Kurt D. Michael

How Effective are Treatments for Child and Adolescent Depression?: a Meta-Analytic Review

We located a comprehensive sample of studies (1980-1999) on the psychosocial and pharmacological treatment of child and adolescent depression through an extensive literature search. Articles that met the inclusionary criteria were subsequently analyzed. The outcome data from 38 studies were extracted and converted into effect sizes (ESs). Comparisons of main effects, demographic, and quality of study variables were conducted. The overall findings of this meta-analysis indicate that several different psychosocial interventions for child and adolescent depression produced moderate to large treatment gains that were clinically meaningful for many afflicted youth. However, in general, the vast majority of pharmacological interventions were not effective in treating depressed children and adolescents. Nonetheless, there is recent evidence that selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine are efficacious, and will likely play an increased role in the management of affective illness in youngsters. The clinical implications and limitations of these data are discussed and suggestions for future research are provided.

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.

Group-Based Motivational Interviewing for Alcohol Use Among College Students: An Exploratory Study

How can practicing psychologists help reduce excessive alcohol consumption among college students? Over 80% of college students consume alcohol, and a significant percentage drinks excessively with myriad problems. Brief interventions based on motivational interviewing (MI) have been identified for use with college populations. The authors randomly assigned 91 freshman students to a brief, classroom-based MI intervention or an assessment control condition. At the end of the semester, MI group participants reported fewer drinks per occasion and fewer episodes of intoxication compared to controls. A classroom-based, MI-style intervention might be an efficient, sustainable, and effective means of reducing heavy drinking among college students.

Culturally Responsive School Mental Health in Rural Communities

When a reader selects a book about cultural competence or responsiveness, the characteristics that typically come to mind are race and ethnicity. The saliency of race and ethnicity is understandable given that by the year 2050 nearly 50 % of the population of the United States will be comprised of racial and ethnic minority populations (U.S. Census Bureau, 2010). However, in recent years, culture is being conceptualized more broadly to include the culture of gender, age, economic status, location (e.g., urban, rural), and community (e.g., military). Thus, it is important that school mental health (SMH) services are sensitive to these diverse cultures and contexts. The goals of this chapter are to highlight some of the unique challenges associated with SMH service provision in rural contexts and to discuss strategies for advancing culturally responsive care in rural SMH. In particular, we focus on issues related to limited access to services, interpersonal connections, and ethical challenges specific to rural contexts (i.e., competence and dual relationships). We also develop a vignette throughout the chapter to help these issues come to life. We begin with a few contextual comments.

An evaluation of an interdisciplinary rural school mental health programme in Appalachia

School mental health (SMH) programmes serve as a necessary niche within rural communities and aim to bring accessible care to youth who may otherwise go without mental health services. The following study evaluated the impact of mental health treatment provided by the Assessment, Support, and Counseling (ASC) Center, an SMH health initiative located within a high school in rural western North Carolina during the 2011–2012 school year. Participants were high school students between 14 and 18 years of age, predominately Caucasian (91.3%) and female (65.5%). Treatment was evaluated based on score change on the Youth Outcome Questionnaire using the reliable change index (RCI; Jacobson & Truax, 1991) to track changes in symptomatology. Following ASC Center treatment, 63% of the clinical sample was deemed to have improved or recovered based on the RCI. While the study did not use an experimental design (with associated cautions regarding interpretation of findings), the results suggest that a moderate dosage of cognitive-behavioural therapy provided to adolescents in the context of a rural SMH programme is associated with reliable change for the majority of youth who take part in the treatment.

Cultivating a new harvest: Rational and preliminary results from a growing interdisciplinary rural school mental health program

It is well established that a significant number of young people suffer from mental health concerns at any given time. Yet a substantial proportion of these young people do not receive adequate treatment. Thus, in order to address this gap in health care, schools are now seen as a natural setting in which to provide much-needed services to a significant number of children and adolescents who might otherwise go without intervention. The present study provides a description and formative evaluation of one such school mental health (SMH) initiative in a small rural school district in Western North Carolina. The initiative was assessed in comparison with what is known about the current landscape of SMH programs. Specific aspects of the initiative were discussed that might represent evolving trends in service provision, such as using graduate trainees as therapists, systemic implementation of regular interdisciplinary meetings and addressing the mental health needs of young people in rural areas.

Nonsuicidal Self-Injury and Suicidal Self-Injury: A Taxometric Investigation

The present research examined the latent structure of self-injurious behavior (SIB) to determine whether suicidal self-injury (SSI) and nonsuicidal self-injury (NSSI) reflect categorically distinct types of SIB or dimensional variations of the same construct. Participants consisted of 1,525 female undergraduates across several universities in the United States who completed the Survey of College Mental Health and Well Being and endorsed a history of SIB. Empirically derived indicators representing intent to die, suicidal history, frequency of SIB, severity of SIB, and number of methods of SIB were submitted to three mathematically independent taxometric procedures. Results of multiple consistency tests converged to indicate that the latent structure of SIB is continuous, with individuals who engage in SSI and NSSI differing in degree rather than kind. The implications of these dimensional findings for the theoretical conceptualization, assessment, and treatment of SIB are discussed.

Convergent Validity of the Internalizing Symptoms Scale for Children with Three Self-Report Measures of Internalizing Problems

Data that serve to support the convergent validity of the Internalizing Symptoms Scale for Children (ISSC), a new child self-report measure for assessing internalizing symptoms, are presented. The results of three studies are presented, wherein ISSC scores were correlated with three established internalizing comparison measures: the Youth Self-Report, the Childrens Depression Inventory, and the Revised Childrens Manifest Anxiety Scale. Correlations were in the desired direction and magnitude for demonstrating the convergent validity of the ISSC as a self-report measure of internalizing symptoms of children. Strong correlations were found between the ISSC and the Internalizing broad-band score of the Youth Self-Report, whereas moderate to moderately high correlations were found between the scores of the ISSC and those of the Childrens Depression Inventory and the Revised Childrens Manifest Anxiety Scale. The ISSC appears to measure the internalizing construct in children and to have promise as a research and clinical tool for use with children ages 8 to 12. Limitations of this investigation and implications for future research in this area are discussed.

Systematic Review of Management For Treatment-Resistant Depression In Adolescents

BackgroundCurrent guidelines for treatment-resistant depression in adolescents remain inadequate. This study aimed to systematically review the management of treatment-resistant depression in adolescent patients.MethodsWe conducted an electronic database search of PUBMED, EMBASE, Cochrane, Web of Science and PsycINFO for studies with adolescent treatment-resistant depression published up to January 2014. Treatment-resistant depression was defined as failure to respond to at least one course of psychological or pharmacological treatment for depression with an adequate dosage, duration, and appropriate compliance during the current illness episode. The Cochrane risk-of-bias method was used to assess the quality of randomized controlled trials. A meta-analysis of all active treatments was conducted.ResultsEight studies with 411 depressed adolescents that fit predetermined criteria investigated pharmacological treatments and psychotherapies. Six were open-label studies, and two were randomized controlled trials. The overall response rate for all active treatments investigated was 46% (95% CI 33 to 59; N = 411) with a moderately high degree of heterogeneity (I2 = 76.1%, 95% CI = 47%-86%). When only the two randomized trials were included, the overall response rate of active treatment was 53% (95% CI = 38-67; N = 347). In these randomized trials, SSRI therapy plus CBT was significantly more effective than SSRI therapy alone, while amitriptyline was not more effective than placebo.ConclusionsApproximately half of the adolescents who presented with treatment-refractory depression responded to active treatment, which suggests that practitioners should remain persistent in managing these challenging cases. The combination of antidepressant medication and psychotherapy should be recommended for adolescents who present with treatment-resistant depression.

Psychotherapy For Depression In Children And Adolescents: Study Protocol For A Systematic Review And Network Meta-Analysis

Introduction Depression is common among children and adolescents and is associated with significantly negative effects. A number of structured psychosocial treatments are administered for depression in children and adolescents; however, evidence of their effectiveness is not clear. We describe the protocol of a systematic review and network meta-analysis to evaluate the efficacy, quality of life, tolerability and acceptability of the use of psychological intervention for this young population. Methods and analysis We will search PubMed, EMBASE, CENTRAL (the Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, CINAHL, LiLACS, Dissertation Abstracts, European Association for Grey Literature Exploitation (EAGLE) and the National Technical Information Service (NTIS) from inception to July 2014. There will be no restrictions on language, publication year or publication type. Only randomised clinical trials (RCTs) with psychosocial treatments for depression in children and adolescents will be considered. The primary outcome of efficacy will be the mean overall change of the total score in continuous depression severity scales from baseline to end point. Data will be independently extracted by two reviewers. Traditional pairwise meta–analyses will be performed for studies that directly compared different treatment arms. Then we will perform a Bayesian network meta–analyses to compare the relative efficacy, quality of life, tolerability and acceptability of different psychological intervention. Subgroup analyses will be performed by the age of participants and the duration of psychotherapy, and sensitivity analyses will be conducted to assess the robustness of the findings. Ethics and dissemination No ethical issues are foreseen. The results will be published in a peer–reviewed journal and disseminated electronically and in print. The meta–analysis may be updated to inform and guide management of depression in children and adolescents. Trials registration number PROSPERO CRD42014010014.