Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Depressive disorders affect 1.6% to 8.9% of children and adolescents and are a significant contributor to adolescent suicide and continued psychosocial impairment in adulthood (Angold & Costello, 2001; Weissman et al., 1999). Current practice parameters endorse two psychosocial interventions for adolescent depression: Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy for Adolescents (IPT-A) (American Academy of Child and Adolescent Psychiatry, 1998). Although the efficacy of both CBT and IPT-A have been demonstrated in numerous trials, few studies have directly compared these interventions or compared them to usual care (UC) interventions delivered in community mental health clinics (CMHC). The purpose of this study is two fold: 1) to determine if improvements in depressive symptomatology associated with individual CBT and IPT-A are significantly different, and; 2) to establish whether individual CBT and IPT-A are superior to UC offered in one CMHC sample. Methods: Empirical studies were identified through a search conducted for the period 1985-2006 using MEDLINE, PsycINFO and Social Work Abstracts. The search terms used were adolescent, child, effectiveness, depression, usual care, CMHC, CBT, and IPT-A. To be included, studies needed to evaluate the efficacy or effectiveness of 12 to 16 weeks of individual IPT-A and/or CBT and UC for depression. Additionally, studies needed to include an assessment of subjects for depressive symptomatology using standardized psychological measures. CBT and IPT-A studies were required to include a control group and random assignment. Of the studies reviewed, 7 (CBT=3; IPT-A=3; UC=1) met criteria for inclusion. The single UC study (Weersing & Weisz, 2002) included in this analysis was comprised of children and adolescents receiving a median of 11 sessions of “eclectic” psychotherapy (i.e., psychodynamic, cognitive, behavioral) in a CMHC. A benchmarking procedure (Kendall & Grove, 1988) was used to compare mean levels of adolescent depressive symptomatology at intake and post-treatment in CBT and IPT-A. Results: A total of 321 subjects with depressive symptoms were included in this analysis (CBT group, N=173; IPT group, N=81, and; UC group, N=67). All three groups had similar degrees of depressive symptoms at baseline (IPT-A, z_nt=1.70; CBT, z_nt=1.69; UC, z_nt=1.79). An independent samples t-test was conducted to compare mean differences among IPT-A and CBT. Treatment outcomes between IPT-A and CBT were not significantly different t(252)=1.64, p=.103. IPT-A and CBT were both markedly superior to UC in reducing 12 to 16 week levels of depressive symptoms (IPT-A, z_nt=.08; CBT, z_nt=.42; UC, z_nt=1.27). Conclusion: Preliminary data suggests that improvements in depressive symptomatology with CBT or IPT-A are not significantly different and are superior to UC. The inclusion of only one UC study is a clear limitation of this analysis. The extent to which IPT-A and CBT can successfully treat “real world” populations is an area for further research. Efforts are currently underway to disseminate and evaluate the effectiveness of CBT and IPT-A among community mental health clinicians at the University of Michigan and the Ministry of Children and Family Development- British Columbia, respectively.