Article
Predictors of Treatment Efficacy in a Clinical Trial of Three Psychosocial Treatments for Adolescent Depression

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ABSTRACT

Objective

To assess the predictors of treatment outcome across treatments, as well as those associated with differential treatment response.

Method

One hundred seven adolescent outpatients, aged 13 to 18 years, with DSM-III-R major depression were randomly assigned to one of three manual-based, brief (12 to 16 sessions) psychosocial treatments: cognitive-behavioral therapy (CBT), systemic-behavioral family therapy, or nondirective supportive therapy. Those with good and poor outcomes were compared.

Result

Continued depression was predicted by clinical referral (versus via advertisement) and was in part mediated by hopelessness. Other predictors of depression were comorbid anxiety disorder and higher levels of cognitive distortion and hopelessness at intake. Achievement of clinical remission was predicted by a higher level of self-reported depression. Poorer functional status was predicted by a higher level of initial interviewer-rated depression. Comorbid anxiety and maternal depressive symptoms predicted differential treatment efficacy. CBT's performance continued to be robust with respect to nondirective supportive therapy, even in the presence of the above-noted adverse predictors.

Conclusion

Predictors of poor outcome may give clues as to how to boost treatment response. Subjects who come to treatment for clinical trials via advertisement (versus clinical referral) may show more favorable treatment responses. CBT is likely to be a robust intervention even in more complex and difficult-to-treat patients.

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    This work was supported by NIMH grants MH 46500 and 55123. The expert assistance of Patricia Nuss and jeanie Knox Houtsinger in preparation of the manuscript is appreciated. The authors gratefully acknowledge the following colleagues who aided in the conduct of this study: Robert Berchick, Carl Bonner, Mary Beth Boylan, Marlane Cully, Tom Devereaux, Terry Feinberg-Steinberg, Tom Gigliotti, Denise Harper, Susan Hogarty, Satish Iyengar, Hope Jacobs, Barbara Johnson, Ann Kolar, Maureen Maher, James Matta, Barbara McDonnell, April Miller, Elizabeth Perkins, Randy Phelps, Kim Poling, Matt Scaife, Joy Schweers, Bill Sherman, Jeannie Starzynski, Susan Wesner, and Karen Woodall.

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