Articles
Impact of Comorbidity on a Cognitive-Behavioral Group Treatment for Adolescent Depression

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ABSTRACT

Objective

Examine hypotheses concerning the negative impact of lifetime psychiatric comorbidity on participation in, and benefit from, a cognitive-behavioral group treatment for depression in adolescents (e.g., greater severity at intake, less recovery and more recurrence, less participation in treatment).

Method

Across two previous studies conducted between 1986 and 1993, 151 depressed adolescents (aged 14–18) were randomly assigned to one of three treatment conditions (two active treatments and a waitlist control) and followed for 24 months posttreatment. Forty percent of participants had one or more lifetime comorbid diagnoses at intake.

Results

Comorbid anxiety disorders were associated with higher depression measure scores at intake and greater decrease in depression scores by posttreatment. Overall lifetime comorbidity was unrelated to diagnostic recovery, but lifetime substance abuse/dependence was associated with slower time to recovery. Participants with attention-deficit and disruptive behavior disorders were more likely to experience depression recurrence posttreatment. Associations between comorbidity and participation or therapy process measures were nonsignificant.

Conclusions

Although some outcomes were worse for some comorbid diagnoses, the reassuring overall conclusion is that the presence of psychiatric comorbidity is generally not a contraindication for the use of structured group cognitive-behavioral interventions for depressed adolescents.

Section snippets

Participants and Procedures

Our sample consisted of 151 adolescent (aged 14–18), who were originally recruited and treated in two controlled clinical trials. In the first clinical trial (Lewinsohn et al., 1990), which occurred between 1986 and 1988, 55 adolescents who met DSM-III criteria for major depressive disorder (MDD) or dysthymia were randomly assigned to treatment condition and completed posttreatment assessment. Participants and their parents completed extensive diagnostic and psychosocial measures at intake,

H 1 : Severity at Intake

BDI scores at intake were examined as a function of TOTAL lifetime comorbidity. As shown in Table 1, adolescents with any comorbidity had significantly higher BDI average intake scores compared with adolescents with no history of comorbidity.

BDI intake scores for the three constituent comorbidity diagnoses were also compared. Statistically significant intake BDI differences were found for the participants with ANX versus those with no ANX (BDI mean [SD] = 29.8 [9.7] versus 23.2 [10.0],

DISCUSSION

Which treatments work, for which patients, with which characteristics? This often-posed question is relevant to the present investigation. Given the prevalence of psychiatric comorbidity among adolescents with mood disorders, teasing apart the relative benefits of depression-specific treatments for youths with and without comorbidity is particularly important. Although the general issues of psychiatric comorbidity has received a great deal of research attention, its specific impacts on clinical

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    This research was supported in part by NIMH awards MH41278 and MH40501 (to Dr. Lewinsohn), and MH56238 (to Dr. Rohde).

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