Disorders - Depressive Disorders
Kerfoot, Michael, Harrington, Richard, Harrington, Val, Rogers, Julia, Verduyn, Chrissie
OBJECTIVE: To test the hypothesis that depressed adolescents given brief cognitive behaviour therapy by trained social workers will be less depressed after this treatment than depressed adolescents who have routine care from their social workers. METHOD: Open study, two randomized parallel groups. 86 social workers were randomized to training in brief CBT or delayed training by remote telephone randomization. 25 social workers who attended CBT training recruited 29 depressed adolescents. 22 social workers in the control group recruited 23 depressed adolescents. RESULTS: Social workers' perceptions of their knowledge and skills in dealing with adolescent depression were better after the training than before. However, in intention to treat analyses, adolescents who had therapy from trained social workers had a similar level of depression post treatment (mean depression score 17.5, 95% CI 11.8 to 23.3) to those who did not have such therapy (mean depression score 16.7, 95 % CI 11.3 to 22.1). There were no significant differences between the groups on other outcomes or at follow-up. CONCLUSIONS: This study failed to recruit enough cases and probably did not therefore have enough statistical power to detect an effect of the intervention. It was also based on a severely impaired sample with many comorbid problems. However, the results suggest that training community-based social workers in cognitive behaviour therapy is neither practical nor effective in improving the outcomes of their clients.
European Child & Adolescent Psychiatry, 13(2) : 92-9
- Year: 2004
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Roberts, Clare, Kane, Robert, Bishop, Brian, Matthews, Heather, Thomson, Helen
This study investigated the long-term effects of the Penn Prevention Program in preventing depressive and anxious symptoms in Australian rural school children with elevated levels of depressive symptoms, at 18- and 30- month follow-up. Seventh grade students from nine primary schools (n = 90) were randomly assigned to receive the programme and nine control schools (n = 99) received their usual health education classes and symptom monitoring. A no-intervention comparison group (n = 114) from 18 rural primary schools matched to the intervention and control group schools received their usual health education classes and were assessed at pre-intervention and 30-month follow-up. Students completed questionnaires on depression, anxiety, explanatory style and social skills. Parents completed the Child Behavior Checklist. No intervention effects were found for any child-report or parent-report variables at the 18-month follow-up. At the 30-month follow-up, intervention group children reported less anxiety than control or comparison groups. However, there were no effects for depression. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract).
International Journal of Mental Health Promotion, 6(3) : 4-16
- Year: 2004
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Rohde, Paul, Clarke, Gregory N., Mace, David E., Jorgensen, Jenel S., Seeley, John R.
OBJECTIVE: To evaluate effectiveness of the Adolescent Coping With Depression (CWD-A) course, a cognitive-behavioral group intervention for depressed adolescents with comorbid conduct disorder. METHOD: Between 1998 and 2001, 93 nonincarcerated adolescents (ages 13-17 years) meeting criteria for major depressive disorder and conduct disorder were recruited from a county juvenile justice department and randomly assigned to the CWD-A or a life skills/tutoring control condition. Participants were assessed post-treatment and at 6- and 12-month follow-up. Dichotomous outcomes were analyzed with logistic regression; dimensional measures were analyzed using random effects regression. RESULTS: Major depressive disorder recovery rates post-treatment were greater in CWD-A (39%) compared with life skills/tutoring control (19%) (odds ratio 2.66, 95% confidence interval = 1.03-6.85). CWD-A participants reported greater reductions in Beck Depression Inventory-II (r2 = 0.055, p =.033) and Hamilton Depression Rating Scale (r2 = 0.047, p =.039) scores and improved social functioning (r2 = 0.064, p =.019) post-treatment. Group differences in major depressive disorder recovery rates at 6- and 12-month follow-up were nonsignificant, as were differences in conduct disorder both post-treatment and during follow-up. CONCLUSIONS: This is the first randomized, controlled trial of a psychosocial intervention with adolescents with major depressive disorder and conduct disorder. Although the CWD-A appears to be an effective acute treatment for depression in adolescents with multiple disorders, findings emphasize the need to improve long-term outcomes for depressed adolescents with psychiatric comorbidity and imply that interventions for comorbid populations focus directly on each specific disorder.
Journal of the American Academy of Child & Adolescent Psychiatry, 43(6) : 660-8
- Year: 2004
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Wagner, Karen Dineen, Robb, Adelaide S., Findling, Robert L., Jin, Jianqing, Gutierrez, Marcelo M., Heydorn, William E.
OBJECTIVE: Open-label trials with the selective serotonin reuptake inhibitor citalopram suggest that this agent is effective and safe for the treatment of depressive symptoms in children and adolescents. The current study investigated the efficacy and safety of citalopram compared with placebo in the treatment of pediatric patients with major depression. METHOD: An 8-week, randomized, double-blind, placebo-controlled study compared the safety and efficacy of citalopram with placebo in the treatment of children (ages 7-11) and adolescents (ages 12-17) with major depressive disorder. Diagnosis was established with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Patients (N=174) were treated initially with placebo or 20 mg/day of citalopram, with an option to increase the dose to 40 mg/day at week 4 if clinically indicated. The primary outcome measure was score on the Children's Depression Rating Scale-Revised; the response criterion was defined as a score of < or =28. RESULTS: The overall mean citalopram dose was approximately 24 mg/day. Mean Children's Depression Rating Scale-Revised scores decreased significantly more from baseline in the citalopram treatment group than in the placebo treatment group, beginning at week 1 and continuing at every observation point to the end of the study (effect size=2.9). The difference in response rate at week 8 between placebo (24%) and citalopram (36%) also was statistically significant. Citalopram treatment was well tolerated. Rates of discontinuation due to adverse events were comparable in the placebo and citalopram groups (5.9% versus 5.6%, respectively). Rhinitis, nausea, and abdominal pain were the only adverse events to occur with a frequency exceeding 10% in either treatment group. CONCLUSIONS: In this population of children and adolescents, treatment with citalopram reduced depressive symptoms to a significantly greater extent than placebo treatment and was well tolerated.
American Journal of Psychiatry, 161(6) : 1079-83
- Year: 2004
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Williams, A., Hagerty, B. M., Yousha, S. M., Horrocks, J., Hoyle, K. S., Liu, D.
The purpose of this prospective study was to investigate the effects of the Boot Camp Survival Training for Navy Recruits-A Prescription (BOOT STRAP) intervention on stress, depression, situational events, interpersonal factors, and recruit training performance. Divisions of Navy recruits were randomly selected and 801 recruits participated for the 9 weeks of their training. Recruits "at risk" for depression were randomly assigned to the intervention or nonintervention groups, and the remaining recruits served as the comparison group. The at-risk recruits who received the BOOT STRAP intervention significantly increased their sense of belonging, experienced less loneliness, used more problem-solving coping skills, and decreased insecure attachment by the end of recruit training. Percentages of recruits in the study successfully completing basic training were 84% of the comparison group, 86% of the intervention group, and only 74% of the nonintervention group. Results suggest that the BOOT STRAP intervention improves recruit functioning, strengthens training performance, helps reduce attrition, and may have important implications for stress and depression interventions. Copyright copyright by Association of Military Surgeons of U.S., 2004.
Military Medicine., 169(10) : 814-820
- Year: 2004
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Physical activity, exercise
Whittington, Craig J., Kendall, Tim, Fonagy, Peter, Cottrell, David, Cotgrove, Andrew, Boddington, Ellen
BACKGROUND: Questions concerning the safety of selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression in children led us to compare and contrast published and unpublished data on the risks and benefits of these drugs. METHODS: We did a meta-analysis of data from randomised controlled trials that evaluated an SSRI versus placebo in participants aged 5-18 years and that were published in a peer-reviewed journal or were unpublished and included in a review by the Committee on Safety of Medicines. The following outcomes were included: remission, response to treatment, depressive symptom scores, serious adverse events, suicide-related behaviours, and discontinuation of treatment because of adverse events. FINDINGS: Data for two published trials suggest that fluoxetine has a favourable risk-benefit profile, and unpublished data lend support to this finding. Published results from one trial of paroxetine and two trials of sertraline suggest equivocal or weak positive risk-benefit profiles. However, in both cases, addition of unpublished data indicates that risks outweigh benefits. Data from unpublished trials of citalopram and venlafaxine show unfavourable risk-benefit profiles. INTERPRETATION: Published data suggest a favourable risk-benefit profile for some SSRIs; however, addition of unpublished data indicates that risks could outweigh benefits of these drugs (except fluoxetine) to treat depression in children and young people. Clinical guideline development and clinical decisions about treatment are largely dependent on an evidence base published in peer-reviewed journals. Non-publication of trials, for whatever reason, or the omission of important data from published trials, can lead to erroneous recommendations for treatment. Greater openness and transparency with respect to all intervention studies is needed. [References: 29]
Lancet, 363(9418) : 1341-5
- Year: 2004
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Weisz, John R., Hawley, Kristin M., Doss, Amanda Jensen
This article is a review of specific psychotherapies that have been supported in clinical trials. Treatments that showed significant effects in studies published over a period of 4 decades were identified, with the goal of complementing the overall picture of treatment benefit provided in narrative reviews and meta-analyses with a detailing of the specific interventions that have shown significant effects. The article focuses on treatments for four broad clusters of problems and disorders that account for a very large proportion of youth mental health referrals: anxiety, depression, attention-deficit/hyperactivity, and conduct. [References: 336]
Child & Adolescent Psychiatric Clinics of North America, 13(4) : 729-815
- Year: 2004
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Bond, L., Patton, G., Glover, S., Carlin, J. B., Butler, H., Thomas, L., Bowes, G.
STUDY OBJECTIVE:
The aim of this study was to determine the effect of a multilevel school based intervention on adolescents' emotional wellbeing and health risk behaviours.
DESIGN:
School based cluster randomised controlled trial. Students were surveyed using laptop computers, twice in the first year of intervention and annually thereafter for a further two years.
SETTING:
Secondary schools.
PARTICIPANTS:
2678 year 8 students (74%) participated in the first wave of data collection. Attrition across the waves was less than 3%, 8%, and 10% respectively with no differential response rate between intervention and control groups at the subsequent waves (98% v 96%; 92% v 92%, and 90% v 89% respectively).
MAIN RESULTS:
A comparatively consistent 3% to 5% risk difference was found between intervention and control students for any drinking, any and regular smoking, and friends' alcohol and tobacco use across the three waves of follow up. The largest effect was a reduction in the reporting of regular smoking by those in the intervention group (OR 0.57, 0.62, and 0.72 at waves 2, 3, and 4 respectively). There was no significant effect of the intervention on depressive symptoms, and social and school relationships.
CONCLUSIONS:
While further research is required to determine fully the processes of change, this study shows that a focus on general cognitive skills and positive changes to the social environment of the school can have a substantial impact on important health risk behaviours
, 58 : 997-1003
- Year: 2004
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Emslie, Graham J., Hughes, Carroll W., Crismon, M. Lynn, Lopez, Molly, Pliszka, Steve, Toprac, Marcia G., Boemer, Christine, TexasChildren'sMedicationAlgorithm,Project
OBJECTIVE: To evaluate the feasibility and impact on clinical response and function associated with the use of an algorithm-driven disease management program (ALGO) for children and adolescents treated for depression with or without attention-deficit/hyperactivity disorder (ADHD) in community mental health centers. METHOD: Interventions included (1). medication algorithms, (2). clinical and technical support for the physician, (3). uniform chart documentation of outcomes, and (4). a patient/family psychoeducation program. Children eligible for entry into the study were referred to the child psychiatrist for initiation or change in medicine. Outcomes of treatment with the ALGO for up to 4 months are presented. Measures of change included clinical symptoms, functioning, and global improvement (Clinical Global Impression Scale). A historical chart cohort from the same clinics was used as a quasi-control. RESULTS: Thirty-nine individuals (depression = 24; comorbid depression with ADHD = 15) were enrolled for treatment with ALGO. One hundred fourteen children were in the control cohort (74 depressed, 40 comorbid). For the ALGO groups, Children's Depression Rating Scale-Revised depression severity scores decreased from 48.2 to 32.5 and Child Adolescent Functioning Assessment Scale function scores improved from 70.3 to 40.9 (all p < or =.0005). Clinical Global Impression Scale severity scores decreased from 5.7 to 3.7 in ALGO compared to only 5.8 to 4.8 in the control (p <.003). CONCLUSIONS: There was clear improvement in clinical symptoms, functioning, and global response with ALGO treatment. The magnitude of the improvement was greater in children and adolescents treated with the ALGO program compared with a historical cohort. These data support the need for controlled studies in larger populations examining the effects of algorithm-driven disease management programs on the clinical outcomes of children with mental illness.
Journal of the American Academy of Child & Adolescent Psychiatry, 43(5) : 519-27
- Year: 2004
- Problem: Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Woolery, A., Myers, H., Sternlieb, B., Zeltzer, L.
Alternative therapies in health and medicine, 10(2) : 60-63
- Year: 2004
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Mind-body exercises (e.g. yoga, tai chi, qigong)
March, John, Silva, Susan, Petrycki, Stephen, Curry, John, Wells, Karen, Fairbank, John, Burns, Barbara, Domino, Marisa, McNulty, Steven, Vitiello, Benedetto, Severe, Joanne, TADSTeam
CONTEXT: Initial treatment of major depressive disorder in adolescents may include cognitive-behavioral therapy (CBT) or a selective serotonin reuptake inhibitor (SSRI). However, little is known about their relative or combined effectiveness. OBJECTIVE: To evaluate the effectiveness of 4 treatments among adolescents with major depressive disorder. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of a volunteer sample of 439 patients between the ages of 12 to 17 years with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of major depressive disorder. The trial was conducted at 13 US academic and community clinics between spring 2000 and summer 2003. INTERVENTIONS: Twelve weeks of (1) fluoxetine alone (10 to 40 mg/d), (2) CBT alone, (3) CBT with fluoxetine (10 to 40 mg/d), or (4) placebo (equivalent to 10 to 40 mg/d). Placebo and fluoxetine alone were administered double-blind; CBT alone and CBT with fluoxetine were administered unblinded. MAIN OUTCOME MEASURES: Children's Depression Rating Scale-Revised total score and, for responder analysis, a (dichotomized) Clinical Global Impressions improvement score. RESULTS: Compared with placebo, the combination of fluoxetine with CBT was statistically significant (P =.001) on the Children's Depression Rating Scale-Revised. Compared with fluoxetine alone (P =.02) and CBT alone (P =.01), treatment of fluoxetine with CBT was superior. Fluoxetine alone is a superior treatment to CBT alone (P =.01). Rates of response for fluoxetine with CBT were 71.0% (95% confidence interval [CI], 62%-80%); fluoxetine alone, 60.6% (95% CI, 51%-70%); CBT alone, 43.2% (95% CI, 34%-52%); and placebo, 34.8% (95% CI, 26%-44%). On the Clinical Global Impressions improvement responder analysis, the 2 fluoxetine-containing conditions were statistically superior to CBT and to placebo. Clinically significant suicidal thinking, which was present in 29% of the sample at baseline, improved significantly in all 4 treatment groups. Fluoxetine with CBT showed the greatest reduction (P =.02). Seven (1.6%) of 439 patients attempted suicide; there were no completed suicides. CONCLUSION: The combination of fluoxetine with CBT offered the most favorable tradeoff between benefit and risk for adolescents with major depressive disorder.
JAMA, 292(7) : 807-20
- Year: 2004
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Merry, Sally, McDowell, Heather, Wild, Chris J., Bir, Julliet, Cunliffe, Rachel
OBJECTIVE: To conduct a placebo-controlled study of the effectiveness of a universal school-based depression prevention program. METHOD: Three hundred ninety-two students age 13 to 15 from two schools were randomized to intervention (RAP-Kiwi) and placebo programs run by teachers. RAP-Kiwi was an 11-session manual-based program derived from cognitive-behavioral therapy. The placebo was similar but with cognitive components removed. Outcomes were self-rated depression scales, the Reynolds Adolescent Depression Scale (RADS), and the Beck Depression Inventory II (BDI-II). Follow-up was to 18 months. Analysis was done on an intent-to-treat basis. RESULTS: Immediately after the intervention, depression scores were reduced significantly more by RAP-Kiwi than by placebo, with a mean difference in change from baseline between groups of 1.5 on BDI-II (CI > 0.38, p =.01) and 2.24 on RADS (CI > 0.22, p =.04). Categorical analysis confirmed significant clinical benefit with an absolute risk reduction of 3% (95% CI, 1-11%, McNemar chi, p =.03), with the "number needed to treat" for short-term benefit of 33. Group differences in depression scores averaged across time to 18 months were significant on RADS but not on BDI-II. Retention rates were 91% at 6 months and 72% at 18 months. CONCLUSIONS: The RAP-Kiwi program is a potentially effective public health measure. Confirmation of effectiveness measuring episodes of depressive illness and broader measures of adjustment is warranted.
Journal of the American Academy of Child & Adolescent Psychiatry, 43(5) : 538-47
- Year: 2004
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions