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PubMed1993

A review for school nursing professionals: adolescent depression.

Adolescent depression occurs within various developmental, social, and biologic contexts, and is manifested by traditional depressive symptoms such as fatigue, loss of interest in daily activities, weight changes, sleep disturbances, sad moods, difficulty with concentration, behavioral agitation or lethargy, feelings of worthlessness, and recurrent thoughts of death. Depressed adolescents may combine these symptoms with certain additional behaviors such as academic deterioration, substance abuse, sexual activity, somatic complaints, eating disorders, conduct disorders, and other risk-taking behaviors. School nurses can play a central role in the prevention, assessment, referral, and follow-up care of this significant adolescent health problem.

Adolescent↗
PubMed2001

Depressed adolescents of depressed and nondepressed mothers: tests of an interpersonal impairment hypothesis.

Two groups of depressed youngsters were compared. From an interpersonal perspective, it was hypothesized that depressed adolescents of depressed mothers would have significantly more interpersonal dysfunction than depressed youngsters of nondepressed mothers. In a large community sample of youth and their families, 65 depressed offspring of women with histories of a major depressive episode or dysthymia were compared with 45 depressed offspring of never-depressed women. As predicted, after controlling for current symptoms and family social status variables, depressed offspring of depressed mothers displayed significantly more negative interpersonal behaviors and cognitions compared with depressed offspring of nondepressed mothers, but they did not differ on academic performance. Implications concerning mechanisms, course, and consequences of different forms of adolescent depression are presented.

Adolescent↗
PubMed1988

Psychodynamic treatment of depressed adolescents.

Depression may be conceptualized as the response to the loss of meaning or satisfaction sufficient to affect the individual's optimal view of the self. At each stage of the life cycle, the failure to achieve developmental tasks threatens the concept of the self, producing a phase-specific vulnerability to depression. Adolescence presents particular stresses by forcing the youngster to relinquish the relative familiarity and security of a childhood psychosocial role and create a sense of self independent of family, without childhood denial mechanisms, and of value to a new peer culture. Most individuals experience a sense of loss, confusion, apprehension, and dysphoria during this difficult period of transition. Many who seek psychotherapy require only a secure holding environment that will support their self-esteem as they create new avenues of worth and satisfaction. A few, however, are so hampered by psychosocial limitations that they cannot master this developmental passage without more extensive therapeutic assistance.

Adolescent↗
PubMed1981

Psychopathologic patterns in depressed adolescents.

Depression in adolescents may be masked by symptoms not commonly found in adults. These symptoms may require, at least initially, a management approach not necessarily in the best interest of treatment of the underlying depression. Suicidal behavior in adolescents can be manipulative and unrelated to depression. Management of such adolescents must differ from the management of patients whose suicidal behavior is the direct result of depression.

Adolescent↗
PubMed2005

Comparative efficacy of cognitive behavioral therapy, fluoxetine, and their combination in depressed adolescents: initial lessons from the treatment for adolescents with depression study.

Adolescents with major depressive disorder (MDD), their families and clinicians experience significant challenges when weighing the potential risks versus benefits of available choices in the treatment of MDD. Although MDD is highly prevalent in adolescents and is associated with marked suffering, impairment and risk of suicide, the scientific data regarding the safety and efficacy of treatments for pediatric depression are limited. Controlled clinical trials have provided support for the use of psychotherapy and fluoxetine for the treatment of pediatric depression, but until recently no information on the comparative efficacy of these recommended interventions alone or in combination was available. The Treatment for Adolescents with Depression Study provides a very important therapeutic advance in the field by convincingly showing that combination treatment with cognitive behavioral therapy and fluoxetine has the best benefit to risk ratio for adolescents with moderate to severe depression, and is superior to monotherapy. Moreover, the study results confirm that fluoxetine alone is effective in the treatment of depressed adolescents.

Adolescent↗
PubMed1998

Interactional processes in families with depressed and non-depressed adolescents: reinforcement of depressive behavior.

Problem-solving interactions were observed in 86 families of depressed adolescents and 408 families of non-depressed adolescents. Sequential analyses indicated that mothers of depressed adolescents were more likely than mothers of non-depressed adolescents to increase facilitative behavior in response to adolescent depressive behavior. Additionally, fathers of depressed adolescents were more likely than their counterparts in families of non-depressed adolescents to decrease aggressive behavior subsequent to adolescent depressive behavior. These analyses suggest that parents of depressed adolescents may be inadvertently reinforcing depressive behavior. Decreases in adolescent depressive symptomatology from year 1 to year 2 were not accompanied by changes in family interaction patterns.

Adolescent↗
PubMed2006

Impact of comorbid anxiety in an effectiveness study of interpersonal psychotherapy for depressed adolescents.

OBJECTIVE: To assess the impact of comorbid anxiety on treatment for adolescent depression in an effectiveness study of interpersonal psychotherapy for depressed adolescents (IPT-A). METHOD: A randomized clinical trial was conducted from April 1, 1999, through July 31, 2002. Sixty-three depressed adolescents, ages 12 to 18, received either IPT-A or treatment as usual delivered by school-based mental health clinicians. Adolescents with and without probable comorbid anxiety disorders were compared on depression and overall functioning. All analyses used an intent-to-treat design. RESULTS: Comorbid anxiety was associated with higher depression scores at baseline (p <.01) and poorer depression outcome posttreatment (p <.05). IPT-A was nonsignificantly more effective in treating the depression of adolescents with comorbid anxiety (p =.07). Adolescents whose depression and functioning improved during the course of treatment also showed an improvement in anxiety (p <.01), largely irrespective of treatment condition. CONCLUSIONS: Adolescents with comorbid depression and anxiety present with more severe depression and may be more difficult to treat. Structured treatments like IPT-A may be particularly helpful for comorbidly depressed adolescents as compared to supportive therapy.

Adolescent↗
PubMed1991

Helping Parents of Suicidal or Depressed Adolescents.

Depression and suicide are common in the United States, especially in adolescents. This chapter discusses the ways that the physician may help parents of these adolescents and presents various options for parental involvement in the treatment process.

Journal Article↗
PubMed2002

Screening for adolescent depression: comparison of the Kutcher Adolescent Depression Scale with the Beck depression inventory.

Self-report instruments commonly used to assess depression in adolescents have limited or unknown reliability and validity in this age group. We describe a new self-report scale, the Kutcher Adolescent Depression Scale (KADS), designed specifically to diagnose and assess the severity of adolescent depression. This report compares the diagnostic validity of the full 16-item instrument, brief versions of it, and the Beck Depression Inventory (BDI) against the criteria for major depressive episode (MDE) from the Mini International Neuropsychiatric Interview (MINI). Some 309 of 1,712 grade 7 to grade 12 students who completed the BDI had scores that exceeded 15. All were invited for further assessment, of whom 161 agreed to assessment by the KADS, the BDI again, and a MINI diagnostic interview for MDE. Receiver operating characteristic (ROC) curve analysis was used to determine which KADS items best identified subjects experiencing an MDE. Further ROC curve analyses established that the overall diagnostic ability of a six-item subscale of the KADS was at least as good as that of the BDI and was better than that of the full-length KADS. Used with a cutoff score of 6, the six-item KADS achieved sensitivity and specificity rates of 92% and 71%, respectively-a combination not achieved by other self-report instruments. The six-item KADS may prove to be an efficient and effective means of ruling out MDE in adolescents.

Adolescent↗
PubMed2004

A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents.

CONTEXT: Adolescent depression is highly prevalent and has substantial morbidity, including suicide attempts, school dropout, and substance abuse, but many depressed adolescents are untreated. The school-based health clinic offers the potential for accessible and efficient treatment, although it is unknown whether school-based clinicians can be trained to implement evidence-based psychotherapies for depression in routine care. OBJECTIVE: To assess the effectiveness of interpersonal psychotherapy modified for depressed adolescents (IPT-A) compared with treatment as usual (TAU) in school-based mental health clinics. DESIGN: A 16-week randomized clinical trial was conducted from April 1, 1999, through July 31, 2002. SETTING: Five school-based mental health clinics in New York City, NY. Patients Sixty-three adolescents referred for a mental health intake visit who met eligibility criteria. Eligible patients had a mean Hamilton Depression Rating Scale score of 18.6 (SD, 5.5) and a mean Children's Global Assessment Scale score of 52.6 (SD, 5.5) and met DSM-IV criteria for major depressive disorder, dysthymia, depression disorder not otherwise specified, or adjustment disorder with depressed mood. Mean age was 15.1 years (SD, 1.9 years). The sample was predominantly female (n = 53 [84%]), Hispanic (n = 45 [71%]), and of low socioeconomic status. Intervention Patients were randomly assigned to receive IPT-A (n = 34) or TAU (n = 29) from school-based health clinic clinicians. MAIN OUTCOME MEASURES: The Hamilton Depression Rating Scale, Beck Depression Inventory, Children's Global Assessment Scale, Clinical Global Impressions scale, and the Social Adjustment Scale-Self-Report. RESULTS: Adolescents treated with IPT-A compared with TAU showed greater symptom reduction and improvement in overall functioning. Analysis of covariance showed that compared with the TAU group, the IPT-A group showed significantly fewer clinician-reported depression symptoms on the Hamilton Depression Rating Scale (P =.04), significantly better functioning on the Children's Global Assessment Scale (P =.04), significantly better overall social functioning on the Social Adjustment Scale-Self-Report (P =.01), significantly greater clinical improvement (P =.03), and significantly greater decrease in clinical severity (P =.03) on the Clinical Global Impressions scale. CONCLUSIONS: Interpersonal psychotherapy delivered in school-based health clinics is an effective therapy for adolescent depression. This effort is a significant step toward closing the gap between treatment conducted in the laboratory and community clinic.

Adolescent↗
PubMed1991

Interpersonal psychotherapy for adolescent depression: description of modification and preliminary application.

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.

Adolescent↗
PubMed2004

Lifetime history of sexual abuse, clinical presentation, and outcome in a clinical trial for adolescent depression.

OBJECTIVE: To investigate the impact of sexual abuse on clinical presentation and treatment outcome in depressed adolescents. METHOD: 107 adolescent outpatients, 13 to 18 years old, with DSM-III-R major depression were randomly assigned to cognitive-behavioral therapy (CBT), systemic behavioral family therapy (SBFT), or nondirective supportive therapy (NST) from Oct. 1, 1991 through May 31, 1995. Subjects were classified on the basis of the presence or absence of lifetime history of sexual abuse. Since only 1 subject assigned to SBFT had a history of sexual abuse, we restricted our analyses to those 72 subjects assigned to either CBT or NST. The impact of lifetime history of sexual abuse on service use, depression, and treatment outcome was examined. RESULTS: Depressed adolescents with a past history of sexual abuse were more likely, at 2-year follow-up, to have had a psychiatric hospitalization and have a depressive relapse, even controlling for maternal depression, source of referral, race, and treatment assignment. CBT was more efficacious than NST in absence of sexual abuse but was not better than NST in those with a history of sexual abuse. CONCLUSION: Sexual abuse is a negative predictor of long-term outcome in adolescent depression. CBT for depression may not be as efficacious for those depressed adolescents with a history of sexual abuse. These findings suggest that a history of sexual abuse should be assessed not only in clinical practice, but also in research studies of depressive outcome. Further work is indicated to understand the relationship between sexual abuse and poor outcome in order to help restore these high-risk youths to an optimal developmental trajectory.

Adolescent↗
PubMed2001

Autonomy and relatedness in family interactions with depressed adolescents.

This study investigated family interaction patterns associated with adolescent depression. Twenty adolescent-mother dyads with clinically depressed adolescents participated in the study. Twenty dyads with externalizing youths and 20 nonclinic dyads were included as controls. Dimensions of autonomy and relatedness were rated during a videotaped mother-adolescent problem-solving task. Adolescent perceptions of parent attachment were also evaluated. Results indicated that depressed adolescents and their mothers did not differ in their behavior compared with nonclinic adolescents. Dyads with externalizing adolescents showed the highest impairment in autonomy and relatedness. Depressed adolescents perceived the quality of their relationships with their parents to be impaired relative to nonclinic dyads, as did externalizing adolescents.

Adolescent↗
PubMed2000

Compliance with recommendations to remove firearms in families participating in a clinical trial for adolescent depression.

OBJECTIVE: To assess the rate and correlates of compliance with clinicians' recommendations to remove firearms from the homes of depressed adolescents participating in a clinical trial. METHOD: The parents of 106 adolescents with major depression who participated in a randomized psychotherapy clinical trial were asked systematically about firearms in the home. Those who answered affirmatively were given information about the suicide risk conveyed by guns in the home and urged to remove them. The rates of gun removal and acquisition were assessed at the end of the treatment and over the subsequent 2-year naturalistic follow-up. RESULTS: Of those who had guns at intake, 26.9% reported removing them by the end of the acute trial. Retention was associated with urban origin, marital dissatisfaction, and paternal psychopathology. Of those who did not have guns at intake, 17.1% reported acquiring them over 2-year follow-up. Living in a 2-parent household and marital dissatisfaction were associated with gun acquisition. CONCLUSIONS: Families of depressed adolescents may frequently be noncompliant with recommendations to remove guns from the home despite compliance with other aspects of treatment. More efficacious interventions to reduce access to guns in the homes of at-risk youths are needed.

Adolescent↗
PubMed1998

Adolescent depression in Japan: as studied from Shimoda's theory and Harter's theory.

Through the daily treatment of depressive adolescents we have come to feel that such cases present with a common specific state at onset that includes hypersensitivity and a tendency to neuroticism. This state is reminiscent of the introverted character of children reported by Shimoda in 1929 and of immodithymic character that he later proposed as the pre-pathological character of bipolar disorders. In contrast, we supposed that it might be important to evaluate these adolescents from the low self-worth theory and to compare adolescent psychopathology between the USA and Japan. In order to ascertain these issues, we performed a clinical survey of the junior and high school students who came to outpatient clinics, and thereby demonstrated the necessity of understanding the depressive adolescents from the standpoint of character theory and self-worth theory. We then attempted some field work with ordinary junior high school children as object using Harter's self-perception profile and Kovac's CDI. The results showed that depressive tendencies and self-worth differed greatly among Japanese junior high school children and American counterparts. We have used these findings to discuss the psychopathology of depressive tendencies in Japanese adolescents.

Adolescent↗
PubMed2002

Parental expressed emotion in depressed adolescents: prediction of clinical course and relationship to comorbid disorders and social functioning.

BACKGROUND: High expressed emotion (EE) predicts worse clinical course for a number of disorders. High EE is more frequent in parents of disordered children than normal controls. It is uncertain whether EE and its components are disorder-specific, whether EE is more closely related to parent characteristics or child characteristics, and whether EE predicts clinical course independently of clinical variables that reflect severity of disorder. EE has not been investigated in adolescent depression. METHOD: The 57 participants in this study were a sub-sample of a longitudinal study of the clinical course of depression. Adolescents and parents were recruited from consecutive referrals to all psychiatric outpatient clinics and inpatient units in a geographic catchment area. The association between EE and one-year clinical outcome of major depressive disorder was tested and associations between EE and characteristics of the adolescent, the parent, and the family were examined. RESULTS: EE was independent of socio-demographic characteristics, comorbid diagnoses, and parental depression. High EE was associated with worse adolescent social functioning according to either adolescent or parent report. High EE was associated with the presence of more depression symptoms. Low EE predicted major depression remission in participants without comorbid attention-deficit/hyperactivity disorder (ADHD), but this association was not independent of the association between social functioning and depression remission. CONCLUSIONS: The findings indicate a need to examine possible protective effects of low EE. Relationships between EE, social functioning, and depression persistence and remission require further examination.

Adolescent↗
PubMed2003

Cognitive behavioural therapy skills training for adolescent depression.

BACKGROUND: Adolescent depression is mainly managed in primary care. However, there are many problems associated with access to general practice and detection, assessment and treatment of youth depression by general practitioners. Clinical guidelines recommend the use of cognitive behavioural therapy (CBT) in treating adolescent depression. Stage 1 of the 'Time for a Future' project involved establishing a new service in Geelong, Victoria, 'The Clockwork Young People's Health Service'. The service aimed to address the barriers to optimal management of adolescent depression. OBJECTIVE: This article aims to outline Stage 2 of the Time for a Future project which involved training of 'Clockwork' GPs and other practitioners in CBT skills. DISCUSSION: The training program was well received by 68 community and Clockwork GPs, who reported significant changes in their confidence to detect, assess and treat adolescent depression. Ten GPs from Clockwork were a small but important subset of the study because the Clockwork model overcame many of the structural barriers that deter optimal management of adolescent depression by GPs. When real and perceived barriers were addressed concurrently with training, further positive outcomes were possible.

Adolescent↗