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A Clinical Psychotherapy Trial for Adolescent Depression Comparing Cognitive, Family, and Supportive Therapy
Abstract
BACKGROUND: Previous studies in nonclinical samples have shown psychosocial treatments to be efficacious in the treatment of adolescent depression, but few psychotherapy treatment studies have been conducted in clinically referred, depressed adolescents. METHODS: One hundred seven adolescent patients with DSM-III-R major depressive disorder (MDD) were randomly assigned to 1 of 3 treatments: individual cognitive behavior therapy, systemic behavior family therapy (SBFT), or individual nondirective supportive therapy (NST). Treatments were 12 to 16 sessions provided in as many weeks. Intent-to-treat analyses were conducted using all follow-up data. RESULTS: Of the 107 patients enrolled in the study, 78 (72.9%) completed the study, 4 (3.7%) never initiated treatment, 10 (9.3%) had exclusionary criteria that were undetected at entry, 8 (7.5%) dropped out, and 7 (6.5%) were removed for clinical reasons. Cognitive behavior therapy showed a lower rate of MDD at the end of treatment compared with NST (17.1% vs 42.4%; P = .02), and resulted in a higher rate of remission (64.7%, defined as absence of MDD and at least 3 consecutive Beck Depression Inventory scores < 9) than SBFT (37.9%; P = .03) or NST (39.4%; p = .04). Cognitive behavior therapy resulted in more rapid relief in interviewer-rated (vs both treatments, P = .03) and self-reported depression (vs SBFT, P = .02). All 3 treatments showed significant and similar reductions in suicidality and functional impairment. Parents' views of the credibility of cognitive behavior therapy improved compared with parents' views of both SBFT (P = .01) and NST (P = .05). CONCLUSIONS: Cognitive behavior therapy is more efficacious than SBFT or NST for adolescent MDD in clinical settings, resulting in more rapid and complete treatment response.
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“Trials comparing CBT to either family therapy or supportive psychotherapy show that it is better at both improving mood and achieving remission.9”
From Computerised cognitive behaviour therapy for depression in adolescents: Study protocol for a feasibility randomised controlled trial (2014) · cites this paper as [9]
In the citing paper
“Other bias | High risk | Authors state that an ITT analysis was carried out on all 107 participants in the Brent 1997 publication, however in the Renaud 1998 publication it states that analysis was carried out on 100 randomised participants (see ITT analysis de- tails above)”
From Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents (2012) · cites this paper as Brent 1997 publication
In the citing paper
“Random sequence genera- tion (selection bias) | Low risk |”
From Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents (2012) · cites this paper as Brent 1997 publication
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“…(Tompson et al, this issue; for review, Diamond & Josephson, 2005), it is also important to note that there have been negative results where family treatments performed poorly or added little to CBT or other approaches (Brent et al., 1997; Clarke et al., 1999; for review, Cottrell & Boston, 2002).”
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“This response rate of nearly 60% to BT is commensurate with that found in most clinical trials of CBT for youth depression (Brent et al., 1997; Eckshtain & Gaynor, 2012; The Treatment for Adolescents With Depression Study Team, 2004) even though we controlled for those showing a rapid early response.”
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“In addition, while several large-scale randomized trials have been conducted with depressed adolescents (e.g., Brent et al., 1997; Clarke, Rohde, Lewinsohn, Hops, & Seeley, 1999; Rohde, Clarke, Mace, Jorgensen, & Seeley, 2004; The Treatment for Adolescents with Depression Study Team [TADS], 2004),…”
BackgroundTargeting Family Risk Factors in the Context of Treating Youth Depression: A Survey of Psychologists
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“Moreover, in recommending other psychological treatments if CBT is not efficacious in mild-to-moderate depression, the guidelines do not appear to make it sufficiently clear that the existing evidence favours CBT over other therapies such as family or supportive work (Brent et al, 1997).”
BackgroundA guide to what works for depression in young people
Purcell, R., Ryan, S., Scanlan, F., Morgan, A. J., Callahan, P. M., Allen, N., & Jorm, A. F. (2010) · Swinburne figshare (Swinburne University of Technology) · Cited by 9
Evidence‐based psychiatric practice: doctrine or trap?
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Horwitz, S. M., & Hoagwood, K. (2002) · Mental Health Services Research · doi:10.1023/a:1020972817525 · Cited by 9
“Given that suicide is a leading cause of death in adolescents, wide scale testing and dissemination of these interventions is a high priority (Brent et al., 1997; Shaffer et al., 1983).”
BackgroundChildhood Depression: Diagnosis and Treatment Strategies in General Pediatrics
Shoaf, T., Emslie, G. J., & Mayes, T. L. (2001) · Pediatric Annals · doi:10.3928/0090-4481-20010301-06 · Cited by 9
Efficacy of an Internet-based Intervention Targeted to Adolescents with Subthreshold Depression
Makarushka, M. M. (2011) · Scholars' Bank (University of Oregon) · Cited by 9
A multisite psychotherapy and medication trial for depressed adolescents: background and benefits
Kratochvil, C. J., Simons, A., Vitiello, B., Walkup, J., Emslie, G., Rosenberg, D., & March, J. S. (2005) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(05)80021-5 · Cited by 9
Kurzweil, S. (2023) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.20220025 · Cited by 11
Koslow, S. H., Ruiz, P., & Nemeroff, C. B. (2014) · Cambridge University Press eBooks · doi:10.1017/cbo9781139519502.028 · Cited by 8
Depressive Symptomatology in Greek Preadolescents: The Role of Parenting Style Perceptions
Kleftaras, G., & Αλεξόπουλος, Δ. Α. (2015) · Marriage & Family Review · doi:10.1080/01494929.2015.1060286 · Cited by 9
“Based on research findings, the overall prevalence estimate ranges from 1% to 6% for severe depressive symptomatology (Brent et al., 1997; Ivarsson, Svalander, & Litlere, 2006; Oldehinkel, Veenstra, Ormel, de Winter, & Verhulst, 2006) and from 4% to 35% for low or mild depressive symptomatology…”
BackgroundAdolescent outpatients with depressive disorders: Clinical characteristics and treatment received
Pelkonen, M. U. I., & MARTTUNEN, M. J. (2005) · Nordic Journal of Psychiatry · doi:10.1080/08039480510022981 · Cited by 8
“The patients were consecutively referred depressed adolescents, and were more severely impaired in terms of psychosocial functioning and suicide attempts than, for example, subjects in recent psychotherapy trials (15, 34).”
BackgroundMizuta, A., Noda, T., Nakamura, M., Tatsumi, A., & Ojima, T. (2016) · Journal of School Health · doi:10.1111/josh.12365 · Cited by 8
Selective serotonin-reuptake inhibitors and suicidal ideation and behavior in children
Caballero, J., & Nahata, M. C. (2005) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/62.8.864 · Cited by 8
Treatment of depressive illness among children and adolescents in the United States
Skaer, T. L., Robison, L. M., Sclar, D. A., & Galin, R. S. (2000) · Current Therapeutic Research · doi:10.1016/s0011-393x(00)80049-1 · Cited by 8
Strober, M. A., Pataki, C. S., & DeAntonio, M. (1998) · Journal of Affective Disorders · doi:10.1016/s0165-0327(98)00037-8 · Cited by 8
Harrington, R. (2004) · Cambridge University Press eBooks · doi:10.1017/cbo9780511543845.016 · Cited by 8
Metadata
- Authors
- Brent, D. A.
- Corresponding author
- Brent, David A.
- ORCID
- Brent, David A.
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 1997-09-01
- Volume
- 54
- Issue
- 9
- Pages
- 877
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W1993925129
- Cited by
- 753
- References
- 58
- Citations by year
- 2025: 4 · 2024: 12 · 2023: 12 · 2022: 12 · 2021: 24 · 2020: 12 · 2019: 9 · 2018: 17 · 2017: 11 · 2016: 16 · 2015: 32 · 2014: 31 · 2013: 22 · 2012: 35
- FWCI
- 35.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh046500-07)
- National Institute of Mental Health (MH 46500)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- adolescent depression, major depressive disorder, cognitive behavioral therapy, supportive therapy, family therapy, treatment efficacy, remission, suicidality, functional disability, parental attitudes
- MeSH terms
- Adolescent, Age Factors, Attitude to Health, Depressive Disorder, Family Therapy, Female, Humans, Male, Person-Centered Psychotherapy, Parents, Patient Dropouts, Social Class, Suicide, Comorbidity, Cognitive Behavioral Therapy, Treatment Outcome
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