ARTICLES
A Pilot Study of Adjunctive Family Psychoeducation in Adolescent Major Depression: Feasibility and Treatment Effect

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ABSTRACT

Objective

To obtain preliminary evidence of the feasibility and effectiveness of adjunctive family psychoeducation in adolescent major depressive disorder.

Method

Participants were from outpatient clinics in Hamilton and London, Ontario. Over 24 months, 41 adolescents ages 13 through 18 years meeting major depressive disorder criteria were recruited (31 in Hamilton, 10 in London). Participants were randomized to usual treatment or usual treatment plus family psychoeducation. Outcome measures were readministered at 2 weeks, mid-treatment, posttreatment, and 3-month follow-up. Intent-to-treat analyses used χ2 and t tests and growth curve analysis. Standardized effects based on growth curve estimates were calculated for continuous outcomes.

Results

The London site was withdrawn because of poor participant retention. In Hamilton, no participant missed more than one assessment and there was good family psychoeducation adherence. Compared to controls, participants in the experimental group showed greater improvement in social functioning and adolescent-parent relationships (with medium standardized effect size >0.5), and parents reported greater satisfaction with treatment.

Conclusions

There were positive treatment effects on family and social functioning processes postulated to mediate the clinical course of major depressive disorder. The study provides support for further evaluation of family psychoeducation in this clinical population.

Section snippets

Participants

The study was undertaken with review and monitoring by the Ethics Review Committees of Hamilton Health Sciences and of the London Health Sciences Centre. Participants were drawn from outpatient clinics serving depressed adolescents in Hamilton and London, Ontario, Canada. In Hamilton, participants were from a child and adolescent mood disorders clinic that was the main provider of outpatient services for this region (population 500,000). In London, referrals were sought from four inpatient and

Sampling, Randomization, Adherence to Treatment

In London, there were 10 referrals, but because of poor adherence, baseline data were complete for four subjects and only two were followed beyond the mid-treatment assessment. Therefore, this site has been dropped from the study and the description that follows refers to the Hamilton site alone. This decision was made because none of the London participants received more than one FPE session; in this small study, including data from these subjects would have rendered the findings impossible to

DISCUSSION

The first objective was to explore the feasibility of FPE in adolescent MDD. In Hamilton, depressed adolescents were recruited from recent clinic referrals and more than half of eligible referrals agreed to participate. Once involved in the study, no families dropped out and FPE participation rates were high. The participants had moderate to severe depression, as evidenced by low CGAS scores, high rates of comorbid disorders, and a long duration of the index MDD episode. In FPE families, the

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    The study was supported by a grant from The Hospital for Sick Children Foundation, Toronto, Ontario.

    Article Plus (online only) materials for this article appear on the Journal's Web site: www.jaacap.com.

    Disclosure: Dr. Sanford received a stipend for presenting on bipolar disorder at a drug company-sponsored continuing education event in 2004 (Abbott). Dr. Steele receives research funding, participates in national advisory board meetings, receives unrestricted educational grants, or serves on speakers' bureaus for Janssen, Eli Lilly, and Shire; she is also a consultant for CMED, a division of Omnicon Canada Inc. The other authors have no financial relationships to disclose.

    Deceased

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