than the Resolved class. The Dual Chronic and Decreasing Drugs/Persistent ASB classes also had more past-year MDD symptoms than the Persistent AOD/Adolescent ASB class. Youth at highest risk for developing or maintaining depression in adulthood had the common characteristic of persistent antisocial behavior. This suggests young adulthood depression is associated more with persistent antisocial behavior than with persistent substance use in comorbid youth. As such, interventions targeting high-risk youth, particularly those with persistent antisocial behavior, are needed to help reduce the risk of severe psychosocial consequences (including risk for suicide) in adulthood.
Article
Introduction: Depressive disorders are among the most common psychiatric disorders in children and adolescents, and have adverse effects on their psychosocial functioning. Questions concerning the efficacy and safety of antidepressant medications in the treatment of depression in children and adolescents, led us to integrate the direct and indirect evidence using network meta-analysis to create hierarchies of these drugs. Methods and analysis: Seven databases with PubMed, EMBASE, the Cochrane Library, Web of Science, CINAHL, LiLACS and PsycINFO will be searched from 1966 to December 2013 (updated to May, 2015). There are no restrictions on language or type of publication. Randomised clinical trials assessing first-generation and newer-generation antidepressant medications against active comparator or placebo as acute treatment for depressive disorders in children and adolescents (under 18 years of age) will be included. The primary outcome for efficacy will be mean improvement in depressive symptoms, as measured by the mean change score of a depression rating scale from baseline to post-treatment. The tolerability of treatment will be defined as side effect discontinuation, as defined by the proportion of patients who discontinued treatment due to adverse events during the trial. We will also assess the secondary outcome for efficacy (response rate), acceptability (all-cause discontinuation) and suicide-related outcomes. We will perform the Bayesian network meta-analyses for all relative outcome measures. Subgroup analyses and sensitivity analyses will be conducted to assess the robustness of the findings. Dissemination: The network meta-analysis will provide useful information on antidepressant treatment for child and adolescent depression. The results will be disseminated through peer-reviewed publication or conference presentations. Trial registration number: PROSPERO CRD42015016023.
Article
Previous meta-analyses of psychotherapies for child and adolescent depression were limited because of the small number of trials with direct comparisons between two treatments. A network meta-analysis, a novel approach that integrates direct and indirect evidence from randomized controlled studies, was undertaken to investigate the comparative efficacy and acceptability of psychotherapies for depression in children and adolescents. Systematic searches resulted in 52 studies (total N=3805) of nine psychotherapies and four control conditions. We assessed the efficacy at post-treatment and at follow-up, as well as the acceptability (all-cause discontinuation) of psychotherapies and control conditions. At post-treatment, only interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) were significantly more effective than most control conditions (standardized mean differences, SMDs ranged from −0.47 to −0.96). Also, IPT and CBT were more beneficial than play therapy. Only psychodynamic therapy and play therapy were not significantly superior to waitlist. At follow-up, IPT and CBT were significantly more effective than most control conditions (SMDs ranged from −0.26 to −1.05), although only IPT retained this superiority at both short-term and long-term follow-up. In addition, IPT and CBT were more beneficial than problem-solving therapy. Waitlist was significantly inferior to other control conditions. With regard to acceptability, IPT and problem-solving therapy had significantly fewer all-cause discontinuations than cognitive therapy and CBT (ORs ranged from 0.06 to 0.33). These data suggest that IPT and CBT should be considered as the best available psychotherapies for depression in children and adolescents. However, several alternative psychotherapies are understudied in this age group. Waitlist may inflate the effect of psychotherapies, so that psychological placebo or treatment-as-usual may be preferable as a control condition in psychotherapy trials.
Article
Background Psychotherapy is widely used for depressed adolescents, but evidence supporting its efficacy is sparse. Methods In a controlled, 12-week, clinical trial of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), 48 clinic-referred adolescents (aged 12-18 years) who met the criteria for DSM-III-R major depressive disorder were randomly assigned to either weekly IPT-A or clinical monitoring. Patients were seen biweekly by a "blind" independent evaluator to assess their symptoms, social functioning, and social problem-solving skills. Thirty-two of the 48 patients completed the protocol (21 IPT-A–assigned patients and 11 patients in the control group). Results Patients who received IPT-A reported a notably greater decrease in depressive symptoms and greater improvement in overall social functioning, functioning with friends, and specific problem-solving skills. In the intent-to-treat sample, 18 (75%) of 24 patients who received IPT-A compared with 11 patients (46%) in the control condition met recovery criterion (Hamilton Rating Scale for Depression score ≤6) at week 12. Conclusions These preliminary findings support the feasibility, acceptability, and efficacy of 12 weeks of IPT-A in acutely depressed adolescents in reducing depressive symptoms and improving social functioning and interpersonal problem-solving skills. Because it is a small sample consisting largely of Latino, low socioeconomic status adolescents, further studies must be conducted with other adolescent populations to confirm the generalizability of the findings.
Article
To comparatively analyze the efficacy, acceptability, and tolerability of various augmentation agents in adult patients with treatment-resistant depression. An electronic literature search of PubMed, EMBASE, the Cochrane Library, Web of Science, EBSCO, PsycINFO, EAGLE, and NTIS for trials published up to December 2013 was conducted. Several clinical trial registry agencies and US Food and Drug Administration reports were also reviewed. No language, publication date, or publication status restrictions were imposed. Randomized controlled trials comparing 11 augmentation agents (aripiprazole, bupropion, buspirone, lamotrigine, lithium, methylphenidate, olanzapine, pindolol, quetiapine, risperidone, and thyroid hormone) with each other and with placebo for adult treatment-resistant depression were included. The proportion of patients who responded to treatment was defined as primary efficacy, and the proportion of all-cause discontinuation and side-effects discontinuation were respectively defined as acceptability and tolerability, which were assessed with odds ratios (ORs) and a Bayesian random-effects model with 95% credible intervals (CrIs). A total of 48 trials consisting of 6,654 participants were eligible. In terms of the primary efficacy, quetiapine (OR = 1.92; 95% CrI, 1.39-3.13), aripiprazole (OR = 1.85; 95% CrI, 1.27-2.27), thyroid hormone (OR = 1.84; 95% CrI, 1.06-3.56), and lithium (OR = 1.56; 95% CrI, 1.05-2.55) were significantly more effective than placebo. Sensitivity analyses indicated that efficacy estimates for aripiprazole and quetiapine were more robust than those for thyroid hormone and lithium. In terms of acceptability, no significant difference was found between active agents and placebo. In terms of tolerability, compared to placebo, quetiapine (OR = 3.85; 95% CrI, 1.92-8.33), olanzapine (OR = 3.36; 95% CrI, 1.60-8.61), aripiprazole (OR = 2.51; 95% CrI, 1.11-7.69), and lithium (OR = 2.30; 95% CrI, 1.04-6.03) were significantly less well tolerated. Quetiapine and aripiprazole appear to be the most robust evidence-based options for augmentation therapy in patients with treatment-resistant depression, but clinicians should interpret these findings cautiously in light of the evidence of potential treatment-related side effects. © Copyright 2015 Physicians Postgraduate Press, Inc.
Article
Depression is common among children and adolescents and is associated with significantly negative effects. A number of structured psychosocial treatments are administered for depression in children and adolescents; however, evidence of their effectiveness is not clear. We describe the protocol of a systematic review and network meta-analysis to evaluate the efficacy, quality of life, tolerability and acceptability of the use of psychological intervention for this young population. Methods and analysis: We will search PubMed, EMBASE, CENTRAL (the Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, CINAHL, LiLACS, Dissertation Abstracts, European Association for Grey Literature Exploitation (EAGLE) and the National Technical Information Service (NTIS) from inception to July 2014. There will be no restrictions on language, publication year or publication type. Only randomised clinical trials (RCTs) with psychosocial treatments for depression in children and adolescents will be considered. The primary outcome of efficacy will be the mean overall change of the total score in continuous depression severity scales from baseline to end point. Data will be independently extracted by two reviewers. Traditional pairwise meta–analyses will be performed for studies that directly compared different treatment arms. Then we will perform a Bayesian network meta–analyses to compare the relative efficacy, quality of life, tolerability and acceptability of different psychological intervention. Subgroup analyses will be performed by the age of participants and the duration of psychotherapy, and sensitivity analyses will be conducted to assess the robustness of the findings. Ethics and dissemination: No ethical issues are foreseen. The results will be published in a peer–reviewed journal and disseminated electronically and in print. The meta–analysis may be updated to inform and guide management of depression in children and adolescents.
Article
To conduct a randomized controlled trial to evaluate the preliminary efficacy of family-based interpersonal psychotherapy (FB-IPT) for treating depression in preadolescents (aged 7-12 years) as compared to child-centered therapy (CCT), a supportive and nondirective treatment that closely approximates the standard of care for pediatric depression in community mental health. Preadolescents with depression (N = 42) were randomly assigned FB-IPT or CCT. Pre- and posttreatment assessments included clinician-administered measures of depression, parent- and child-reported depression and anxiety symptoms, and parent-child conflict and interpersonal impairment with peers. Preadolescents receiving FB-IPT had higher rates of remission (66.0% versus 31%), a greater decrease in depressive symptoms from pre- to posttreatment, and lower depressive symptoms at posttreatment (R(2) = 0.35, ΔR(2) = 0.22; B = -8.15, SE = 2.61, t[37] = -3.13, p = .002, F(2) = 0.28) than did preadolescents with depression receiving CCT. Furthermore, preadolescents in the FB-IPT condition reported significant reductions in anxiety and interpersonal impairment compared with preadolescents in the CCT condition. Changes in social and peer impairment from pre- to posttreatment were associated with preadolescents' posttreatment depressive symptoms. There was a significant indirect effect for decreased social impairment accounting for the association between the FB-IPT and preadolescents' posttreatment depressive symptoms. Findings indicate FB-IPT is an effective treatment for preadolescent depression and support further investigation of interpersonal mechanisms by which FB-IPT may reduce preadolescent depression. Clinical trial registration information-Phase II Study of Family Based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents; http://clinicaltrials.gov; NCT02054312. Copyright © 2015 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Article
We employed standard literature search techniques and surveyed participants on the International Society for Interpersonal Psychotherapy listserve (isiptlist@googlegroups.com) to catalogue the multiple and highly creative ways in which Klerman's and Weissman's original concept of interpersonal psychotherapy (IPT) has been modified to meet the needs of a vast range of patient populations. Focusing first on adaptations of the individual treatment model for subgroups of adult patients, we next describe further adaptations of four major off-shoots of IPT: interpersonal counseling (IPC), IPT for adolescents (IPT-A), group IPT (IPT-G) and most recently, brief IPT (IPT-B). We then discuss IPT “in-laws,” those treatments that have married IPT with of other forms of psychotherapy for patients with bipolar disorder, panic symptomatology, and substance abuse. We conclude with that although there have been myriad successful adaptations of IPT, there remain some conditions for which IPT adaptations have not been found to be efficacious.
Article
Pediatric depression entails a higher risk for psychiatric disorders, somatic complaints, suicide, and functional impairment later in life. Cognitive behavior therapy (CBT) is recommended for the treatment of depression in children, yet research is based primarily on adolescents. The present meta-analysis investigated the efficacy of CBT in children aged 8-12 years with regard to depressive symptoms. We included randomized controlled trials of CBT with participants who had an average age of ≤ 12 years and were diagnosed with either depression or reported elevated depressive symptoms. The search resulted in 10 randomized controlled trials with 267 participants in intervention and 256 in comparison groups. The mean age of participants was 10.5 years. The weighted between-group effect size for CBT was moderate, Cohen's d = 0.66. CBT outperformed both attention placebo and wait-list, although there was a significant heterogeneity among studies with regard to effect sizes. The weighted within-group effect size for CBT was large, d = 1.02. Earlier publication year, older participants, and more treatment sessions were associated with a larger effect size. In conclusion, the efficacy of CBT in the treatment of pediatric depression symptoms was supported. Differences in efficacy, methodological shortcomings, and lack of follow-up data limit the present study and indicate areas in need of improvement.
Article
Purpose: A meta-analysis comparing the efficacy and acceptability of selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs) in depressed children, adolescents, and young adults was performed. Methods: A comprehensive literature search of the PubMed, Cochrane, Embase, Web of Science, and PsycINFO databases was conducted from 1970 to December 2013. Only clinical trials that randomly assigned one SSRI or TCA to patients aged 7 to 25 years who met the diagnostic criteria for unipolar depressive disorder were included. Primary efficacy was determined by the pooling of standardized mean differences (SMDs) calculated from the difference in the reduction in mean depression rating scale scores for the 2 antidepressants. Acceptability was determined by pooling the risk ratios (RRs) of dropouts for all reasons and for adverse effects as well as the suicide-risk outcome. Findings: Five trials with a total of 422 patients were considered to be eligible for inclusion. SSRIs were significantly more effective than TCAs in primary efficacy (SMD = -0.52; 95% CI, -0.81 to -0.24; P = 0.0003). Patients taking SSRIs had a significantly greater response to depressive symptoms than patients taking TCAs (RR = 1.55; 95% CI, 1.04 to 2.29; P = 0.03). On an individual SSRI basis, fluoxetine had a significantly greater efficacy than TCAs (SMD = -0.82; 95% CI, -1.34 to -0.29; P = 0.003). On an individual TCA basis, only imipramine was not significantly worse than SSRIs (SMD = -0.27; 95% CI, -0.56 to 0.02; P = 0.06). Significantly more patients taking TCAs discontinued treatment than patients taking SSRIs (35.8% vs 25.1%; RR = 0.70; 95% CI, 0.52 to 0.93; P = 0.02). Implications: SSRI therapy has a superior efficacy and is better tolerated compared with TCA therapy in young patients.
Article
A novel hybrid material composed of reduced graphene oxide (RGO) and 1,8,15,22-tetra-iso-pentyloxyphthalocyanine copper (3-CuPc) derivative was obtained. The resultant RGO/3–CuPc hybrid was characterized by Fourier transform infrared, Ultraviolet-visible, X-ray photoelectron and Raman spectroscopy, transmission electron microscopy and scan electron microscopy. The results indicated that 3-CuPc molecules were successfully anchored on the surface of the RGO sheets by the π–π stacking interaction. The NH3 sensing behaviors of the RGO/3–CuPc hybrids were also investigated and compared with the sensors based on pristine RGO. The results showed that the response of the RGO/3–CuPc hybrid sensor is five times more sensitive than that of pristine RGO, and the recovery time is 10 times faster than that of pristine RGO. The RGO/3–CuPc hybrid sensor exhibited excellent response, reversibility and selectivity, indicating a remarkable accumulation effect as a result of 3-CuPc functionalized graphene. An innovative method for the application of RGO/MPc hybrids in the gas sensing field was provided.
Book
The Cochrane Handbook for Systematic Reviews of Interventions (the Handbook) has undergone a substantial update, and Version 5 of the Handbook is now available online at www.cochrane-handbook.org and in RevMan 5. In addition, for the first time, the Handbook will soon be available as a printed volume, published by Wiley-Blackwell. We are anticipating release of this at the Colloquium in Freiburg. Version 5 of the Handbook describes the new methods available in RevMan 5, as well as containing extensive guidance on all aspects of Cochrane review methodology. It has a new structure, with 22 chapters divided into three parts. Part 1, relevant to all reviews, introduces Cochrane reviews, covering their planning and preparation, and their maintenance and updating, and ends with a guide to the contents of a Cochrane protocol and review. Part 2, relevant to all reviews, provides general methodological guidance on preparing reviews, covering question development, eligibility criteria, searching, collecting data, within-study bias (including completion of the Risk of Bias table), analysing data, reporting bias, presenting and interpreting results (including Summary of Findings tables). Part 3 addresses special topics that will be relevant to some, but not all, reviews, including particular considerations in addressing adverse effects, meta-analysis with non-standard study designs and using individual participant data. This part has new chapters on incorporating economic evaluations, non-randomized studies, qualitative research, patient-reported outcomes in reviews, prospective meta-analysis, reviews in health promotion and public health, and the new review type of overviews of reviews.
Article
this chapter will describe Interpersonal Psychotherapy (IPT) for depression, including the theoretical and empirical bases, efficacy studies, and derivative forms, and will also make recommendations for its use in clinical practice Interpersonal Psychotherapy (IPT) is based on the observation that major depression—regardless of symptom patterns, severity, presumed biological or genetic vulnerability, or the patients' personality traits—usually occurs in an interpersonal context, often an interpersonal loss or dispute / IPT is a brief, weekly psychotherapy that is usually conducted for 12 to 16 weeks, although it has been used for longer periods of time with less frequency as maintenance treatment for recovered depressed patients with major depression / the focus is on improving the quality of the depressed patients' current interpersonal functioning and the problems associated with the onset of depression (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Aim: The aim of the present study was to examine the intervention effects of intensive interpersonal psychotherapy for depressed adolescents with suicidal risk (IPT-A-IN) by comparison with treatment as usual (TAU) at schools. Methods: A total of 347 students from one-fifth of the classes of a high school in southern Taiwan completed the Beck Depression Inventory-II, the Beck Scale for Suicide Ideation, the Beck Anxiety Inventory and the Beck Hopelessness Scale for screening for suicidal risk. Of them, 73 depressed students who had suicidal risk on screening were randomly assigned to the IPT-A-IN or TAU group. Analysis of covariance (ANCOVA) was performed to examine the effect of IPT-A-IN on reducing the severity of depression, suicidal ideation, anxiety and hopelessness. Results: Using the pre-intervention scores as covariates, the IPT-A-IN group had lower post-intervention severity of depression, suicidal ideation, anxiety and hopelessness than the TAU group. Conclusion: Intensive school-based IPT-A-IN is effective in reducing the severity of depression, suicidal ideation, anxiety and hopelessness in depressed adolescents with suicidal risk.
Article
In this review, a framework for the assessment of suicidal risk in the adolescent is described, based on existing epidemiological and clinical studies. The assessment of risk can then be used to determine the immediate disposition, intensity of treatment, and level of care. Furthermore, the assessment of psychiatric and psychological characteristics of the individual and family, as well as the motivation and precipitants for the suicidal episode, can be used to target areas of vulnerability and thereby help the patient reduce the risk of recurrent suicidal behavior. The approach to treatment, guided by the assessment, uses a model of suicidal behavior that is based on our clinical experience and the few extant clinical trials of the treatment of suicidal behavior. Recommended interventions involve treatment of psychopathology; amelioration of cognitive distortion and difficulties with social skills, problem-solving, and affect regulation; and family psychoeducation and intervention. Given the chronic and recurrent nature of the conditions associated with adolescent suicide attempts, a long-term care plan involving both continuation and maintenance treatment is advocated. Further research is necessary to identify the most effective approaches to the treatment of adolescent suicide attempters.
Article
To conduct an open-treatment trial to evaluate the feasibility, acceptability and clinical outcomes of using a family-based adaptation of Interpersonal Psychotherapy for Depressed Adolescents with a sample of preadolescents (ages 9-12) presenting for outpatient treatment for depression. Sixteen preadolescents who met criteria for a depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition participated in this open-treatment trial of family-based interpersonal psychotherapy (FB-IPT). Parents chose whether their preadolescents should receive FB-IPT only (n = 10) or FB-IPT with antidepressant medication (n = 6). Pre- and post-treatment assessments included clinician-administered measures of depression and global functioning, and parent- and child-reported anxiety symptoms. FB-IPT was associated with high treatment compliance rates (88%) and was associated with significant decreases in preadolescents' depressive and anxiety symptoms. Preadolescents who received FB-IPT only were as likely as those receiving FB-IPT and medication to have significant reductions in depressive symptoms and anxiety symptoms, and to experience significant improvement in global functioning. Parents were more likely to choose combination treatment when their depressed preadolescents had a comorbid anxiety disorder. Further research on FB-IPT is needed to establish its efficacy as compared with usual outpatient treatment, its ability to be disseminated to child clinicians with varying levels of training and in adequately powered randomized controlled trials that can detect group differences.
Article
Summary estimates of treatment effect from random effects meta-analysis give only the average effect across all studies. Inclusion of prediction intervals, which estimate the likely effect in an individual setting, could make it easier to apply the results to clinical practice
Article
Remission and response were suggested as the most relevant outcome criteria for the treatment of depression. There is still marked uncertainty as to what cut-offs should be used on current depression rating scales. The goal of the present study was to compare the validity of different HAMD, MADRS and BDI cut-offs for response and remission. The naturalistic prospective study was performed in 12 psychiatric hospitals in Germany. All evaluable patients (n=846) were hospitalized and had to meet DSM-IV criteria for major depressive disorder. Biweekly ratings were assessed using HAMD-21, MADRS and BDI. A CGI-S score of 1 and a CGI-I score of at least 2 was used as the primary comparative measure of remission and response, respectively. A HAMD-21 cut-off ≤7 (AUC: 0.92), HAMD-17 cut-of ≤6 (AUC: 0.90), MADRS cut-off ≤7 (AUC: 0.94) and BDI cut-off ≤12 (AUC: 0.83) were associated with a maximum of specificity and sensitivity for defining remission. A minimum decrease of 47% of the HAMD-21 (AUC: 0.90), ≤57% for HAMD-17 (AUC: 0.89), ≤ 46% for MADRS (0.91) and a decrease of 47% for the BDI baseline score (AUC: 0.78) best corresponded CGI response criteria. Our data largely confirmed currently used remission and response criteria in naturalistically treated patients.
Article
The study evaluated the efficacy of an indicated prevention program for adolescent depression. Fifty-seven adolescents with elevated depression symptoms were randomized to receive Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) or school counseling (SC). Hierarchical linear modeling examined differences in rates of change in depression symptoms and overall functioning and analysis of covariance examined mean differences between groups. Rates of depression diagnoses in the 18-month follow-up period were compared. Adolescents in IPT-AST reported significantly greater rates of change in depression symptoms and overall functioning than SC adolescents from baseline to post-intervention. At post-intervention, IPT-AST adolescents reported significantly fewer depression symptoms and better overall functioning. During the follow-up phase, rates of change slowed for the IPT-AST adolescents, whereas the SC adolescents continued to show improvements. By 12-month follow-up, there were no significant mean differences in depression symptoms or overall functioning between the two groups. IPT-AST adolescents reported significantly fewer depression diagnoses in the first 6 months following the intervention but by 12-month follow-up the difference in rates of diagnoses was no longer significant. IPT-AST leads to an immediate reduction in depression symptoms and improvement in overall functioning. However, the benefits of IPT-AST are not consistent beyond the 6-month follow-up, suggesting that the preventive effects of the program in its current format are limited. Future studies are needed to examine whether booster sessions lengthen the long-term effects of IPT-AST.
Article
Interpersonal psychotherapy (IPT) is a brief treatment developed and tested specifically for depressed adults. This paper describes a modification for use with depressed adolescents (IPT-A) that will be tested in a controlled clinical trial. A description of IPT, its efficacy in adults, a rationale for developing IPT-A, and preliminary experience with depressed adolescents treated with IPT-A are presented. Data available on the treatment of depressed adolescents using drugs and/or psychotherapy is more than a decade behind that of adults. The specification and testing of psychotherapy will accelerate a rational, scientific basis for their treatment.