Disorders - Depressive Disorders
Sawyer, Michael G., Harchak,
Taylor F., Spence, Susan H., Bond, Lyndal, Graetz, Brian, Kay, Debra, Patton, George, Sheffield, Jeanie
Purpose: To investigate the effectiveness of a universal intervention designed
to reduce depressive symptoms experienced by adolescents at high school. The results from annual assessments during the 3-year intervention and a 2-
year follow-up are reported. Methods: Twenty-five pairs of secondary schools matched on socio-economic status were randomly assigned to either an
intervention or a comparison group (n = 5,633 year 8 students, mean age = 13.1 years, SD = .5). The intervention used a comprehensive classroom
curriculum program, enhancements to school climate, improvements in care pathways, and community forums. A range of measures completed by students
and teachers was used to assess changes in depressive symptoms, risk and protective factors relevant to depression, and the quality of the school
environment. Results: Changes in the levels of depressive symptoms and in the levels of risk and protective factors experienced by students in the
two groups did not differ significantly over the 5 years of the study. Statistically significant differences in the ratings of school climate across
this time were found only for teacher-rated assessments. Conclusions: There was little evidence that a multicomponent universal intervention
delivered over a 3-year period reduced levels of depressive symptoms among participating students. Implementing universal interventions to improve
student mental health is difficult in school settings that commonly have a crowded agenda of educational and health-related programs. Successful
implementation will require programs which are perceived by teachers and students as relevant to educational and learning goals, and which can be
effectively delivered in conjunction with other school programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Journal of Adolescent Health, 47(3) : 297-
304
- Year: 2010
- Problem: Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Weisz, JR., Southam-Gerow, MA., Gordis, EB., Connor-Smith, JK., Chu, BC.:
Langer, DA., ... Weiss, B.
Community clinic therapists were randomized to (a) brief training and supervision in
cognitive - behavioral therapy (CBT) for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), ages 8 - 15, of whom
33% were Caucasian, 26% were African American, and 26% were Latino/Latina. Most youths were from low-income families and all had Diagnostic and
Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) depressive disorders (plus multiple comorbidities). All
youths were randomized to CBT or UC and treated until normal termination. Session coding showed more use of CBT by CBT therapists and more
psychodynamic and family approaches by UC therapists. At posttreatment, depression symptom measures were at subclinical levels, and 75% of youths had
no remaining depressive disorder, but CBT and UC groups did not differ\ron these outcomes. However, compared with UC, CBT was (a) briefer (24 vs. 39
weeks), (b) superior in parent-rated therapeutic alliance, (c) less likely to require additional services (including all psychotropics combined and
depression medication in particular), and (d) less costly. The findings showed advantages for CBT in parent engagement, reduced use of medication and
other services, overall cost, and possibly speed of improvement - a hypothesis that warrants testing in future research.
Journal of Consulting &
Clinical Psychology, 77(3) : 383-396
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
VanVoorhees, B. W., Fogel, J., Reinecke, M. A., Gladstone, T., Stuart, S., Gollan, J., Bradford,
N., et-al
OBJECTIVE: The
authors sought to evaluate 2 approaches with varying time and complexity in engaging adolescents with an Internet-based preventive intervention for
depression in primary care. The authors conducted a randomized controlled trial comparing primary care physician motivational interview (MI, 5-10
minutes) + Internet program versus brief advice (BA, 1-2 minutes) + Internet program. SETTING: Adolescent primary care patients in the United States,
aged 14 to 21 years. PARTICIPANTS: Eighty-four individuals (40% non-white) at increased risk for depressive disorders (subthreshold depressed mood
>3-4 weeks) were randomly assigned to either the MI group (n = 43) or the BA group (n = 40). MAIN OUTCOME MEASURES: Patient Health Questionnaire-
Adolescent and Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: Both groups substantially engaged the Internet site (MI, 90.7% vs
BA 77.5%). For both groups, CES-D-10 scores declined (MI, 24.0 to 17.0, p < .001; BA, 25.2 to 15.5, p < .001). The percentage of those with
clinically significant depression symptoms based on CES-D-10 scores declined in both groups from baseline to 12 weeks, (MI, 52% to 12%, p < .001; BA,
50% to 15%, p < .001). The MI group demonstrated declines in self-harm thoughts and hopelessness and was significantly less likely than the BA group
to experience a depressive episode (4.65% vs 22.5%, p = .023) or to report hopelessness (MI group of 2% vs 15% for the BA group, p = .044) by 12
weeks. CONCLUSIONS: An Internet-based prevention program in primary care is associated with declines in depressed mood and the likelihood of having
clinical depression symptom levels in both groups. Motivational interviewing in combination with an Internet behavior change program may reduce the
likelihood of experiencing a depressive episode and hopelessness. (copyright) 2008 Lippincott Williams & Wilkins.
Journal of Developmental & Behavioral
Pediatrics, 30(1) : 23-37
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Stice, Eric, Shaw, Heather, Bohon, Cara, Marti, C. Nathan, Rohde, Paul
In this meta-analytic review, the authors summarized the effects of depression prevention
programs for youth as well as investigated participant, intervention, provider, and research design features associated with larger effects. They
identified 47 trials that evaluated 32 prevention programs, producing 60 intervention effect sizes. The average effect for depressive symptoms from
pre-to-posttreatment (r = .15) and pretreatment to-follow-up (r = .11) were small, but 13 (41%) prevention programs produced significant reductions
in depressive symptoms and 4 (13%) produced significant reductions in risk for future depressive disorder onset relative to control groups. Larger
effects emerged for programs targeting high-risk individuals, samples with more females, samples with older adolescents, programs with a shorter
duration and with homework assignments, and programs delivered by professional interventionists. Intervention content (e.g., a focus on problem-
solving training or reducing negative cognitions) and design features (e.g., use of random assignment and structured interviews) were unrelated to
effect sizes. Results suggest that depression prevention efforts produce a higher yield if they incorporate factors associated with larger
intervention effects (e.g., selective programs with a shorter duration that include homework). (PsycINFO Database Record (c) 2010 APA, all rights
reserved) (journal abstract)
Journal of Consulting & Clinical Psychology, 77(3) : 486-
503
- Year: 2009
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any)
Williams, S. B., O'Connor, E. A., Eder, M., Whitlock, E. P.
CONTEXT. Depression among youth is a disabling condition that is
associated with serious long-term morbidities and suicide. OBJECTIVE. To assess the health effects of routine primary care screening for major
depressive disorder among children and adolescents aged 7 to 18 years. METHODS. Medline, the Cochrane Central Registry of Controlled Trials,
PsycInfo, the Cochrane Database of Systematic Reviews, recent systematic reviews, experts, and bibliographies from selected studies were the data
sources. The studies selected were fair- and good-quality (on the basis of US Preventive Services Task Force criteria) controlled trials of screening
and treatment (selective serotonin reuptake inhibitor and/or psychotherapy), diagnostic accuracy studies, and large observational studies that
reported adverse events. Two reviewers quality-graded each article. One reviewer abstracted relevant information into standardized evidence tables,
and a second reviewer checked key elements. RESULTS.We found no data describing health outcomes among screened and unscreened populations. Although
the literature on diagnostic screening test accuracy is small and methodologically limited, it indicates that several screening instruments have
performed fairly well among adolescents. The literature on treatment efficacy of selective serotonin reuptake inhibitors and/or psychotherapy is also
small but includes good-quality randomized, controlled trials. Available data indicate that selective serotonin reuptake inhibitors, psychotherapy,
and combined treatment are effective in increasing response rates and reducing depressive symptoms. Not all specific selective serotonin reuptake
inhibitors, however, seem to be efficacious. Selective serotonin reuptake inhibitor treatment was associated with a small absolute increase in risk
of suicidality (ie, suicidal ideation, preparatory acts, or attempts). No suicide deaths occurred in any of the trials. CONCLUSIONS. Limited
available data suggest that primary care-feasible screening tools may accurately identify depressed adolescents and treatment can improve depression
outcomes. Treating depressed youth with selective serotonin reuptake inhibitors may be associated with a small increased risk of suicidality and
should only be considered if judicious clinical monitoring is possible.
Pediatrics, 123(4) : e716-e735
- Year: 2009
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Tang, Tze-Chun, Jou, Shaw-Hwa, Ko, Chih-Hung, Huang, Shih-Yin, Yen, Cheng-Fang,
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. (PsycINFO Database Record (c) 2010
APA, all rights reserved) (journal abstract)
Psychiatry & Clinical Neurosciences, 63(4) : 463-
470
- Year: 2009
- 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: Psychological Interventions
(any), Interpersonal therapy (IPT)
Vitiello, Benedetto, Brent, David A., Greenhill, Laurence
L., Emslie, Graham, Wells, Karen, Walkup, John T., Stanley, Barbara, et-al
Objective: Method: Results: Conclusions: To examine the course
of depression during the treatment of adolescents with depression who had recently attempted suicide.Adolescents (N = 124), ages 12 to 18 years, with
a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression
Rating Scale-Revised (CDRS-R) score of 36 or higher, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused
on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study
participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission
rates were computed with the last observation carried forward.Most patients (n = 104 or 84%) chose treatment assignment, and overall, three fourths
(n = 93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12 and to 27.0 (10.1) at week
24 (p < .0001), with a Clinical Global Impression -defined improvement rate of 58.0% at week 12 and 72.2% at week 24 and a remission (CDRS-R ≤ 28)
rate of 32.5% at week 12 and 50.0% at week 24. The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline (r = 0.43, p <
.0001) and declined in parallel.When vigorously treated with a combination of medication and psychotherapy, adolescents with depression who have
recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents
with depression.\rCopyright © 2009 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Journal of the American Academy of Child & Adolescent
Psychiatry, 48(10) : 997-1004
- Year: 2009
- Problem: Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
O'Kearney, R., Kang, K., Christensen, H., Griffiths, K.
Background: This study evaluates
the benefits of a self-directed Internet intervention for depression (MoodGYM) delivered as a part ofthe high school curriculum. Method: One hundred
and fifty-seven girls, aged 15 and 16 years, were allocated to undertake either MoodGYM or their usual curriculum. Mood GYM's impact on depressive
symptoms, risk of depression, attributional style, depression literacy and attitudes toward depression was examined using random effect regression.
Results: MoodGYM produced a significantly faster rate of decline in depressive symptoms over the trial period than the control condition. The effect
size for MoodGYM was not significant immediately after the intervention (Cohen's d = .19, 95% CI -.18-.56) but was moderate and significant 20 weeks
after the intervention (d = .46, 95% CI .10-.82). Girls with high depression scores before intervention showed the strongest benefits on self-
reported depression at follow-up (d = .92, 95% CI .10-1.38). There were no significant intervention effects on depression status, attributional
style, depression literacy, and attitudes. Approximately 70% of girls in the MoodGYM group completed less than three of its modules and completion of
fewer modules was related to high depression score before intervention. Conclusions: The findings suggest that there are benefits from MoodGYM on
self-reported depressive symptoms but has low rates of completion highlight problems in ensuring adherence to Internet programs for depression.
(copyright) 2008 Wiley-Liss, Inc.
Depression & Anxiety, 26(1) : 65-72
- Year: 2009
- Problem: Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Fristad, Mary A., Verducci, Joseph S., Walters,
Kimberly, Young, Matthew E.
Context:
Childhood mood disorders lack sufficient evidence- based treatments. While psychosocial treatments are recommended for both childhood depression and
bipolar disorder, empirical support is scarce. Objective: To determine whether adjunctive multifamily psychoeducational psychotherapy would improve
outcome for children aged 8 to 12 years with depression or bipolar disorder. Design: One hundred sixty-five children were studied in a randomized
controlled trial of multifamily psychoeducational psychotherapy plus treatment as usual (n=78) compared with a wait-list control (WLC) condition plus
treatment as usual (n=87). Assessments occurred at baseline and at 6, 12, and 18 months. Intervention occurred between baseline and 6 months for the
immediate treatment group and between 12 and 18 months for the WLC group. Setting: University medical center. Participants: Children were recruited
from mental health and physical health care providers, media contacts, and word of mouth. All had a major mood disorder (major depressive disorder or
dysthymic disorder, 30%; bipolar disorder type I, type II, or not otherwise specified, 70%). Intervention: Children and 1 or more parents
participated in eight 90-minute multifamily psychoeducational psychotherapy sessions. Parent and child groups met separately but began and ended
sessions together. Main Outcome Measures: The Mood Severity Index (MSI) combines Mania Rating Scale and Children's Depression Rating Scale - Revised
scores. Results: Multifamily psychoeducational psychotherapy plus treatment as usual was associated with lower MSI scores at follow-up in intent-to-
treat analyses compared with WLC plus treatment as usual. The WLC group showed a similar decrease in MSI scores 1 year later, when also following
their treatment. Conclusion: Brief, adjunctive psychoeducational group psychotherapy is associated with improved outcome for children aged 8 to 12
years with major mood disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Archives of General Psychiatry, 66(9) : 1013-1020
- Year: 2009
- Problem: Bipolar Disorders, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation
Khalsa, S. B. S., Shorter, S. M., Cope, S., Wyshak, G., Sklar, E.
Yoga and meditation can alleviate stress, anxiety, mood disturbance, and musculoskeletal problems, and can
enhance cognitive and physical performance. Professional musicians experience high levels of stress, performance anxiety, and debilitating
performance-related musculoskeletal disorders (PRMDs). The goal of this controlled study was to evaluate the benefits of yoga and meditation for
musicians. Young adult professional musicians who volunteered to participate in a 2-month program of yoga and meditation were randomized to a yoga
lifestyle intervention group (n = 15) or to a group practicing yoga and meditation only (n = 15). Additional musicians were recruited to a no-
practice control group (n = 15). Both yoga groups attended three Kripalu Yoga or meditation classes each week. The yoga lifestyle group also
experienced weekly group practice and discussion sessions as part of their more immersive treatment. All participants completed baseline and end-
program self-report questionnaires that evaluated music performance anxiety, mood, PRMDs, perceived stress, and sleep quality; many participants
later completed a 1-year followup assessment using the same questionnaires. Both yoga groups showed a trend towards less music performance anxiety
and significantly less general anxiety/tension, depression, and anger at end-program relative to controls, but showed no changes in PRMDs, stress, or
sleep. Similar results in the two yoga groups, despite psychosocial differences in their interventions, suggest that the yoga and meditation
techniques themselves may have mediated the improvements. Our results suggest that yoga and meditation techniques can reduce performance anxiety and
mood disturbance in young professional musicians. (copyright) 2009 Springer Science+Business Media, LLC.
Applied Psychophysiology Biofeedback, 34(4) : 279-
289
- Year: 2009
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Meditation, Mind-body exercises (e.g. yoga, tai chi, qigong)
Kennard, B. D., Silva, S. G., Tonev, S., Rohde, P., Hughes, J. L., Vitiello, B., Kratochvil, C.
J., Curry, J. F., Emslie, G. J., Reinecke, M., March, J.
Objective: We examine remission rate probabilities, recovery
rates, and residual symptoms across 36 weeks in the Treatment for Adolescents with Depression Study (TADS). Method: The TADS, a multisite clinical
trial, randomized 439 adolescents with major depressive disorder to 12 weeks of treatment with fluoxetine, cognitive-behavioral therapy, their
combination, or pill placebo. The pill placebo group, treated openly after week 12, was not included in the subsequent analyses. Treatment
differences in remission rates and probabilities of remission over time are compared. Recovery rates in remitters at weeks 12 (acute phase remitters)
and 18 (continuation phase remitters) are summarized. We also examined whether residual symptoms at the end of 12 weeks of acute treatment predicted
later remission. Results: At week 36, the estimated remission rates for intention-to-treat cases were as follows: combination, 60%; fluoxetine, 55%;
cognitive-behavioral therapy, 64%; and overall, 60%. Paired comparisons reveal that, at week 24, all active treatments converge on remission
outcomes. The recovery rate at week 36 was 65% for acute phase remitters and 71% for continuation phase remitters, with no significant between-
treatment differences in recovery rates. Residual symptoms at the end of acute treatment predicted failure to achieve remission at weeks 18 and 36.
Conclusions: Most depressed adolescents in all three treatment modalities achieved remission at the end of 9 months of treatment. (copyright)2009 by
the American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent
Psychiatry, 48(2) : 186-195
- Year: 2009
- Problem: Depressive Disorders
- 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)
Kennard, B. D., Silva, S. G., Mayes, T. L., Rohde, P., Hughes, J. L., Vitiello, B., Kratochvil, C. J., Curry, J. F., Emslie, G. J., Reinecke, M. A., March, J.
S.
Objective: The authors examined whether initial assignment to receive placebo for 12 weeks followed by open active treatment as
clinically indicated was associated with different levels of benefit and risk of harm across 36 weeks as compared with initial assignment to receive
active treatments. Method: Adolescents with major depressive disorder (N=439) were randomly assigned to receive an initial 12 weeks of treatment with
fluoxetine, cognitive-behavioral therapy (CBT), combination treatment with fluoxetine and CBT, or clinical management with placebo; those assigned to
placebo received open active treatment as clinically indicated after 12 weeks of placebo. Assessments were conducted every 6 weeks for 36 weeks. The
primary outcome measures were response and remission based on scores on the Children's Depression Rating Scale-Revised and the Clinical Global
Impression improvement subscale. Results: At week 36, the response rate was 82% in the placebo/open group and 83% in the active treatment groups. The
remission rate was 48% in the placebo/open group and 59% in the act ive treatment groups, a difference that approached statistical significance.
Patients who responded to placebo generally retained their response. Those who did not respond to placebo subsequently responded to active treatment
at the same rate as those initially assigned to active treatments. There were no differences between groups in rates of suicidal events, study
retention, or symptom worsening. Conclusions: Remis s ion rates at 9 months were lower in patients treated initially with placebo, but 3 months of
placebo treatment was not associated with any harm or diminished response to subsequent treatment.
American Journal of Psychiatry, 166(3) : 337-344
- Year: 2009
- Problem: Depressive Disorders
- 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), Other Psychological Interventions