Laura Mufson

Prevention of Depressive Symptoms in Adolescents: A Randomized Trial of Cognitive-Behavioral and Interpersonal Prevention Programs

This study evaluated the efficacy of 2 programs for preventing depressive symptoms in adolescents. Participants were 380 high school students randomly assigned to a cognitive-behavioral program (CB), an interpersonal psychotherapy-adolescent skills training program (IPT-AST), or a no-intervention control. The interventions involved eight 90-min weekly sessions run in small groups during wellness classes. At postintervention, students in both the CB and IPT-AST groups reported significantly lower levels of depressive symptoms than did those in the no-intervention group, controlling for baseline depression scores; the 2 intervention groups did not differ significantly from each other. The effect sizes, using Cohens d, for the CB intervention and the IPT-AST intervention were 0.37 and 0.26, respectively. Differences between control and intervention groups were largest for adolescents with high levels of depressive symptoms at baseline. For a high-risk subgroup, defined as having scored in the top 25th percentile on the baseline depression measure, the effect sizes for the CB and the IPT-AST interventions were 0.89 and 0.84, respectively. For the whole sample, sociotropy and achievement orientation moderated the effect of the interventions. Intervention effects were short term and were not maintained at 6-month follow-up.

Interpersonal Psychotherapy for Depressed Adolescents: A One-Year Naturalistic Follow-up Study

OBJECTIVE To report on a 1-year naturalistic follow-up study of 14 depressed adolescents who were treated for 3 months with interpersonal psychotherapy adapted for depressed adolescents (IPT-A). METHOD The 14 depressed adolescents were contacted approximately 1 year after completion of 3 months of IPT-A to participate in an evaluation of depressive symptomatology, social functioning, and life events. Both self-report and clinician-rated measures were administered. RESULTS Ten adolescents participated in the follow-up evaluation. Only one of them met criteria for an affective disorder. The majority of subjects reported few depressive symptoms and had maintained their improvements in social functioning since completion of treatment for depression. The life events survey suggested that the subjects had experienced a significant number of negative life events during their lifetime. There were no reported hospitalizations, pregnancies, or suicide attempts since completion of treatment, and all were attending school regularly. CONCLUSIONS Despite the limitations of a naturalistic follow-up and the small sample size, the results suggest that the adolescents maintained their state of recovery from depression until 1 year after completing treatment with IPT-A.

Interpersonal Psychotherapy for Adolescent Depression: Description of Modification and Preliminary Application

Interpersonal psychotherapy (IPT) is a brief treatment developed and tested specifically for depressed adults. This paper describes a modification for use with depressed adolescents (IPT-A) that will be tested in a controlled clinical trial. A description of IPT, its efficacy in adults, a rationale for developing IPT-A, and preliminary experience with depressed adolescents treated with IPT-A are presented. Data available on the treatment of depressed adolescents using drugs and/or psychotherapy is more than a decade behind that of adults. The specification and testing of psychotherapy will accelerate a rational, scientific basis for their treatment.

A Pilot Study of Interpersonal Psychotherapy for Preventing Excess Weight Gain in Adolescent Girls At-risk for Obesity

OBJECTIVE Interpersonal psychotherapy (IPT) is effective at reducing binge episodes and inducing weight stabilization in obese adults with binge eating disorder. METHOD We piloted the administration of IPT to girls at-risk for excess weight gain (BMI 75th-97th percentile; IPT-WG) with and without loss of control (LOC) eating. Thirty-eight girls (12-17 years) were randomized to IPT-WG or a standard-of-care health education group. RESULTS All 38 girls completed the programs and all follow-up visits through 6 months. Thirty-five of 38 returned for a complete assessment visit at 1 year. Among girls with baseline LOC (n = 20), those in IPT-WG experienced greater reductions in such episodes than girls in health education (p = .036). Regardless of LOC status, over 1 year girls in IPT-WG were less likely to increase their BMI as expected for their age and BMI percentile (p = .028). DISCUSSION IPT-WG is feasible and acceptable to adolescent girls at-risk for adult obesity and may prevent excess weight gain over 1 year.

Preventing Excessive Weight Gain in Adolescents: Interpersonal Psychotherapy for Binge Eating

The most prevalent disordered eating pattern described in overweight youth is loss of control (LOC) eating, during which individuals experience an inability to control the type or amount of food they consume. LOC eating is associated cross‐sectionally with greater adiposity in children and adolescents and seems to predispose youth to gain weight or body fat above that expected during normal growth, thus likely contributing to obesity in susceptible individuals. No prior studies have examined whether LOC eating can be decreased by interventions in children or adolescents without full‐syndrome eating disorders or whether programs reducing LOC eating prevent inappropriate weight gain attributable to LOC eating. Interpersonal psychotherapy, a form of therapy that was designed to treat depression and has been adapted for the treatment of eating disorders, has shown efficacy in reducing binge eating episodes and inducing weight stabilization among adults diagnosed with binge eating disorder. In this paper, we propose a theoretical model of excessive weight gain in adolescents at high risk for adult obesity who engage in LOC eating and associated overeating patterns. A rationale is provided for interpersonal psychotherapy as an intervention to slow the trajectory of weight gain in at‐risk youth, with the aim of preventing or ameliorating obesity in adulthood.

Preventing depression: a randomized trial of interpersonal psychotherapy-adolescent skills training†

Background: The study evaluated the efficacy of an indicated prevention program for adolescent depression. Methods: Fifty‐seven adolescents with elevated depression symptoms were randomized to receive Interpersonal Psychotherapy‐Adolescent Skills Training (IPT‐AST) or school counseling (SC). Hierarchical linear modeling examined differences in rates of change in depression symptoms and overall functioning and analysis of covariance examined mean differences between groups. Rates of depression diagnoses in the 18‐month follow‐up period were compared. Results: Adolescents in IPT‐AST reported significantly greater rates of change in depression symptoms and overall functioning than SC adolescents from baseline to post‐intervention. At post‐intervention, IPT‐AST adolescents reported significantly fewer depression symptoms and better overall functioning. During the follow‐up phase, rates of change slowed for the IPT‐AST adolescents, whereas the SC adolescents continued to show improvements. By 12‐month follow‐up, there were no significant mean differences in depression symptoms or overall functioning between the two groups. IPT‐AST adolescents reported significantly fewer depression diagnoses in the first 6 months following the intervention but by 12‐month follow‐up the difference in rates of diagnoses was no longer significant. Conclusions: IPT‐AST leads to an immediate reduction in depression symptoms and improvement in overall functioning. However, the benefits of IPT‐AST are not consistent beyond the 6‐month follow‐up, suggesting that the preventive effects of the program in its current format are limited. Future studies are needed to examine whether booster sessions lengthen the long‐term effects of IPT‐AST. Depression and Anxiety, 2010.  © 2010 Wiley‐Liss, Inc.

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A)

OBJECTIVES Recently the Food and Drug Administration (FDA) published a black box warning on the use of serotonin receptor reuptake inhibitors for adolescent depression. This situation makes the non-pharmacological therapeutic alternatives more relevant than ever before. The aim of this review is to introduce the theoretical formulation, practical application and efficacy studies of Interpersonal Psychotherapy for depressed adolescents (IPT-A). METHOD A review is offered of published papers in peer-reviewed journals, books and edited chapters using Medline and PsychInfo publications between 1966 and February 2005. RESULTS IPT-A is an evidence-based psychotherapy for depressed adolescents in both hospital-based and community outpatient settings. CONCLUSION IPT-A is a brief and efficient therapy for adolescent depression. Training programs for child psychologists and psychiatrists are recommended.

Empirically Supported Psychotherapy in Social Work Training Programs: Does the Definition of Evidence Matter?.

Objectives: A national survey finds that 62% of social work programs do not require didactic and clinical supervision in any empirically supported psychotherapy (EST). The authors report the results of analysis of national survey data using two alternative classifications of EST to determine if the results are because of the definition of EST used in the national survey. Method: Psychotherapies in the national survey are classified by three definitions of EST. Data are weighted to provide estimates generalizable to the population of social work programs. Results: The classification of EST does not have a major impact on the findings of the national survey. The national survey definition produce estimates of training in any EST in social work that fall between the two alternate definitions. Conclusions: Regardless of which definition is used, the data clearly show that the majority of social work programs offer little training in EST.

The relationship between parental diagnosis, offspring temperament and offspring psychopathology: a longitudinal analysis

BACKGROUND The study examines the relationship between child temperament and a diagnosis of anxiety and/or depression as an adult and what influence parent psychopathology may have on the temperament-diagnosis relationship. METHODS The sample consists of 151 offspring who were initially selected as being at high or low risk for major depression on the basis of the presence or absence of a lifetime history of MDD in their parents. The parents and offspring were independently interviewed with a modified version of the Schedule for Affective Disorders and Schizophrenia-Lifetime (Mannuzza et al., 1986) and completed a battery of instruments which included the Dimensions of Temperament Survey (Lerner et al., 1982). They were interviewed three times during the course of the study: Time 1, Time 2, and Time 10. RESULTS There is a similar distribution of offspring disorders in the same parental diagnostic groups. There is a significant temperamental difference between the offspring of parents with a single disorder in comparison to offspring of parents with comorbid disorder. The former is characterized by significantly greater levels of adaptability/approachability. Low attention span at Time 1 is significantly predictive of an offspring lifetime diagnosis of major depression controlling for ADHD in comparison to offspring with neither disorder. Greater irritability, higher activity level and lower adaptability at Time 1 were significantly predictive of offspring lifetime diagnosis of comorbid disorder in comparison to the MDD only group. LIMITATIONS This is a retrospective cohort study using a temperament measure from Time 1 versus lifetime diagnoses and consisting of a relatively small sample size for several of the diagnostic categories. CONCLUSIONS There appears to be a link between parental psychopathology and offspring temperament. The data also provide further support for the notion that comorbid anxiety and depression disorder is a distinct entity in comparison to MDD only and new evidence that it may be predicted by a specific underlying temperament profile.

Interpersonal Psychotherapy for depressed adolescents (IPT-A): An overview

This paper reviews the main principles of Interpersonal Psychotherapy and its adaptation for depressed adolescents (IPT-A). The work of IPT-A is put in the context of the significant problem of depression in adolescence and the other treatments and their efficacy in the treatment of adolescent depression. The paper also provides an overview of the approach and specific techniques to be used with adolescents. The efficacy and effectiveness data on IPT-A are presented briefly. IPT-A is an empirically supported psychotherapy for depressed, non-bipolar and non-psychotic adolescents. IPT-A is unique among evidence-based treatments in its demonstrated effectiveness when transported from a laboratory setting to a community setting (school-based health clinics) and delivered by community clinicians. Future studies are needed with other populations that include long-term follow-up of outcomes and are conducted by other investigator teams.