Vitiello, B., Ordonez, A. E.

Pharmacological treatment of children and adolescents with depression

INTRODUCTION: Despite an increasing number of studies, there is debate whether antidepressants have a favorable benefit/risk balance in depressed youth. Areas covered: A systematic search identified 23 systematic reviews and meta-analyses published between 2010-2016. More than 30 controlled clinical trials were conducted in adolescents, but only a few in pre-pubertal patients. About one-third of the trials were severely statistically underpowered. Most studies failed to detect differences from placebo, but a few found fluoxetine effective. Although no suicide occurred in these studies, antidepressants increased suicidality risk (including suicidal ideation and behavior) versus placebo (OR = 2.39). Only two placebo-controlled trials with acceptable statistical power were publicly funded: both showed efficacy of fluoxetine, and one found a higher incidence of suicidality (OR = 3.7, 95% C.I. 1.00-13.7). Expert opinion: In youth, antidepressants have, on average, a small therapeutic effect. The high placebo response is exacerbated by the large number of sites in many industry-funded studies. There is evidence that fluoxetine leads to greater and faster improvement than placebo or psychotherapy in adolescents. Considering both the high response to non-specific interventions and safety concerns, antidepressants should be used cautiously in youth, and limited to patients with moderate-to-severe depression for whom psychosocial interventions are either ineffective or not feasible.

Expert Opinion on Pharmacotherapy, 17(17) : 2273-2279

Yap, M. B. H., Morgan, A. J., Cairns, K., Jorm, A. F., Hetrick, S. E., Merry, S.

Parents in prevention: A meta-analysis of randomized controlled trials of parenting interventions to prevent internalizing problems in children from birth to age 18

Purpose of the research Burgeoning evidence that modifiable parental factors can influence children's and adolescents' risk for depression and anxiety indicates that parents can play a crucial role in prevention of these disorders in their children. However, it remains unclear whether preventive interventions that are directed primarily at the parent (i.e. where the parent receives more than half of the intervention) are effective in reducing child internalizing (including both depression and anxiety) problems in the longer term. Principal results Compared to a range of comparison conditions, parenting interventions reduced child internalizing problems, at a minimum of 6 months after the intervention was delivered. Mean effects were very small for measures of internalizing and depressive symptoms, and small for measures of anxiety symptoms. Pooled effects for anxiety diagnoses were significant and indicated a number needed to treat (NNT) of 10. Pooled effects for depression diagnoses approached significance but suggested a NNT of 11. These results were based on effects reported at the longest follow-up interval for each included study, which ranged from 6 months up to 15 years for internalizing measures, 5.5 years for depressive measures, and 11 years for anxiety measures. Major conclusions Our findings underscore the likely benefits of increasing parental involvement in preventing internalizing problems, particularly anxiety problems, in young people. Copyright © 2016 Elsevier Ltd

Clinical Psychology Review, 50 : 138- 158

Rohde, P., Stice, E., Shaw, H., Gau, J. M.

Pilot trial of a dissonance-based cognitive-behavioral group depression prevention with college students

Objective: Conduct a pilot trial testing whether a new cognitive-behavioral (CB) group prevention program that incorporated cognitive-dissonance change principles was feasible and appeared effective in reducing depressive symptoms and major depressive disorder onset relative to a brochure control condition in college students with elevated depressive symptoms. Method: 59 college students (M age = 21.8, SD = 2.3; 68% female, 70% White) were randomized to the 6-session Change Ahead group or educational brochure control condition, completing assessments at pretest, posttest, and 3-month follow-up. Results: Recruitment and screening methods were effective and intervention attendance was high (86% attended all 6 sessions). Change Ahead participants showed medium-large reductions in depressive symptoms at posttest (M d = 0.64), though the effect attenuated by 3-month follow-up. Incidence of major depression onset at 3-month follow-up was 4% for Change Ahead participants versus 13% (difference ns). Conclusions: Change Ahead appears highly feasible and showed positive indications of reduced acute phase depressive symptoms and MDD onset relative to a minimal intervention control in this initial pilot. Given the brevity of the intervention, its apparent feasibility, and the lack of evidence-based depression prevention programs for college students, continued evaluation of Change Ahead appears warranted.

Behaviour Research & Therapy, 82 : 21- 27

Sadeghi, K., Ahmadi, S. M., Rezaei, M., Miri, J., Abdi, A., Khamoushi, F., Salehi, M., Jamshidi, K.

A comparative study of the efficacy of cognitive group therapy and aerobic exercise in the treatment of depression among the students

Global Journal of Health Science, 8(10) : 1

Sanchez, O., Carrillo, F. X., Garber, J.

Promoting resilience in children with depressive symptoms

A pilot study was conducted with the primary objective to study the effectiveness of a cognitive-behavioral intervention inspired by the Penn Resiliency Program (PRP; Gillham, Jaycox, Reivich, Seligman, & Silver, 1990; Seligman, Reivich, Jaycox, & Gillham, 2005), for the prevention of depression in students from primary education. The main components of the program include modifying explanatory style and resolving interpersonal problems. Results indicated that there was significant improvement from pre- test to post-test in the experimental group for children with \"high depressive symptoms\" compared with controls. Qualitative analysis were consistent with this trend. Conclusions in light of these results are discussed and potential directions for future research are recommended. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Anales de Psicologia, 32(3) : 741-748

Schleider, J. L., Weisz, J. R.

Reducing risk for anxiety and depression in adolescents: Effects of a single-session intervention teaching that personality can change

Efforts to reduce youth mental health problems have advanced greatly but have not lowered overall rates of youth mental illness. Thus, a need exists for disseminable, mechanism-targeted approaches to reducing risk of youth psychopathology. Accordingly, we conducted a randomized-controlled trial testing whether a single-session intervention teaching growth personality mindsets (the belief that personality is malleable) reduced known risk factors for anxiety and depression in adolescents experiencing or at risk for internalizing problems (N = 96, ages 12-15). Compared to a supportive- therapy control, a 30-min computer-guided mindset intervention strengthened adolescents' perceived control; this improvement was associated with increases in growth mindsets. Further, electrodermal activity recovery slopes showed that youths receiving the mindset intervention recovered from a lab-based social stressor over three times as fast as control group youths. Improvements in growth mindsets and perceived control were linked with faster stress recovery. Results suggest a disseminable strategy for reducing internalizing problem risk among adolescents. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Behaviour Research and Therapy, 87 : 170- 181

Sibinga, E. M. S., Webb, L., Ghazarian, S. R., Ellen, J. M.

School-based mindfulness instruction: An RCT

Background and Objective: Many urban youth experiencesignificant and unremitting negative stressors, including those associated with community violence, multigenerational poverty, failing educational systems, substance use, limited avenues for success, health risks, and trauma. Mindfulness instruction improves psychological functioning in a variety of adult populations; research on mindfulness for youth is promising, but has been conducted in limited populations. Informed by implementation science, we evaluated an adapted mindfulness-based stress reduction (MBSR) program to ameliorate the negative effects of stress and trauma among low-income, minority, middle school public school students. Methods: Participants were students at two Baltimore City Public Schools who were randomly assigned by grade to receive adapted MBSR or health education (Healthy Topics [HT]) programs. Self-report survey data were collected at baseline and postprogram. Deidentified data were analyzed in the aggregate, comparing MBSR and HT classes, by using regression modeling. Results: Three hundred fifth-to eighth-grade students (mean 12.0 years) were in MBSR and HT classes and provided survey data. Participants were 50.7% female, 99.7% African American, and 99% eligible for free lunch. The groups were comparable at baseline. Postprogram, MBSR students had significantly lower levels of somatization, depression, negative affect, negative coping, rumination, self-hostility, and posttraumatic symptom severity (all Ps <.05) than HT. Conclusions: These findings support the hypothesis that mindfulness instruction improves psychological functioning and may ameliorate the negative effects of stress and reduce trauma-associated symptoms among vulnerable urban middle school students. Additional research is needed to explore psychological, social, and behavioral outcomes, and mechanisms of mindfulness instruction.

Pediatrics, 137(1) :

Zemestani, M., Davoodi, I., Honarmand, M. M., Zargar, Y., Ottaviani, C.

Comparative effects of group metacognitive therapy versus behavioural activation in moderately depressed students

Background: The high incidence and prevalence rates of depression among students identify them as a vulnerable population and make the case for the development of cost-effective treatments. Aims: We aimed to examine the comparative effects of brief group metacognitive therapy (MCT) versus behavioural activation (BA) treatments for depression, anxiety, and emotion regulation in university students. Method: All participants (25 women, 16 men; age range: 18-30 years) fulfilled criteria for major depression and were randomly assigned to MCT (n = 15), BA (n = 15), or a wait-list control group (n = 15). The treatment groups received 8 weekly MCT or BA sessions. Scores on the Beck Depression Inventory, Beck Anxiety Inventory, and Cognitive Emotion Regulation Questionnaire were used as outcome measures. Results: This pilot study showed that both treatments were equally effective for depressive and anxiety symptoms. However, therapeutic techniques differed with regards to their effects on specific facets of emotion regulation, such as Positive Reappraisal and Catastrophizing, with MCT being more effective compared to BA. BA also showed a stronger relapse at follow-up with regards to Acceptance and Refocus on Planning. Conclusions: Results suggest that groups MCT and BA may be implemented as cost-effective treatments for students with moderate depression. Copyright © 2015 Taylor & Francis Group, LLC.

Journal of Mental Health, 25(6) : 479-485

Zhang, S., Wang, H., Chen, C., Zhou, J., Wang, X.

Effcacy of Williams LifeSkills Training in improving psychological health of Chinese male juvenile violent offenders: A randomized controlled study

This randomized controlled study was conducted to evaluate the efficacy of Williams LifeSkills Training (WLST) as a means of improving the psychological health of Chinese male juvenile violent offenders. Sixty-six participants were assigned randomly to receive the usual intervention plus 8 weeks of WLST (study group, n = 33) or only the usual intervention (control group, n = 33). We found that the study group exhibited significantly decreased State-Trait Anxiety Inventory (STAI X-1, X-2) STAX2 scores and Trait Coping Style Questionnaire (TCSQ) negative scores, and increased Interpersonal Support Evaluation List (ISEL) tangible scores from baseline to 9 weeks later (P <0.01). In addition, a between-group difference in changes of TCSQ negative score was observed at the end of week 9 (P <0.05). These fndings suggest that WLST can improve trait anxiety, coping style, and interpersonal support in male Chinese juvenile violent offenders.

Neuroscience Bulletin, 31(1) : 53- 60

Spirito, A., Wolff, J. C., Seaboyer, L. M., Hunt, J., Esposito-Smythers, C., Nugent, N., Zlotnick, C., Miller, I.

Concurrent treatment for adolescent and parent depressed mood and suicidally: Feasibility, acceptability, and preliminary findings

Objective: The purpose of this study was to conduct a treatment development study to examine the feasibility, acceptability, and preliminary efficacy of treating depressed, suicidal adolescents and their depressed parent concurrently in a cognitive behavioral therapy (CBT) protocol (Parent-Adolescent-CBT [PA-CBT]). Methods: A randomized, controlled, repeated measures design was used to test the hypothesis that PA-CBT would lead to greater reductions in suicidality and depression compared with Adolescent Only CBT (AO-CBT). Participants included 24 adolescent and parent dyads in which the adolescent met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for current major depressive episode (MDE) and the parent met DSMIV criteria for current or past MDE. Results: The concurrent protocol was found to be feasible to implement with most depressed adolescents and parents. Adolescent ratings of program satisfaction were somewhat lower in PA-CBT, suggesting that some teens view treatment negatively when they are required to participate with a parent. The concurrent treatment protocol was more effective in reducing depressed mood in the parent-adolescent dyad at the end of maintenance treatment (24 weeks) than treating an adolescent alone for depression; the largest effect was on parental depressed mood. This difference between dyads was no longer significant, however, at the 48 week follow-up. Adolescent and parent suicidal ideation improved equally in both groups during active and maintenance treatment, and remained low at follow-up in both groups. Conclusions: The PA-CBT protocol is feasible to conduct and acceptable to most but not all adolescents. The strongest effect was on parental depressed mood. A larger study that has sufficient power to test efficacy and moderators of treatment outcome is necessary to better understand which adolescents would benefit most from concurrent treatment with a parent. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).

Journal of Child & Adolescent Psychopharmacology, 25(2) : 131-139

Siddique, J., Reiter, J. P., Brincks, A., Gibbons, R. D., Crespi, C. M., Brown, C. H.

Multiple imputation for harmonizing longitudinal non-commensurate measures in individual participant data meta-analysis

There are many advantages to individual participant data meta-analysis for combining data from multiple studies. These advantages include greater power to detect effects, increased sample heterogeneity, and the ability to perform more sophisticated analyses than meta-analyses that rely on published results. However, a fundamental challenge is that it is unlikely that variables of interest are measured the same way in all of the studies to be combined. We propose that this situation can be viewed as a missing data problem in which some outcomes are entirely missing within some trials and use multiple imputation to fill in missing measurements. We apply our method to five longitudinal adolescent depression trials where four studies used one depression measure and the fifth study used a different depression measure. None of the five studies contained both depression measures. We describe a multiple imputation approach for filling in missing depression measures that makes use of external calibration studies in which both depression measures were used. We discuss some practical issues in developing the imputation model including taking into account treatment group and study. We present diagnostics for checking the fit of the imputation model and investigate whether external information is appropriately incorporated into the imputed values.

Statistics in Medicine, 34(26) : 3399- 3414

Zhou, X., Hetrick, S. E., Cuijpers, P., Qin, B., Barth, J., Whittington, C. J., Cohen, D., Del-Giovane, C., Liu, Y., Michael, K. D., Zhang, Y., Weisz, J. R., Xie, P.

Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis

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.

World Psychiatry, 14(2) : 207- 222