The Impact of Perceived Interpersonal Functioning on Treatment for Adolescent Depression: IPT-A Versus Treatment as Usual in School-Based Health Clinics

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


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

Download full-text


Available from: Laura Mufson
  • Source
    • "The 54-item instrument yields seven scores, including functioning in each of the six roles and a total score. The measure has been used extensively in studies of treatments for mental disorders (Bateman & Fonagy, 1999; Grote et al., 2009; Gunlicks-Stoessel, Mufson, Jekal, & Turner, 2010; Lenze et al., 2002), and research has demonstrated a high correlation (0.72) between interview ratings of overall adjustment and the SAS-SR (Weissman & Bothwell, 1976). The average SAS-R internal consistency in the current study based on the three time assessments was α = 0.80. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A randomized clinical trial was conducted to evaluate the efficacy of interpersonal psychotherapy (IPT) for ethnically and racially diverse, economically disadvantaged women with major depressive disorder. Non-treatment-seeking urban women (N = 128; M age = 25.40, SD = 4.98) with infants were recruited from the community. Participants were at or below the poverty level: 59.4% were Black and 21.1% were Hispanic. Women were screened for depressive symptoms using the Center for Epidemiologic Studies Depression Scale; the Diagnostic Interview Schedule was used to confirm major depressive disorder diagnosis. Participants were randomized to individual IPT or enhanced community standard. Depressive symptoms were assessed before, after, and 8 months posttreatment with the Beck Depression Inventory-II and the Revised Hamilton Rating Scale for Depression. The Social Support Behaviors Scale, the Social Adjustment Scale-Self-Report, and the Perceived Stress Scale were administered to examine mediators of outcome at follow-up. Treatment effects were evaluated with a growth mixture model for randomized trials using complier-average causal effect estimation. Depressive symptoms trajectories from baseline through postintervention to follow-up showed significant decreases among the IPT group compared to the enhanced community standard group. Changes on the Perceived Stress Scale and the Social Support Behaviors Scale mediated sustained treatment outcome.
    Full-text · Article · Nov 2013 · Development and Psychopathology
  • Source
    • "Finally interpersonal psychotherapy (IPT), a conversational treatment with some principles derived from STPP (e.g. therapeutic relationship development, attending to the here and now) and SCC (problem solving in the real world and promoting peer group relationships) has been shown to be efficacious and effective with children and adolescents with mild to moderate depression suggesting that relatively brief, active psychological treatments not focussed on distorted or abnormal cognitive processing treatments are indeed able to alleviate depressive symptoms and improve social functioning at least in the short term [33]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Up to 70% of adolescents with moderate to severe unipolar major depression respond to psychological treatment plus Fluoxetine (20-50 mg) with symptom reduction and improved social function reported by 24 weeks after beginning treatment. Around 20% of non responders appear treatment resistant and 30% of responders relapse within 2 years. The specific efficacy of different psychological therapies and the moderators and mediators that influence risk for relapse are unclear. The cost-effectiveness and safety of psychological treatments remain poorly evaluated. Methods/Design: Improving Mood with Psychoanalytic and Cognitive Therapies, the IMPACT Study, will determine whether Cognitive Behavioural Therapy or Short Term Psychoanalytic Therapy is superior in reducing relapse compared with Specialist Clinical Care. The study is a multicentre pragmatic effectiveness superiority randomised clinical trial: Cognitive Behavioural Therapy consists of 20 sessions over 30 weeks, Short Term Psychoanalytic Psychotherapy 30 sessions over 30 weeks and Specialist Clinical Care 12 sessions over 20 weeks. We will recruit 540 patients with 180 randomised to each arm. Patients will be reassessed at 6, 12, 36, 52 and 86 weeks. Methodological aspects of the study are systematic recruitment, explicit inclusion criteria, reliability checks of assessments with control for rater shift, research assessors independent of treatment team and blind to randomization, analysis by intention to treat, data management using remote data entry, measures of quality assurance, advanced statistical analysis, manualised treatment protocols, checks of adherence and competence of therapists and assessment of cost-effectiveness. We will also determine whether time to recovery and/or relapse are moderated by variations in brain structure and function and selected genetic and hormone biomarkers taken at entry.
    Full-text · Article · Jul 2011 · Trials
  • [Show abstract] [Hide abstract]
    ABSTRACT: Depression is a persistent and impairing illness for adolescents. Many adolescents have limited access to care and/or do not receive adequate treatment for their depression. Researchers have developed a number of empirically supported interventions for adolescent depression; the challenge is to bring these treatments into community settings and assess their effectiveness under real world conditions. This paper provides a critical examination of research conducted on the use of Interpersonal Psychotherapy for depressed adolescents (IPT-A). The paper presents evidence for the efficacy and effectiveness of IPT-A. Implementation and dissemination efforts are discussed in regard to lessons learned and directions for future research.
    No preview · Article · Jan 2010 · Child and Adolescent Mental Health
Show more