Melanie D. Bertino

Depression and suicidal behavior in adolescents: a multi-informant and multi-methods approach to diagnostic classification.

Background: Informant discrepancies have been reported between parent and adolescent measures of depressive disorders and suicidality. We aimed to examine the concordance between adolescent and parent ratings of depressive disorder using both clinical interview and questionnaire measures and assess multi-informant and multi-method approaches to classification. Method: Within the context of assessment of eligibility for a randomized clinical trial, 50 parent–adolescent pairs (mean age of adolescents = 15.0 years) were interviewed separately with a structured diagnostic interview for depression, the KID-SCID. Adolescent self-report and parent-report versions of the Strengths and Difficulties Questionnaire, the Short Mood and Feelings Questionnaire and the Depressive Experiences Questionnaire were also administered. We examined the diagnostic concordance rates of the parent vs. adolescent structured interview methods and the prediction of adolescent diagnosis via questionnaire methods. Results: Parent proxy reporting of adolescent depression and suicidal thoughts and behavior is not strongly concordant with adolescent report. Adolescent self-reported symptoms on depression scales provide a more accurate report of diagnosable adolescent depression than parent proxy reports of adolescent depressive symptoms. Adolescent self-report measures can be combined to improve the accuracy of classification. Parents tend to over report their adolescent’s depressive symptoms while under reporting their suicidal thoughts and behavior. Conclusion: Parent proxy report is clearly less reliable than the adolescent’s own report of their symptoms and subjective experiences, and could be considered inaccurate for research purposes. While parent report would still be sought clinically where an adolescent refuses to provide information, our findings suggest that parent reporting of adolescent suicidality should be interpreted with caution.

Adolescent depressive disorders and family based interventions in the family options multicenter evaluation: study protocol for a randomized controlled trial

BackgroundThere is increasing community and government recognition of the magnitude and impact of adolescent depression. Family based interventions have significant potential to address known risk factors for adolescent depression and could be an effective way of engaging adolescents in treatment. The evidence for family based treatments of adolescent depression is not well developed. The objective of this clinical trial is to determine whether a family based intervention can reduce rates of unipolar depressive disorders in adolescents, improve family functioning and engage adolescents who are reluctant to access mental health services.Methods/DesignThe Family Options study will determine whether a manualized family based intervention designed to target both individual and family based factors in adolescent depression (BEST MOOD) will be more effective in reducing unipolar depressive disorders than an active (standard practice) control condition consisting of a parenting group using supportive techniques (PAST). The study is a multicenter effectiveness randomized controlled trial. Both interventions are delivered in group format over eight weekly sessions, of two hours per session. We will recruit 160 adolescents (12 to 18 years old) and their families, randomized equally to each treatment condition. Participants will be assessed at baseline, eight weeks and 20 weeks. Assessment of eligibility and primary outcome will be conducted using the KID-SCID structured clinical interview via adolescent and parent self-report. Assessments of family mental health, functioning and therapeutic processes will also be conducted. Data will be analyzed using Multilevel Mixed Modeling accounting for time x treatment effects and random effects for group and family characteristics. This trial is currently recruiting. Challenges in design and implementation to-date are discussed. These include diagnosis and differential diagnosis of mental disorders in the context of adolescent development, non-compliance of adolescents with requirements of assessment, questionnaire completion and treatment attendance, breaking randomization, and measuring the complexity of change in the context of a family-based intervention.Trial registrationAustralia and New Zealand Clinical Trials Registry Title: engaging youth with high prevalence mental health problems using family based interventions; number 12612000398808. Prospectively registered on 10 April 2012.

A pilot study of brief psychodynamic psychotherapy for depression and anxiety in young Iranian adults: The effect of attachment style on outcomes

This pilot study examines the feasibility and efficacy of a brief psychodynamic therapy called brief empathic psychotherapy (BEP; B. Seruya, 1997, Empathic brief psychotherapy, Jason Aronson, Northvale, NJ) as a treatment for anxiety and depressive symptoms in a group of young university students in Iran. The study used an uncontrolled repeated-measures design with data collected at baseline, completion of treatment and at 3 months following completion. Participants were 20 students from an Iranian university who presented to the university’s health center with symptoms of anxiety and depression. All subjects were Persian. There were 9 men and 11 women participants, aged 19 to 24 years. Participants completed the Depression Anxiety Stress Scale, short-form (A. Sahebi, M. J. Asghari, & R. S. Salari, 2004) and the Adult Attachment Scale (AAS; C. Hazan & P. Shaver, 1987) at each time point. The recruited sample included an equal number of participants with avoidant and anxious attachment styles, based on participants’ AAS scores. Both the anxious and the avoidant groups received 12 sessions of weekly individual therapy. Substantial and statistically significant posttreatment reductions were found in anxiety and depression symptoms for both attachment styles and these reductions increased in the follow-up period. Effect sizes were very large by Cohen’s criteria. This pilot study suggests that there is preliminary support for BEP as a feasible and potentially efficacious treatment of anxiety and depression in an Iranian cultural context. The study also suggests that BEP may be equally effective for individuals with either avoidant or ambivalent attachment styles, although this finding requires further investigation. Findings are discussed in terms of different therapeutic approaches suitable for individuals with anxious versus avoidant attachment styles.