Carter, T., Guo, B., Turner, D., Morres, I., Khalil, E., Brighton, E., Armstrong, M., Callaghan, P.

Preferred intensity exercise for adolescents receiving treatment for depression: A pragmatic randomised controlled trial

Background: Exercise has been shown to be effective in treating depression, but trials testing the effect of exercise for depressed adolescents utilising mental health services are rare. The aim of this study was to determine the effectiveness of a preferred intensity exercise intervention on the depressive symptoms of adolescents with depression. Methods: We randomly assigned 87 adolescents who were receiving treatment for depression to either 12 sessions of aerobic exercise at preferred intensity alongside treatment as usual or treatment as usual only. The primary outcome was depressive symptom change using the Children's Depression Inventory 2nd Version (CDI-2) at post intervention. Secondary outcomes were health-related quality of life and physical activity rates. Outcomes were taken at baseline, post intervention and at six month follow up. Results: CDI-2 score reduction did not differ significantly between groups at post-intervention (est. 95 % CI -6.82, 1.68, p = 0.23). However, there was a difference in CDI-2 score reduction at six month follow-up in favour of the intervention of -4.81 (est. 95 % CI -9.49, -0.12, p = 0.03). Health-related quality of life and physical activity rates did not differ significantly between groups at post-intervention and follow-up. Conclusions: There was no additional effect of preferred intensity exercise alongside treatment as usual on depressive reduction immediately post intervention. However, effects were observed at six months post-intervention, suggesting a delayed response. However, further trials, with larger samples are required to determine the validity of this finding. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).

BMC Psychiatry, 15 : ArtID 247

Zhou, X., Qin, B., Del-Giovane, C., Pan, J., Gentile, S., Liu, Y., Lan, X., Yu, J., Xie, P.

Efficacy and tolerability of antidepressants in the treatment of adolescents and young adults with depression and substance use disorders: a systematic review and meta- analysis

AIMS: To measure the effectiveness of antidepressants for adolescents and young adults with co-occurring depression and substance use disorder. DESIGN, SETTING AND PARTICIPANTS: Meta-analysis of randomized controlled clinical trials. A comprehensive literature search of PubMed, Cochrane, Embase, Web of Science and PsychINFO was conducted (from 1970 to 2013). Prospective, parallel groups, double-blind, controlled trials with random assignment to an antidepressant or placebo on young patients (age<=25 years) who met diagnostic criteria of both substance use and unipolar depressive disorder were included. Five trials were selected for this analysis and included 290 patients. MEASUREMENTS: Our efficacy outcome measures were depression outcomes (dichotomous and continuous measures) and substance-use outcomes (change of frequency or quantity of substance-use). Secondary analysis was conducted to access the tolerability of antidepressant treatment. FINDINGS: For dichotomous depression outcome, antidepressants group was significantly more effective than placebo group [risk ratio (RR)=1.21; 95% confidence interval (CI) 1.01-1.45], with low heterogeneity (I(2) =0%). Although no statistically significant effects for continuous depression outcome [standardized mean differences (SMD)=-0.13; 95% CI, -0.55 to 0.30] were found with moderate heterogeneity (I(2) =63%), subgroup analysis showed that the medicine group with a sample size of more than 50 showed statistically significant efficacy compared with the placebo group (SMD -0.53, 95% CI -0.82 to -0.25). Moreover, there was no significant difference for substance-use outcomes and tolerability outcomes between the medication and placebo groups. CONCLUSIONS: Antidepressant medication has a small overall effect in reducing depression in young patients with combined depressive and substance-use disorders, but does not appear to improve substance use outcomes. Copyright © 2014 Society for the Study of Addiction.

Addiction (Abingdon, England), 110(1) : 38-48

van-der-Zwan, J. E., de-Vente, W., Huizink, A. C., Bogels, S. M., de-Bruin, E. I.

Physical activity, mindfulness meditation, or heart rate variability biofeedback for stress reduction: a randomized controlled trial

In contemporary western societies stress is highly prevalent, therefore the need for stress-reducing methods is great. This randomized controlled trial compared the efficacy of self-help physical activity (PA), mindfulness meditation (MM), and heart rate variability biofeedback (HRV-BF) in reducing stress and its related symptoms. We randomly allocated 126 participants to PA, MM, or HRV-BF upon enrollment, of whom 76 agreed to participate. The interventions consisted of psycho-education and an introduction to the specific intervention techniques and 5 weeks of daily exercises at home. The PA exercises consisted of a vigorous-intensity activity of free choice. The MM exercises consisted of guided mindfulness meditation. The HRV-BF exercises consisted of slow breathing with a heart rate variability biofeedback device. Participants received daily reminders for their exercises and were contacted weekly to monitor their progress. They completed questionnaires prior to, directly after, and 6 weeks after the intervention. Results indicated an overall beneficial effect consisting of reduced stress, anxiety and depressive symptoms, and improved psychological well-being and sleep quality. No significant between-intervention effect was found, suggesting that PA, MM, and HRV-BF are equally effective in reducing stress and its related symptoms. These self-help interventions provide easily accessible help for people with stress complaints.

Applied Psychophysiology and Biofeedback, 40(4) : 257-268

Melnyk, B. M., Amaya, M., Szalacha, L. A., Hoying, J., Taylor, T., Bowersox, K.

Feasibility, Acceptability, and Preliminary Effects of the COPE Online Cognitive-Behavioral Skill-Building Program on Mental Health Outcomes and Academic Performance in Freshmen College Students: A Randomized Controlled Pilot Study

PROBLEM: Despite the increasing prevalence of mental health disorders in university students, few receive needed evidence-based treatment. OBJECTIVE: The purpose of this study was to assess the feasibility and preliminary effects of a seven-session online cognitive-behavioral skill-building intervention (i.e., COPE, Creating Opportunities for Personal Empowerment) versus a comparison group on their anxiety, depressive symptoms, and grade performance. METHODS: A randomized controlled pilot study was conducted from September 2012 to May 2013 with 121 college freshmen enrolled in a required one credit survey course. FINDINGS: Although there were no significant differences in anxiety and depressive symptoms between the groups, only COPE students with an elevated level of anxiety at baseline had a significant decline in symptoms. Grade point average was higher in COPE versus comparison students. Evaluations indicated that COPE was a positive experience for students. CONCLUSIONS: COPE is a promising brief intervention that can be integrated effectively into a required freshman course. Copyright © 2015 Wiley Periodicals, Inc.

Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc, 28(3) : 147-154

Melnyk, B. M., Jacobson, D., Kelly, S. A., Belyea, M. J., Shaibi, G. Q., Small, L., OHaver, J. A., Marsiglia, F. F.

Twelve-Month Effects of the COPE Healthy Lifestyles TEEN Program on Overweight and Depressive Symptoms in High School Adolescents

BACKGROUND: We evaluated the 12-month effects of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) program versus an attention control program (Healthy Teens) on overweight/obesity and depressive symptoms in high school adolescents. METHODS: A cluster randomized controlled trial was conducted. Participants were 779 culturally diverse adolescents in the US Southwest. COPE is a cognitive-behavioral skills-building intervention with 20min of physical activity integrated into a health course and taught by teachers once a week for 15 weeks. Outcome measures included body mass index (BMI) and depressive symptoms. RESULTS: COPE teens had a significantly lower BMI at 12months (F(1,698) =11.22, p=.001) than Healthy Teens (24.95 versus 25.48). There was a significant decrease in the proportion of overweight and obese COPE teens from baseline to 12 months (chi(2) =5.40, p=.02) as compared with Healthy Teens. For youth who began the study with extremely elevated depressive symptoms, COPE teens had significantly lower depression at 12 months compared with Healthy Teens (COPE M=42.39; Healthy Teens M=57.90); (F(1 ,12) =5.78, p=.03). CONCLUSIONS: COPE can improve long-term physical and mental health outcomes in teens. Copyright © 2015, American School Health Association.

The Journal of school health, 85(12) : 861- 870

Raes, F., Griffith, J. W., VanDerGucht, K., Williams, J. M. G.

School-based prevention and reduction of depression in adolescents: A cluster-randomized controlled trial of a mindfulness group program

This reprinted article originally appeared in Mindfulness 5, 5, 2014, pp. 477-486. Our objective was to conduct the first randomized controlled trial of the efficacy of a group mindfulness program aimed at reducing and preventing depression in an adolescent school-based population. For each of 12 pairs of parallel classes with students (age range 13-20) from five schools (N = 408), one class was randomly assigned to the mindfulness condition and one class to the control condition. Students in the mindfulness group completed depression assessments (the Depression Anxiety Stress Scales) prior to and immediately following the intervention and 6 months after the intervention. Control students completed the questionnaire at the same times as those in the mindfulness group. Hierarchical linear modeling showed that the mindfulness intervention showed significantly greater reductions (and greater clinically significant change) in depression compared with the control group at the 6-month follow-up. Cohen's d was medium sized (> .30) for both the pre-to-post and pre-to-follow-up effect for depressive symptoms in the mindfulness condition. The findings suggest that school-based mindfulness programs can help to reduce and prevent depression in adolescents. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Mindfulness, 5 : 477-486

Gallego, J., Aguilar-Parra, J. M., Cangas, A. J., Langer, A. I., Manas, I.

Effect of a mindfulness program on stress, anxiety and depression in university students

Two of the problems that currently affect a large proportion of university students are high levels of anxiety and stress experienced in different situations, which are particularly high during the first years of their degree and during exam periods. The present study aims to investigate whether mindfulness training can bring about significant changes in the manifestations of depression, anxiety, and stress of students when compared to another group undergoing a physical activity program and a control group. The sample consisted of 125 students from the Bachelor of Education Program. The measuring instrument used was the Abbreviated Scale of Depression, Anxiety and Stress (DASS-21). The results indicate that the effects of reducing the identified variables were higher for the mindfulness group than for the physical education group and for the control group F(2) = 5.91, p = .004, eta2 = .106. The total scores for all variables related to the mindfulness group decreased significantly, including an important stress reduction t(29) = 2.95, p = .006, d = .667. Mindfulness exercises and some individual relaxing exercises involving Physical Education could help to reduce manifestations of stress and anxiety caused by exams in students.

The Spanish journal of psychology, 17 : E109

Matos, A. P., Do-Rosario-Pinheiro, M., Oliveira, S., Marques, C.

Prevention of depression in adolescents: Some results of application of a parental program [conference abstract]

Introduction: The Parental Program for the Prevention of Depression in Adolescents (3PDA) was developed to improve the efficacy of the Program for the Prevention of Depression in Adolescents (PPDA), which include new components that enhance welfare and psychological suffering, such as emotional validation and compassion. Objectives: To describe the implementation and evaluation processes of the program, and analyze the efficacy of the 3PPDA in the results of PPDA (Arnarson &Craighead, 2009). Methods: The total sample was comprised by 42 parents of adolescents aged between 13 and 15 years, considered at risk (scores between the 75th and the 90th percentiles on the CDI) that had attended the PPDA. The sample was divided into two groups: 14 were allocated into the experimental group (parents attending the 3PDA) and 28 into the control group (parents not attending the 3PDA). The 3PDA is composed by 10 thematic sessions, during 5 weeks, 10 hours in total. To collect the data, indicators of satisfaction to assess each session were used, like asssiduity, overall satisfation and instructor-group interaction. Results: We found high values on the satisfaction indicators. The group of adolescents whose parents are not at the 3PDA have 3 times more depressive symptoms at the end of the intervention compared with the group of adolescents whose parents are at the 3PDA. Conclusions: Although the small sample of parental experimental group, the 3PDA seems to be relevant in increasing the effectiveness of PPDA.

Atencion Primaria, 46 (Supplement 5) : 8

Zamirinejad, S., Hojjat, S. K., Golzari, M., Borjali, A., Akaberi, A.

Effectiveness of resilience training versus cognitive therapy on reduction of depression in female Iranian college students

Issues in Mental Health Nursing, 35(6) : 480- 488

Azevedo, A., Matos, A. P.

New treatment for depression with adolescents: Preliminary results [conference abstract]

Introduction: In adolescence, depression appears to be a very impairing condition, due to its serious psychosocial consequences and recurrence (Monroe &Harkness, 2011). For this reason, it is necessary to treat it as soon as possible, using interventions effective in maintainning the therapeutic gains. We developed a new treatment composed by components of the \"third generation therapies\". Methods: The present pilot study of the randomized controlled trial was conducted in the Pediatric Hospital of Coimbra, Portugal, and enrolled eight severely depressed adolescents aged between 14 and 18 years. The population was identified by diagnostic interview and characterized by self-report instruments. We compared the experimental group, to which the treatment was applied, and the control group, under \"treatment as usual\" condition, in pre-treatment and post-treatment moments. Results: The preliminary results showed that the treatment was effective in reducing depressive symptoms, suicidal ideation and risk factors as self-criticism, and in promoting protective factors, such as self compassion. Conclusions: These preliminary data seem very promising. It is necessary to replicate them with a larger sample, which is now being enlarged. To test its capacity for maintaining treatment gains, a large follow up study is being conducted.

Atencion Primaria, 46 (Supplement 5) : 8

Challen, A. R., Machin, S. J., Gillham, J. E.

The UK Resilience Programme: A school-based universal nonrandomized pragmatic controlled trial

Objective: The study aimed to assess the effectiveness of an 18-hr cognitive behavioral group intervention in reducing depressive symptoms (and associated outcomes) in a universal sample of students in mainstream schools in England. The intervention, the UK Resilience Programme (UKRP), was based on the Penn Resiliency Program for Children and Adolescents. Method: Students (N = 2,844; 49% female; 67% White) were ages 11-12 at 16 schools. Classes of students were assigned arbitrarily into intervention (UKRP) or control (usual school provision) conditions based on class timetables. Outcome measures were the Children's Depression Inventory (Kovacs, 1992) (depressive symptoms, primary outcome); Revised Children's Manifest Anxiety Scale (C. R. Reynolds & Richmond, 1985) (anxiety); and child-reported Goodman (1997) Strengths and Difficulties Questionnaire (behavior). Students were surveyed at baseline, postintervention, 1-year follow-up, and 2-year follow-up. Results: At postintervention, UKRP students reported lower levels of depressive symptoms than control group students, but the effect was small (d = 0.093, 95% CI [-0.178, -0.007], p =.034) and did not persist to 1-year or 2-year follow-ups. There was no significant impact on symptoms of anxiety or behavior at any point. Conclusions: UKRP produced small, short-term impacts on depression symptoms and did not reduce anxiety or behavioral problems. These findings suggest that interventions may produce reduced impacts when rolled out and taught by regular school staff. We discuss the implications of these findings for policy and for future dissemination efforts. (copyright) 2013 American Psychological Association.

Journal of Consulting & Clinical Psychology, 82(1) : 75- 89

Atkinson, S. D., Prakash, A., Zhang, Q., Pangallo, B. A., Bangs, M. E., Emslie, G. J., March, J. S.

A double- blind efficacy and safety study of duloxetine flexible dosing in children and adolescents with major depressive disorder

Objective: The purpose of this study was to evaluate the efficacy and safety of duloxetine flexible dose in children (7-11 years) and adolescents (12-17 years) with major depressive disorder (MDD). Methods: Patients (n=337) in this 36 week study (10 week acute and 26 week extension treatment) received duloxetine (60- 120mg once daily [QD], n=117), fluoxetine (20-40mg QD, n=117), or placebo (n=103). Measures included: Children's Depression Rating Scale-Revised (CDRS-R), treatment-emergent adverse events (TEAEs), and Columbia-Suicide Severity Rating Scale (C-SSRS). Results: Neither active drug (duloxetine or fluoxetine) separated significantly (p<0.05) from placebo on mean change from baseline to end-point (10 weeks) on the CDRS-R total score. There were no significant differences between the duloxetine or fluoxetine groups compared with placebo on serious AEs (SAEs), total TEAEs, or discontinuation for AE during acute treatment. There were no completed suicides or deaths, and no clinically significant electrocardiogram (ECG) abnormalities observed during the study. One fluoxetine and one duloxetine patient experienced alanine aminotransferase (ALT) three or more times the upper limit of normal, which resolved during the study. A total of 8 (7.1%) duloxetine patients, 7 (6.8%) placebo patients, and 9 (8.0%) fluoxetine patients had worsening of suicidal ideation from baseline during acute treatment. Of the patients with suicidal ideation at baseline, 15/19 (79%) duloxetine, 19/19 (100%) placebo, and 16/19 (84%) fluoxetine had improvement in suicidal ideation at end-point during acute treatment. One duloxetine and two fluoxetine patients had treatment-emergent suicidal behavior during the 36 week study. Conclusion: Trial results were inconclusive, as neither the investigational drug (duloxetine) nor the active control (fluoxetine) separated from placebo on the CDRS-R at 10 weeks. No new duloxetine safety signals were identified relative to those seen in adults. Clinical Trial Registry Number: NCT00849901 (copyright) Mary Ann Liebert, Inc.

Journal of Child & Adolescent Psychopharmacology, 24(4) : 180-189