Disorders - depressive disorders
Garcia, C., Pintor, J., Vazquez, G., Alvarez-Zumarraga, E.
The authors examined the
feasibility and preliminary outcomes of Project Wings Girls' Groups, a school-based mental health promotion program designed to improve well-being
in Latina adolescents, as observed in outcomes, including perceived stress, depressive symptoms, coping, and connectedness. This pilot randomized
controlled trial compared outcomes over 9 months postintervention for 42 9th and 10th grade adolescents attending two urban high schools. Girls were
randomized to Project Wings Girls' Groups, a 16-session facilitated curriculum, including sharing circles, mind-body exercises, and coping skills
building or the attention control (i.e., similar format but focused on general health topics). Feasibility of retention and long-term follow-up data
collection was demonstrated, with lessons learned for future study. Although not statistically powered, this trial demonstrated findings in the
expected direction, including reduced perceived stress and depression and increased connectedness. A trial with sufficient power is warranted to
examine Project Wings' effects on mental health problems among Latina adolescents. (copyright) The Author(s) 2011.
Western Journal of
Nursing Research, 35(4) : 434-458
- Year: 2013
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Gerson, M. W., Fernandez, N.
We developed and tested a brief three-session
program to build resilience (protection from depressive symptoms) and thriving (positive growth) in undergraduates by teaching adaptive explanatory
styles. In Study 1, a pretest - posttest waiting list control experiment with 28 undergraduates found that our Program for Accelerated Thriving and
Health (PATH) significantly increased optimistic and personal control explanatory styles (Attributional Style Questionnaire), resilience (Beck
Depression Inventory-II), and thriving (Connor - Davidson Resilience Scale 10). In Study 2, a placebo control experiment with 63 undergraduates found
a modified version of the program to significantly increase resilience. All effects were at least moderate in size. As predicted, a personal control
explanatory style significantly predicted thriving in both studies. Predictors of resilience and thriving were discussed in terms of differentiating
the constructs. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
Journal of Applied Social Psychology, 43(11) : 2169-
2184
- Year: 2013
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Findling, R. L., Robb, A., Bose, A.
Objective: The purpose of this study was to evaluate the extended efficacy, safety, and tolerability of escitalopram
relative to placebo in adolescents with major depressive disorder (MDD). Methods: Adolescents (12-17 years) who completed an 8-week randomized,
double-blind, flexible-dose, placebo-controlled, lead-in study of escitalopram 10-20 mg versus placebo could enroll in a 16-24-week, multisite
extension trial; patients maintained the same lead-in randomization (escitalopram or placebo) and dosage (escitalopram 10 or 20 mg/day, or placebo)
during the extension. The primary efficacy was Children's Depression Rating Scale-Revised (CDRS-R) change from the lead-in study baseline to
treatment week 24 (8-week lead-in study plus 16-week extension); the secondary efficacy was Clinical Global Impressions-Improvement (CGI-I) score at
week 24. All efficacy analyses used the last observation carried forward (LOCF) approach; sensitivity analyses used observed cases (OC) and mixed-
effects model for repeated measures (MMRM). Safety was evaluated via adverse event (AE) reports and the clinician-rated Columbia-Suicide Severity
Rating Scale (C-SSRS). Results: Following lead-in, 165 patients enrolled in the double-blind extension (82 placebo; 83 escitalopram); 40 (48.8%)
placebo and 37 (44.6%) escitalopram patients completed treatment. CDRS-R total score improvement was significantly greater for escitalopram than for
placebo (p=0.005, LOCF; p=0.014; MMRM). Response rates (CDRS-R (greater-than or equal to)40% reduction from baseline [adjusted and unadjusted] and
CGI-I (less-than or equal to)2) were significantly higher for escitalopram than for placebo (LOCF); remission rates (CDRS-R (less-than or equal
to)28) were 50.6% for escitalopram and 35.7% for placebo (p=0.002). OC analyses were not significantly different between groups. The most frequent
escitalopram AEs ((greater-than or equal to)5% and more frequent than placebo) were headache, nausea, insomnia, vomiting, influenza-like symptoms,
diarrhea, and urinary tract infection. Most AEs were mild/moderate and not related to the study drug. AEs suggestive of self-harm occurred in 5.7%
and 7.1% of placebo and escitalopram patients. Occurrence of suicidal behavior and/or suicidal ideation assessed by C-SSRS was 10.9% (14/128) for
placebo and 14.5% (19/131) for escitalopram. Conclusions: Extended use of escitalopram was generally safe and resulted in modest improvement in
efficacy in adolescents with MDD. (copyright) Copyright 2013, Mary Ann Liebert, Inc. 2013.
Journal of Child & Adolescent Psychopharmacology, 23(7) : 468-480
- Year: 2013
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
DelBello, M., Welge, J., Strawn, J., Patino-Duran, L. R., Stahl, L., Blom, T., Strakowski, S., McNamara, R.
Background:
Family studies demonstrate that offspring of bipolar parents have an elevated risk of developing mood disorders compared with the general population.
When these offspring develop major depressive disorder, their risk of developing mania (and by definition bipolar I disorder) is increased further
(ie, they are at ultra-high risk). Moreover, antidepressant medications that are commonly used to treat depressive symptoms may increase risk of
developing manic symptoms. Therefore, studies of potential treatments for mood symptoms in ultra-high risk youth are urgently needed to establish
early intervention, and ultimately prevention, strategies. The aim of our 12-week double-blind placebo-controlled study was to examine the efficacy
and tolerability of long-chain omega-3 (LCn-3) fatty acids for the treatment of depressive symptoms in ultrahigh risk youth and to investigate
predictors and mediators of treatment response. Methods: Sixty youth (ages 9-20 years) with a current DSMIV- TR diagnosis of Major Depressive
Disorder or Depressive Disorder NOS, a Childhood Depression Rating Scale- Revised Version (CDRS-R) of score (greater-than or equal to) 28, and at
least one biological parent with bipolar I disorder, were recruited to participate in this 12-week double-blind placebo-controlled study. Fifty-six
subjects were randomized to LCn-3 fatty acid supplements (2100 mg/d) or placebo (olive oil). Symptom and tolerability ratings were performed weekly
and red blood cell (RBC) LCn-3 fatty acid levels were obtained at baseline and endpoint from each participant. Results: The mean age of participants
was 13.7 + 4.0 years, and a majority of participants were girls (82%) and White (67%). At baseline subjects displayed moderate symptoms of depression
(mean CDRS-R: 47 + 8), and there was a trend for an inverse correlation between baseline CDRS scores and RBC LCn-3 fatty acid levels (R2=0.06,
p=0.085). Among participants with post-baseline LCn-3 measurements, RBC LCn-3 fatty acid (EPA +DHA) levels increased and arachidonic acid (AA) to EPA
+DHA (AA/EPA +DHA) ratios decreased, significantly from baseline to endpoint in the group treated with LCn-3 fatty acids (n=20) but not in the
placebo group (n=20). There were statistically significant baseline to endpoint reductions in CDRS-R scores in both treatment groups (LCn-3 fatty
acids: -21.1 + 8.9 and placebo: -18.9 + 8.4), although there was no significant group difference in improvement (p=0.42). The mean + SD percent
reduction in CDRS-R score was 66 + 27% in the LCn-3 fatty acid group and 53 + 27% in the placebo group (p=0.11). The baseline AA/EPA +DHA ratio was
inversely correlated with baseline to endpoint change in CDRS-R score (ie, smaller baseline ratios were associated with greater CDRS-R improvement,
p=0.031), and larger baseline to endpoint decreases in the AA/DHA + EPA ratio were associated with smaller reductions in CDRS-R scores. In an ANCOVA
model, this effect appeared to be similar in both treatment groups (p=0.044 for main effect of change in AA/EPA + DHA, and no significant interaction
with treatment assignment, p=0.69). After adjusting for the baseline to endpoint change in the AA/EPA +DHA ratio, treatment with LCn-3 fatty acids
was associated with greater reductions in CDRS-R scores than placebo (p=0.017). The most commonly reported adverse events were headache (Placebo:
83%, LCn-3: 77%) and drowsiness (Placebo: 72%, LCn-3: 77%). Reported gastrointestinal adverse events were nausea (Placebo: 52%, LCn-3: 54%), vomiting
(Placebo: 38%, LCn- 3: 19%), diarrhea (Placebo: 17%, LCn-3: 27%), and heartburn (Placebo: 17%, LCn-3: 31%). Conclusions: This study provides
preliminary evidence that LCn-3 fatty acid supplementation is well-tolerated and improves depressive symptoms in youth at high risk for developing
mania. Additionally, we found that higher baseline LCn-3 fatty acid levels predicted greater improvement in depressive symptoms. Although the results
suggest that supplementation may produce treatment benefits, in contrast to our expectation, larger decreases in A to DHA + EPA ratios were
associated with less improvement in depressive symptoms. These findings indicate that the amount, duration, and/or rate of change in LCn-3 fatty acid
levels may impact the therapeutic benefits of omega-3 fatty acid supplementation. Additional dose finding studies to identify a plausible biological
mechanism for our findings and to determine whether omega-3 fatty acid supplementation is more effective and better tolerated than conventional
antidepressant medications for the treatment of ultra-high risk youth are necessary.
Neuropsychopharmacology, 38 : S374-S375
- Year: 2013
- Problem: Bipolar Disorders, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)
Donker, T., Batterham, P. J., Warmerdam, L., Bennett,
K., Bennett, A., Cuijpers, P., Griffiths, K. M., Christensen, H.
Background: By identifying which predictors and
moderators lead to beneficial outcomes, accurate selection of the best initial treatment will have significant benefits for depressed individuals.
Method: An automated, fully self-guided randomized controlled internet-delivered noninferiority trial was conducted comparing two new interventions
(Interpersonal Psychotherapy FIFT; n=6201 and Cognitive Behavioral Therapy FCBT; n=6101) to an active control intervention (M00dGYM; n=613) over a
period of 4 weeks to spontaneous visitors of an internet-delivered therapy website (e-couch). A range of putative predictors and moderators (socio-
demographic characteristics rage, gender, marital status, education levell, clinical characteristics Fdepression!anxiety symptoms, disability,
quality of life, medication usel, skills Fmastery and dysfunctional attitudesi and treatment preference) were assessed using internet-delivered
self-report measures at baseline and immediately following treatment and at six months follow-up. Analyses were conducted using Mixed Model Repeated
Measures (MMRM). Resu Its: Female gender, lower mastery and lower dysfunctional attitudes predicted better outcome at post-test and!or follow-up
regardless of intervention. No overall differential effects for condition on depression as a function of outcome were found. However, based on time-
specific estimates, a significant interaction effect of age was found. For younger people, internet-delivered 1Ff may be the preferred treatment
choice, whereas older participants derive more benefits from internet-delivered CBT programs. Limitations: Although the sample of participants was
large, power to detect moderator effects was still lacking. Conclusions: Different e-mental health programs may be more beneficial for specific age
groups. The findings raise important possibilities for increasing depression treatment effectiveness and improving clinical practice guidelines for
depression treatment of different age groups. (copyright) 2013 Elsevier B.V. All rights reserved.
Journal of Affective Disorders, 151(1) : 343-
351
- Year: 2013
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Interpersonal therapy (IPT), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Bertha, E. A., Balazs, J.
In adolescence, the number of depressive symptoms is rising notably. Individuals may have
relevant depressive symptoms without meeting the full criteria of a major depressive episode (MDE), a condition referred to as subthreshold
depression (sD). This article presents a review on adolescent sD examining the prevalence, the quality of life (QoL), the risk of developing MDE, and
preventive programs available for adolescents living with sD. A systematic literature search from the year of the introduction of Diagnostic and
Statistic Manual for Mental Disorders Fourth Edition (DSM-IV) until 2012 (18 years) was conducted with a special focus on adolescent sD. Data from 27
studies were included into this review. The results show high prevalence of sD among adolescents, with a negative impact on QoL, and provide evidence
that sD is a significant risk indicator of later MDE; therefore, individuals with sD represent good targets for preventive interventions. Our review
highlights the fact that sD is a significant health problem among adolescents indeed, and adolescents with sD could be a subgroup of youth, who need
further help to reduce their clinically significant depressive symptoms for the successful prevention of a later MDE. (PsycINFO Database Record (c)
2014 APA, all rights reserved) (journal abstract)
European Child & Adolescent Psychiatry, 22(10) : 589-
603
- Year: 2013
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any)
Brown, H. E., Pearson, N., Braithwaite, R. E., Brown, W. J., Biddle, S. J.
H.
Context: Evidence suggests chronic physical activity (PA) participation may be both protective against the onset of and beneficial for
reducing depressive symptoms. Objective: The aim of this article is to assess the impact of PA interventions on depression in children and
adolescents using meta-analysis. Data sources: Published English language studies were located from manual and computerized searches of the following
databases: PsycInfo, The Cochrane Database of Systematic Reviews and The Cochrane Central Register of Controlled Trials, Trials Register of Promoting
Health Interventions (TRoPHI; EPPI Centre), Web of Science and MEDLINE. Study selection: Studies meeting inclusion criteria (1) reported on
interventions to promote or increase PA; (2) included children aged 5 - 11 years and/or adolescents aged 12 - 19 years; (3) reported on results using
a quantitative measure of depression; (4) included a non-physical control or comparison group; and (5) were published in peer-reviewed journals
written in English, up to and including May 2011 (when the search was conducted). Data extraction: Studies were coded for methodological, participant
and study characteristics. Comprehensive Meta- Analysis version-2 software was used to compute effect sizes, with subgroup analyses to identify
moderating characteristics. Study quality was assessed using the Delphi technique. Results: Nine studies were included (n = 581); most were school-
based randomized controlled trials, randomized by individual. Studies used a variety of measurement tools to assess depressive symptoms. The summary
treatment effect was small but significant (Hedges' g = -0.26, standard error = 0.09, 95% confidence intervals = -0.43, -0.08, p = 0.004). Subgroup
analyses showed that methodological (e.g. studies with both education and PA intervention; those with a higher quality score; and less than 3 months
in duration) and participant characteristics (e.g. single-gender studies; those targeting overweight or obese groups) contributed most to the
reduction in depression. Conclusions: There was a small significant overall effect for PA on depression. More outcome-focused, high-quality trials
are required to effectively inform the implementation of programmes to reduce depressive symptoms in children and adolescents. (PsycINFO Database
Record (c) 2014 APA, all rights reserved) (journal abstract)
Sports Medicine, 43(3) : 195-206
- Year: 2013
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Carnevale, T. D.
Although the subject of adolescent depression has gained significant attention, little is
being done in the way of primary prevention. The purpose of this article is to conduct a review of the literature through the lens of the Reach,
Effectiveness, Adoption, Implementation and Maintenance framework. This review was conducted utilizing several online databases, as well as web and
hand searches. Eleven studies were identified through a process of elimination and critically appraised by a two-tiered method. Results indicated
cognitive-behavioral universal prevention interventions can be effective on decreasing depressive symptomalogy in adolescents. All reviewed studies
were conducted in the school environment by professionals and/or school staff; however, only three of the programs implemented demonstrated adoption
and sustainability. School nurses can be instrumental in bridging the gap between the planning and developing of prevention programs and translation
into the real-world school environment. (copyright) The Author(s) 2012.
Journal of School Nursing, 29(3) : 181-
195
- Year: 2013
- Problem: Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any)
Cavanagh, K., Strauss, C., Cicconi, F., Griffiths,
N., Wyper, A., Jones, F.
Objectives: There is growing evidence that mindfulness has
positive consequences for both psychological and physical health in both clinical and non-clinical populations. The potential benefits of mindfulness
underpin a range of therapeutic intervention approaches designed to increase mindfulness in both clinical and community contexts. Self-guided
mindfulness-based interventions may be a way to increase access to the benefits of mindfulness. This study explored whether a brief, online,
mindfulness-based intervention can increase mindfulness and reduce perceived stress and anxiety/depression symptoms within a student population.
Method: One hundred and four students were randomly allocated to either immediately start a two-week, self-guided, online, mindfulness-based
intervention or a wait-list control. Measures of mindfulness, perceived stress and anxiety/depression were administered before and after the
intervention period. Results: Intention to treat analysis identified significant group by time interactions for mindfulness skills, perceived stress
and anxiety/depression symptoms. Participation in the intervention was associated with significant improvements in all measured domains, where no
significant changes on these measures were found for the control group. Conclusions: This provides evidence in support of the feasibility and
effectiveness of shorter self-guided mindfulness-based interventions. The limitations and implications of this study for clinical practice are
discussed. (copyright) 2013 Elsevier Ltd.
Behaviour Research & Therapy, 51(9) : 573-
578
- Year: 2013
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Mindfulness based
therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Bernhardsdottir, J., Vilhjalmsson, R., Champion, J. D.
A study of a brief cognitive behavioral group therapy
intervention for psychologically distressed Icelandic female university students was conducted using a pre-post test quasi-experimental design with
intervention and control group conditions. Students were randomly allocated to control and intervention group conditions (n = 30). The intervention
group received four sessions of cognitive behavioral group therapy, delivered by two advanced practice psychiatric nurses. Assessment of distress
included self-reported depression and anxiety symptoms. Students in the intervention group experienced significantly lower levels of depression and
anxiety symptoms compared to the control group post-test providing preliminary evidence concerning intervention effectiveness for Icelandic students.
;
Issues in Mental Health Nursing, 34(7) : 497-
504
- Year: 2013
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Baum, E. S., Rude, S. S.
Traditional expressive writing (EW) and EW augmented by emotion-acceptance instructions (EWEA) were compared to non-emotional control
writing for their ability to forestall depression symptoms in undergraduates with high or low initial levels of depression symptomatology. EWEA
instructions encouraged participants to take a more accepting, \"emotion friendly\" approach toward expressive writing, stressing the importance of
\"staying present\" with difficult emotional experiences non-judgmentally and with openness. Writing condition interacted significantly with initial
depression such that at the 5-week posttest, EWEA was more beneficial than control writing for participants with low to mild initial depression
symptoms (CESD <17) and EW was more beneficial than control writing for participants with very low initial depression symptoms (CESD <8). But for the
EW condition, this effect was reversed such that participants in this condition with high initial depression (CESD >26) fared worse at posttest than
those in the control group. (copyright) 2012 Springer Science+Business Media, LLC.
Cognitive Therapy & Research, 37(1) : 35-42
- Year: 2013
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Creative expression: music, dance, drama, art
Beardslee, W. R., Brent, D. A., Weersing, V.
R., Clarke, G. N., Porta, G., Hollon, S. D., Gladstone, T. R. G., Gallop, R., Lynch, F. L., Iyengar, S., DeBar, L., Garber,
J.
IMPORTANCE: Adolescent offspring of depressed parents are at high risk for experiencing depressive disorders themselves.
OBJECTIVE: To determine whether the positive effects of a group cognitive-behavioral prevention (CBP) program extended to longer-term (multiyear)
follow-up. DESIGN: A 4-site randomized clinical trial with 33 months of follow-up was conducted. Recruitment of participants was from August 2003
through February 2006. SETTING: The study settings included a health maintenance organization, university medical centers, and a community mental
health center. PARTICIPANTS: Three hundred sixteen adolescent (aged 13-17 years) offspring of parents with current and/or prior depressive disorders;
adolescents had histories of depression, current elevated depressive symptoms, or both but did not currently meet criteria for a depressive disorder.
INTERVENTIONS: The CBP program consisted of 8 weekly 90-minute group sessions followed by 6 monthly continuation sessions. Adolescents were randomly
assigned to either the CBP program or usual care (UC). MAIN OUTCOMES AND MEASURES: The primary outcome was a probable or definite episode of
depression (Depression Symptom Rating score (greater-than or equal to)4) for at least 2 weeks through the month 33 follow-up evaluation. RESULTS:
Over the 33-month follow-up period, youths in the CBP condition had significantly fewer onsets of depressive episodes compared with those in UC.
Parental depression at baseline significantly moderated the intervention effect. When parents were not depressed at intake, CBP was superior to UC
(number needed to treat, 6), whereas when parents were actively depressed at baseline, average onset rates between CBP and UC were not significantly
different. A 3-way interaction among intervention, baseline parental depression, and site indicated that the impact of parental depression on
intervention effectiveness varied across sites. CONCLUSIONS AND RELEVANCE: The CBP program showed significant sustained effects compared with UC in
preventing the onset of depressive episodes in at-risk youth over a nearly 3-year period. Important next steps will be to strengthen the CBP
intervention to further enhance its preventive effects, improve intervention outcomes when parents are currently depressed, and conduct larger
implementation trials to test the broader public health impact of the CBP program for preventing depression in youth. TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT00073671.
JAMA Psychiatry, 70(11) : 1161-
1170
- Year: 2013
- Problem: Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)