Calear, A. L., Christensen, H., Mackinnon, A., Griffiths, K. M.

Adherence to the MoodGYM program: Outcomes and predictors for an adolescent school-based population

Background: Program adherence has been associated with improved intervention outcomes for mental and physical conditions. The aim of the current study is to investigate adolescent adherence to an Internet-based depression prevention program in schools to identify the effect of adherence on outcomes and to ascertain the predictors of program adherence. Methods: Data for the current study (N=1477) was drawn from the YouthMood Project, which was conducted to test the effectiveness of the MoodGYM program in reducing and preventing symptoms of anxiety and depression in an adolescent school-based population. The current study compares intervention effects across three sub-groups: high adherers, low adherers and the wait-list control condition. Results: When compared to the control condition, participants in the high adherence intervention group reported stronger intervention effects at post-intervention and 6-month follow-up than participants in the low adherence group for anxiety (d=0.34- 0.39 vs. 0.11-0.22), and male (d=0.43-0.59 vs. 0.26-0.35) and female depression (d=0.13-0.20 vs. 0.02-0.04). No significant intervention effects were identified between the high and low adherence groups. Being in Year 9, living in a rural location and having higher pre-intervention levels of depressive symptoms or self-esteem were predictive of greater adherence to the MoodGYM program. Limitations: The program trialled is Internet-based and therefore the predictors of adherence identified may not generalise to face-to-face interventions. Conclusions: The current study provides preliminary support for the positive relationship between program adherence and outcomes in a school environment. The identification of significant predictors of adherence will assist in identifying the type of user who will engage most with an online depression prevention program. (copyright) 2012 Elsevier B.V. All rights reserved.

Journal of Affective Disorders, 147(1-3) : 338-344

Amr, M., El-Mogy, A., Shams, T., Vieira, K., Lakhan, S. E.

Efficacy of vitamin C as an adjunct to fluoxetine therapy in pediatric major depressive disorder: A randomized, double- blind, placebo-controlled pilot study

Background: Current antidepressants used to treat pediatric patients have the disadvantage of limited efficacy and potentially serious side effects. The purpose of this study was to assess the efficacy of vitamin C as an adjuvant agent in the treatment of pediatric major depressive disorder in a six-month, double-blind, placebo-controlled pilot trial. Methods. The study group (n=12) was given fluoxetine (10-20mg/day) plus vitamin C (1000mg/day) and control group (n=12) administered fluoxetine (10-20mg/day) plus placebo. The data were analyzed by ANOVA and t-test for independent samples. Results: Both groups demonstrated significantly improved scores on the Childrens Depression Rating Scale (CDRS), the Childrens Depression Inventory (CDI), and the Clinical Global Impression (CGI). ANOVA was significantly different on all clinical measurements (group effect, time effect, and interaction), with the exception of group effect and interaction for CGI. Patients treated for six months with fluoxetine and vitamin C showed a significant decrease in depressive symptoms in comparison to the fluoxetine plus placebo group as measured by the CDRS (t=11.36, P<0.0001) and CDI (t=12.27, P<0.0001), but not CGI (t=0.13, P=0.90). No serious adverse effects were observed. Conclusions: These preliminary results suggest that vitamin C may be an effective adjuvant agent in the treatment of MDD in pediatric patients. (copyright) 2013 Amr et al; licensee BioMed Central Ltd.

Nutrition Journal, 12(1) :

Araya, R., Fritsch, R., Spears, M., Rojas, G., Martinez, V., Barroilhet, S., Vohringer, P., Gunnell, D., Stallard, P., Guajardo, V., Gaete, J., Noble, S., Montgomery, A. A.

School intervention to improve mental health of students in Santiago, Chile: A randomized clinical trial

IMPORTANCE: Depression can have devastating effects unless prevented or treated early and effectively. Schools offer an excellent opportunity to intervene with adolescents presenting emotional problems. There are very few universal school-based depression interventions conducted in low- and middle-income countries. OBJECTIVE: To assess the effectiveness of a school-based, universal psychological intervention to reduce depressive symptoms among adolescents from low-income families. DESIGN, SETTING, AND PARTICIPANTS: A 2-arm, parallel, cluster, randomized clinical trialwas conducted in secondary schools in deprived socioeconomic areas of Santiago, Chile. Almost all students registered in the selected schools consented to take part in the study. A total of 2512 secondary school students from 22 schools and 66 classes participated. INTERVENTIONS: Students in the intervention arm attended 11 one-hour weekly and 2 booster classroom sessions of an intervention based on cognitive-behavioral models. The intervention was delivered by trained nonspecialists. Schools in the control arm received the standard school curriculum. MAIN OUTCOMES AND MEASURES: Scores on the self- administered Beck Depression Inventory-II at 3 months (primary) and 12 months (secondary) after completing the intervention. RESULTS: There were 1291 participants in the control arm and 1221 in the intervention arm. Primary outcome data were available for 82.1% of the participants. There was no evidence of any clinically important difference in mean depression scores between the groups (adjusted difference in mean, -0.19; 95%CI, -1.22 to 0.84) or for any of the other outcomes 3 months after completion of the intervention. No significant differences were found in any of the outcomes at 12 months. CONCLUSIONS AND RELEVANCE: A well-designed and implemented school-based intervention did not reduce depressive symptoms among socioeconomically deprived adolescents in Santiago, Chile. There is growing evidence that universal school interventions may not be sufficiently effective to reduce or prevent depressive symptoms. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN19466209.

JAMA Pediatrics, 167(11) : 1004- 1010

Alavi, A., Sharifi, B., Ghanizadeh, A., Dehbozorgi, G.

Effectiveness of cognitive-behavioral therapy in decreasing suicidal ideation and hopelessness of the adolescents with previous suicidal attempts

Objective: To evaluate the effectiveness of a Cognitive-Behavioral therapy (CBT) for suicide prevention in decreasing suicidal ideation and hopelessness in a sample of depressed 12 to 18 year-old adolescents who had at least one previous suicidal attempt.; Methods: In a clinical trial, 30 depressed adolescents who attempted suicide in the recent 3 months were selected using simple sampling method and divided randomly into intervention and wait-list control groups. Both groups received psychiatric interventions as routine. The intervention group received a 12 session (once a week) of CBT program according to the package developed by Stanley et al, including psychoeducational interventions and individual and family skills training modules. All of the patients were evaluated by Scale for Suicidal Ideation, Beck's hopelessness Inventory, and Beck's Depression Inventory before the intervention and after 12 weeks.; Findings: There were significant differences between the two groups regarding the scores of the above mentioned scales after 12 weeks. Fifty-four to 77 percent decreases in the mean scores of the used scales were observed in the invention group. There were no significant changes in the scores of the control wait-list group. The differences between pre- and post-intervention scores in the intervention group were significant.; Conclusion: CBT is an effective method in reducing suicidal ideation and hopelessness in the depressed adolescents with previous suicidal attempts.;

Iranian Journal of Pediatrics, 23(4) : 467- 472

Brillantes-Evangelista, G.

An evaluation of visual arts and poetry as therapeutic interventions with abused adolescents

The study investigates the effectiveness of visual arts and poetry as interventions in alleviating symptoms of depression and post-traumatic stress disorder (PTSD) among adolescents with history of abuse. Participants were selected from five shelters within Metro Manila based on the depression and PTSD measures. They were divided into three groups: visual arts, poetry, and control groups. Each of the intervention groups went through eight sessions of art works or poetry with specific themes and modality. Results show that participants in the intervention groups had a general decrease of scores from pretest to posttest on the depression and PTSD scales. On the other hand, many participants in the control group obtained higher posttest scores. Results also indicate that the visual arts intervention was significantly effective in alleviating symptoms of PTSD but not of depression; while poetry intervention was significantly effective in alleviating symptoms of depression it was less so in treating PTSD. Nonetheless, analysis on the activities held suggests that the visual arts and poetry interventions helped the adolescents address their issues, make sense of their lives, and create positive alternative stories for themselves. (copyright) 2012 Elsevier Inc.

Arts in Psychotherapy, 40(1) : 71-84

Han, C. K., Ssewamala, F. M., Wang, J. S. H.

Family economic empowerment and mental health among AIDS-affected children living in AIDS-impacted communities: evidence from a randomised evaluation in southwestern Uganda

OBJECTIVE: The authors examine whether an innovative family economic empowerment intervention addresses mental health functioning of AIDS-affected children in communities heavily impacted by HIV/AIDS in Uganda. METHODS: A cluster randomised controlled trial consisting of two study arms, a treatment condition (n=179) and a control condition (n=118), was used to examine the impact of the family economic empowerment intervention on children's levels of hopelessness and depression. The intervention comprised matched children savings accounts, financial management workshops and mentorship. Data were collected at baseline and 12 months post-intervention. RESULTS: Using multivariate analysis with several socioeconomic controls, the authors find that children in the treatment condition (receiving the intervention) report significant improvement in their mental health functioning. Specifically, the intervention reduces hopelessness and depression levels. On the other hand, children in the control condition (not receiving the intervention) report no changes on both measures. CONCLUSIONS: The findings indicate that children with poor mental health functioning living in communities affected by HIV/AIDS may benefit from innovative family economic empowerment interventions. As measures of mental health functioning, both hopelessness and depression have long-term negative psychosocial and developmental impacts on children. These findings have implications for public health programmes intended for long-term care and support of children living in resource poor AIDS-impacted communities.

Journal of epidemiology and community health, 67(3) : 225-230

Hazell, P., Mirzaie, M.

Tricyclic drugs for depression in children and adolescents

Background: There is a need to identify effective and safe treatments for depression in children and adolescents. While tricyclic drugs are effective in treating depression in adults, individual studies involving children and adolescents have been equivocal. Prescribing of tricyclic drugs for depression in children and adolescents is now uncommon, but an accurate estimate of their efficacy is helpful as a comparator for other drug treatments for depression in this age group. This is an update of a Cochrane review first published in 2000 and updated in 2002, 2006 and 2010. Objectives: To assess the effects of tricyclic drugs compared with placebo for depression in children and adolescents and to determine whether there are differential responses to tricyclic drugs between child and adolescent patient populations. Search methods: We conducted a search of the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) (to 12 April 2013), which includes relevant randomised controlled trials from the following bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (all years), EMBASE (1974-), MEDLINE (1950-) and PsycINFO (1967-). The bibliographies of previously published reviews and papers describing original research were cross-checked. We contacted authors of relevant abstracts in conference proceedings of the American Academy of Child and Adolescent Psychiatry, and we handsearched the Journal of the American Academy of Child and Adolescent Psychiatry (1978 to 1999). Selection criteria: Randomised controlled trials comparing the efficacy of orally administered tricyclic drugs with placebo in depressed people aged 6 to 18 years. Data collection and analysis: One of two review authors selected the trials, assessed their quality, and extracted trial and outcome data. A second review author assessed quality and checked accuracy of extracted data. Most studies reported multiple outcome measures including depression scales and clinical global impression scales. For each study, we took the best available depression measure as the index measure of depression outcome. We established predetermined criteria to assist in the ranking of measures. Where study authors reported categorical outcomes, we calculated individual and pooled risk ratios for non-improvement in treated compared with control subjects. For continuous outcomes, we calculated pooled effect sizes as the number of standard deviations by which the change in depression scores for the treatment group exceeded those for the control group. Main results: Fourteen trials (590 participants) were included. No overall difference was found for the primary outcome of response to treatment compared with placebo (risk ratio (RR) 1.07, 95% confidence interval (CI) 0.91 to 1.26; 9 trials, N = 454). There was a small reduction in depression symptoms (standardised mean difference (SMD) -0.32, 95% CI -0.59 to -0.04; 13 trials, N = 533), but the evidence was of low quality. Subgroup analyses suggested a small reduction in depression symptoms among adolescents (SMD -0.45, 95% CI -0.83 to -0.007), and negligible change among children (SMD 0.15, 95% CI -0.34 to 0.64). Treatment with a tricyclic antidepressant caused more vertigo (RR 2.76, 95% CI 1.73 to 4.43; 5 trials, N = 324), orthostatic hypotension (RR 4.86, 95% CI 1.69 to 13.97; 5 trials, N = 324), tremor (RR 5.43, 95% CI 1.64 to 17.98; 4 trials, N = 308) and dry mouth (RR 3.35, 95% CI 1.98 to 5.64; 5 trials, N = 324) than did placebo, but no differences were found for other possible adverse effects. Wide CIs and the probability of selective reporting mean that there was very low-quality evidence for adverse events. There was heterogeneity across the studies in the age of participants, treatment setting, tricyclic drug administered and outcome measures. Statistical heterogeneity was identified for reduction in depressive symptoms, but not for rates of remission or response. As such, the findings from analyses of pooled data should be interpreted with caution. We judged non of these trials to be at low risk of bias, with limited information about many aspects of risk of bias, high dropout rates, and issues regarding measurement instruments and the clinical usefulness of outcomes, which were often variously defined across trials. Authors' conclusions: Data suggest tricyclic drugs are not useful in treating depression in children. There is marginal evidence to support the use of tricyclic drugs in the treatment of depression in adolescents. Copyright © 2013 The Cochrane Collaboration.

Cochrane Database of Systematic Reviews, 2013 (6) (no pagination)(CD002317) :

Parker, B., Turner, W.

Psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused

Background: The sexual abuse of children and adolescents is a significant worldwide problem. It is associated with a wide variety of negative psychological, social and physical consequences for the victims. These effects can often be seen immediately following sexual abuse, but they may manifest later on and sometimes only in adult life. There are a number of different interventions aimed at helping children and adolescents who have been sexually abused, and psychoanalytic/psychodynamic psychotherapy has a long-established tradition of being used for such victims. In this review, we set out to find the evidence for its effectiveness specifically in children and adolescents who have been sexually abused. Objectives: To assess the effectiveness of psychoanalytic/psychodynamic psychotherapy for children and adolescents who have been sexually abused. Search methods: We searched the following databases in May 2013: CENTRAL, Ovid MEDLINE, Embase, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, Conference Proceedings Citation Index - Social Science and Humanities, LILACS and WorldCat. We also searched three trials registers, checked the reference lists of relevant studies and contacted known experts. Selection criteria: Randomised and quasi-randomised trials comparing psychoanalytic/psychodynamic psychotherapy with treatment as usual or no treatment/waiting list control for children and adolescents up to age of 18 who had experienced sexual abuse at any time prior to the intervention. Data collection and analysis: The review authors (BP and WT) independently screened search results to identify studies that met eligibility criteria. Main results: No studies were identified that met the inclusion criteria for this review. Authors' conclusions: There are no randomised and quasi-randomised trials that compare psychoanalytic/psychodynamic therapy with treatment as usual, no treatment or waiting list control for children and adolescents who have been sexually abused. As a result, we cannot draw any conclusions as to the effectiveness of psychoanalytic/psychodynamic psychotherapy for this population. This important gap emphasises the need for further research into the effectiveness of psychoanalytic/psychodynamic psychotherapy in this population. Such research should ideally be in the form of methodologically high-quality, large-scale randomised controlled trials. If these are not conducted, future systematic reviews on this subject may need to consider including other lower quality evidence in order to avoid overlooking important research. Copyright © 2013 The Cochrane Collaboration.

Cochrane Database of Systematic Reviews, 2013 (7) (no pagination)(CD008162) :

vanGinneken, N., Tharyan, P., Lewin, S., Rao, G. N., Meera, S., Pian, J., Chandrashekar, S., Patel, V.

Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries

Background: Many people with mental, neurological and substance-use disorders (MNS) do not receive health care. Non-specialist health workers (NSHWs) and other professionals with health roles (OPHRs) are a key strategy for closing the treatment gap. Objectives: To assess the effect of NSHWs and OPHRs delivering MNS interventions in primary and community health care in low- and middle-income countries. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 21 June 2012); MEDLINE, OvidSP; MEDLINE In Process & Other Non-Indexed Citations, OvidSP; EMBASE, OvidSP (searched 15 June 2012); CINAHL, EBSCOhost; PsycINFO, OvidSP (searched 18 and 19 June 2012); World Health Organization (WHO) Global Health Library (searched 29 June 2012); LILACS; the International Clinical Trials Registry Platform (WHO); OpenGrey; the metaRegister of Controlled Trials (searched 8 and 9 August 2012); Science Citation Index and Social Sciences Citation Index (ISI Web of Knowledge) (searched 2 October 2012) and reference lists, without language or date restrictions. We contacted authors for additional studies. Selection criteria: Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted-time-series studies of NSHWs/OPHR- delivered interventions in primary/community health care in low- and middle-income countries, and intended to improve outcomes in people with MNS disorders and in their carers. We defined an NSHW as any professional health worker (e.g. doctors, nurses and social workers) or lay health worker without specialised training in MNS disorders. OPHRs included people outside the health sector (only teachers in this review). Data collection and analysis: Review authors double screened, double data-extracted and assessed risk of bias using standard formats. We grouped studies with similar interventions together. Where feasible, we combined data to obtain an overall estimate of effect. Main results: The 38 included studies were from seven low- and 15 middle-income countries. Twenty-two studies used lay health workers, and most addressed depression or post-traumatic stress disorder (PTSD). The review shows that the use of NSHWs, compared with usual healthcare services: 1. may increase the number of adults who recover from depression or anxiety, or both, two to six months after treatment (prevalence of depression: risk ratio (RR) 0.30, 95% confidence interval (CI) 0.14 to 0.64; low-quality evidence); 2. may slightly reduce symptoms for mothers with perinatal depression (severity of depressive symptoms: standardised mean difference (SMD) -0.42, 95% CI -0.58 to -0.26; low-quality evidence); 3. may slightly reduce the symptoms of adults with PTSD (severity of PTSD symptoms: SMD -0.36, 95% CI -0.67 to -0.05; low-quality evidence); 4. probably slightly improves the symptoms of people with dementia (severity of behavioural symptoms: SMD -0.26, 95% CI -0.60 to 0.08; moderate-quality evidence); 5. probably improves/slightly improves the mental well-being, burden and distress of carers of people with dementia (carer burden: SMD -0.50, 95% CI -0.84 to -0.15; moderate-quality evidence); 6. may decrease the amount of alcohol consumed by people with alcohol-use disorders (drinks/drinking day in last 7 to 30 days: mean difference -1.68, 95% CI -2.79 to -0.57); low-quality evidence). It is uncertain whether lay health workers or teachers reduce PTSD symptoms among children. There were insufficient data to draw conclusions about the cost-effectiveness of using NSHWs or teachers, or about their impact on people with other MNS conditions. In addition, very few studies measured adverse effects of NSHW-led care - such effects could impact on the appropriateness and quality of care. Authors' conclusions: Overall, NSHWs and teachers have some promising benefits in improving people's outcomes for general and perinatal depression, PTSD and alcohol-use disorders, and patient- and c rer-outcomes for dementia. However, this evidence is mostly low or very low quality, and for some issues no evidence is available. Therefore, we cannot make conclusions about which specific NSHW-led interventions are more effective. Copyright © 2013 The Cochrane Collaboration.

Cochrane Database of Systematic Reviews, 2013 (11) (no pagination)(CD009149) :

Wood, R. G., McConnell, S., Moore, Q., Clarkwest, A., Hsueh, J.

The effects of building strong families: A healthy marriage and relationship skills education program for unmarried parents

Journal of Policy Analysis and Management, 31(2) : 228-252

Cox, G. R., Fisher, C. A., De Silva, S., Phelan, M., Akinwale, O. P., Simmons, M. B., Hetrick, S. E.

Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents

Background: Depressive disorders often begin during childhood or adolescence. There is a growing body of evidence supporting effective treatments during the acute phase of a depressive disorder. However, little is known about treatments for preventing relapse or recurrence of depression once an individual has achieved remission or recovery from their symptoms. Objectives: To determine the efficacy of early interventions, including psychological and pharmacological interventions, to prevent relapse or recurrence of depressive disorders in children and adolescents. Search methods: We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) (to 1 June 2011). The CCDANCTR contains reports of relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). In addition we handsearched the references of all included studies and review articles. Selection criteria: Randomised controlled trials using a psychological or pharmacological intervention, with the aim of preventing relapse or recurrence from an episode of major depressive disorder (MDD) or dysthymic disorder (DD) in children and adolescents were included. Participants were required to have been diagnosed with MDD or DD according to DSM or ICD criteria, using a standardised and validated assessment tool. Data collection and analysis: Two review authors independently assessed all trials for inclusion in the review, extracted trial and outcome data, and assessed trial quality. Results for dichotomous outcomes are expressed as odds ratio and continuous measures as mean difference or standardised mean difference. We combined results using random-effects meta-analyses, with 95% confidence intervals. We contacted lead authors of included trials and requested additional data where possible. Main results: Nine trials with 882 participants were included in the review. In five trials the outcome assessors were blind to the participants' intervention condition and in the remainder of trials it was unclear. In the majority of trials, participants were either not blind to their intervention condition, or it was unclear whether they were or not. Allocation concealment was also unclear in the majority of trials. Although all trials treated participants in an outpatient setting, the designs implemented in trials was diverse, which limits the generalisability of the results. Three trials indicated participants treated with antidepressant medication had lower relapse-recurrence rates (40.9%) compared to those treated with placebo (66.6%) during a relapse prevention phase (odds ratio (OR) 0.34; 95% confidence interval (CI) 0.18 to 0.64, P = 0.02). One trial that compared a combination of psychological therapy and medication to medication alone favoured a combination approach over medication alone, however this result did not reach statistical significance (OR 0.26; 95% CI 0.06 to 1.15). The majority of trials that involved antidepressant medication reported adverse events including suicide-related behaviours. However, there were not enough data to show which treatment approach results in the most favourable adverse event profile. Authors' conclusions: Currently, there is little evidence to conclude which type of treatment approach is most effective in preventing relapse or recurrence of depressive episodes in children and adolescents. Limited trials found that antidepressant medication reduces the chance of relapse-recurrence in the future, however, there is considerable diversity in the design of trials, making it difficult to compare outcomes across studies. Some of the research involving psychological therapies is encouraging, however at present more trials with larger sample sizes need to be conducted in order to explore this treatment approach further. Copyright © 2014 The Cochrane Collaboration.

Cochrane Database of Systematic Reviews, 2012 (11) (no pagination)(CD007504) :

Akers, A., Barton, J., Cossey, R., Gainsford, P., Griffin, M., Micklewright, D.

Visual color perception in green exercise: Positive effects on mood and perceived exertion

Positive effects of green exercise on physical and psychological wellbeing have been found, yet little is known about the underlying cognitive mechanisms responsible for such effects. The purpose of this visual sensation study was to establish the extent to which the color green, as a primitive visual feature of many natural environments, contributes to the green exercise effect. Fourteen participants performed three moderate-intensity 5-min cycling tasks (50% peak power output) while watching video footage of a rural cycling course that simulated cycling through a real natural environment. The three randomly counter-balanced video conditions were unedited (VGREEN), achromatic (VGRAY) or red filter (VRED). Lower total mood disturbance and ratings of perceived exertion were found during the VGREEN compared to VGRAY and VRED. Feelings of anger were higher after VRED compared to the other conditions. Feelings of tension, depression, fatigue, vigor, and confusion did not differ among conditions. This is the first study to show that the color green, as a primitive feature of visual sensation, has a contributory effect toward positive green exercise outcomes. (copyright) 2012 American Chemical Society.

Environmental Science & Technology, 46(16) : 8661-8666