Psychosocial treatments for adolescent depression

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Abstract

Major Depressive Disorders affect between 2% and 5% of adolescents at any one point in time. Depression in adolescence is associated with serious psychosocial deficits and has negative effects on functioning during young adulthood. Starting with the pioneering work of Lenore Butler and her colleagues, many psychosocial interventions have been developed and studied, with generally positive results. On the basis of a meta-analysis of the existing cognitive-behavioral therapy (CBT) studies we estimate an overall effect size of 1.27 and that 63% of patients show clinically significant improvement at the end of treatment. It seems reasonable to conclude that CBT has been demonstrated to be an effective treatment for depressed adolescents. In this article we describe these interventions, most of which are meant to addresss the problems shown by depressed adolescents. The purpose of our article is to bring this literature to the attention of clinicians in a manner which quickly and clearly summarizes the key features of the interventions to make it easy for clinicians to take advantage of this wealth of information and to avail themselves of the existing resources. We conclude by suggesting future directions and several additional areas of application for adolescent depression treatments.

Section snippets

Treatment epidemiology

Many depressed adolescents receive treatment for their depression. In our community study, 61% of community adolescents with MDD received some type of treatment (Lewinsohn, Rohde, & Seeley, 1998a). However, our impression is that most of these treatments are relatively unsystematic and brief, and do not clearly make use of recent research developments in the cognitive-behavioral treatment of depression Brent et al. 1996, Hibbs & Jensen 1996. Treatment in this population has typically been quite

Research on adolescent depression treatments

While lagging behind comparable research on adult depression treatments, the psychosocial treatment of adolescent depression has become a very active area of clinical research in recent years Brent et al. 1996, Hibbs & Jensen 1996. This field began with the pioneering work of early investigators who recognized the existence and importance of depression in young children and adolescents Carlson & Cantwell 1980, Chess et al. 1983, Kovacs 1985, Pozanski & Zrull 1970, Weller, & Weller 1984, Weller

Purpose of this article

The purpose of this article is to bring this treatment literature to the attention of clinicians in a manner that quickly and clearly summarizes the key features of these interventions to make it easy for clinicians to take advantage of this wealth of information and to avail themselves of the existing resources. Clinicians differ in their training, their theoretical orientation, and the context in which they practice. However, we believe that from the available tested interventions, most

Common treatment elements

In our review of ongoing and completed studies of the treatment of adolescent/childhood depression, we have identified the following noteworthy features common to most CBT approaches.

Summary

This article is not meant to be an exhaustive review of the research literature on treatment of depression in adolescents. Interested readers should look elsewhere for this Birmaher et al. 1996b, Hibbs & Jensen 1996, Reynolds & Johnston 1994. Instead, this article is a summary of resources for mental health providers, permitting quick comparisons of different adolescent depression treatments on key features. We hope that this information will facilitate use of CBT techniques in clinical

Future directions

We anticipate that over the next few years considerable effort will be expanded to evaluate the need for interventions for depression in very young children (e.g., Ialongo et al., 1993). The evidence that (a) depression runs in families (Hammen, 1991) and (b) that depression in young mothers can have detrimental impact of the development of their young children (Cummings & Davies, 1994) suggests potential utilization of cognitive-behavioral techniques with ever-younger children to prevent

Acknowledgements

This research was supported by National Institute of Mental Health grant nos. MH41278 and MH40501.

The authors wish to express their appreciation to Dr. David Antonuccio for his valuable comments on this article.

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