Conflict with Parents in Adolescent Depression: Associations with Parental Interpersonal Problems and Depressive Symptoms.

Conflict with parents is common among depressed adolescents, interferes with treatment, and may increase risk of recurrence. Parental depressive symptoms have been shown to predict conflict with adolescent children, but an important role for different kinds of parental interpersonal problems, as described by interpersonal circumplex, is also plausible. This study compared parental interpersonal problems to parental depressive symptoms as predictors of parent-adolescent conflict reported by a depressed adolescent child, using multilevel linear regression, leave-one-out cross-validation and model stacking (N = 100 parents, 57 mothers and 43 fathers, of 60 different adolescents). Cross-validation and model stacking showed that including parental interpersonal problems contributes to accurate predictions. Parents reporting more interpersonal problems related to excessive dominance or submissiveness was associated with increased or decreased conflict, respectively. Parental depressive symptoms were found to be negatively associated with parent-adolescent conflict only in father-adolescent relationships.

Family therapy for adolescents with depression and suicidal ideation: A systematic review and meta-analysis.

OBJECTIVE: To systematically review and meta-analyze the effectiveness of family therapy compared to other active treatments for adolescents with depressive disorders or suicidal ideation. METHOD: We conducted a systematic search of The Cochrane Central Register of Controlled Trials, Medline, Embase, PsycINFO, AMED, CINAHL and Web of Science and performed two meta-analyses of outcomes for depressive symptoms and suicidal ideation. RESULTS: We screened 5,940 records and identified 10 randomized controlled studies of family therapy for depressive disorder or suicidal ideation in adolescents with an active treatment comparison group. Nine studies reported outcome measures of depressive symptoms and four reported outcome measures of suicidal ideation. The meta-analysis showed no significant difference between family therapy and active comparison treatments for end-of-treatment levels of depression. For suicidal ideation our meta-analysis showed a significant effect in favour of family therapy over comparison treatments for suicidal ideation. CONCLUSIONS: Based on the current body of research, we found that family therapy is not superior to other psychotherapies in the treatment of depressive disorder. However, family therapy leads to significantly improved outcomes for suicidal ideation, compared to other psychotherapies. The evidence for the treatment of depression is of low quality needs more research.

Associations between insecure attachment styles to parents and suicidal ideation in adolescents with depression.

OBJECTIVE: Suicidal ideation and depressive symptoms are often interrelated in clinical settings. Insecure attachment may be a risk factor for suicidal ideation in depressed adolescents. To our knowledge, this study is the first to examine the association between self-reported insecure attachment styles to both parents and suicidal ideation in a clinical sample of adolescents with depression. METHODS: Fifty clinically depressed adolescents (13-17 years, 84% girls) completed self-reported measures of suicidal ideation, depressive symptoms, and attachment style to parents. RESULTS: There was a statistically significant bivariate association between higher levels of attachment anxiety in relation to mothers and fathers and higher levels of suicidal ideation. When attachments to both parents were included in the same multivariate model, only attachment anxiety to the mother was significantly associated with the level of suicidal ideation. Self-reported depressive symptoms remained significantly associated with the level of suicidal ideation in all analyses. Younger adolescents with attachment anxiety reported higher levels of suicidal ideation than older adolescents. CONCLUSION: Conclusions about directionality and causality of associations between insecure attachment and suicidal ideation are limited due to the cross-sectional design. Our findings suggest that attachment anxiety in relation to the mother and father is associated with increased levels of suicidal ideation. Implication of these findings for treatment selection is discussed.

Effectiveness of attachment-based family therapy compared to treatment as usual for depressed adolescents in community mental health clinics.

BACKGROUND: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent's quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. OBJECTIVE: To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD. METHOD: Sixty adolescents (86.7% girls), aged 13-18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed by blinded evaluators at baseline and post-treatment with the Hamilton Depression Scale (HAMD). Self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks. Analyses were performed according to intent-to-treat principles. RESULTS: At post-treatment, clinician-rated remission rates on the HAMD (5% in ABFT and 3.33% in TAU, p = 1, OR = 1.54, Fisher's exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X2[2, N = 60] = 0.06, p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3%) of adolescents were still in the clinical range after 16 weeks of treatment. CONCLUSION: ABFT was not superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study's small sample size, missing data, and implementation challenges. Continued efforts to improve treatment for MDD in outpatient clinics are warranted. Future research should examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings. Trial registration Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013.

Efficacy of attachment-based family therapy compared to treatment as usual for suicidal ideation in adolescents with MDD.

Attachment-Based Family Therapy (ABFT) is the only empirically supported family therapy model designed to treat adolescent depression, including those at risk for suicide, and their families. ABFT aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. To study the effectiveness of ABFT compared with Treatment as Usual (TAU) in reducing suicidal ideation in clinically depressed adolescents. Sixty adolescents (86.7% girls), aged 13 to 18 years (M = 14.9), with major depressive disorder referred to two CAMHS were randomized to receive 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions according to the treatment manual. Suicidal ideation was measured with the Suicidal Ideation Questionnaire-Junior at 4, 6, 8, 10, 12, 14, and 16 weeks. Linear mixed models were fitted to test our hypothesis, time was the only factor to have a significant effect on suicidal ideation t(31.05) = -3.32, p < .01. Participants in both treatment groups reported significantly reduced suicidal ideation, but the majority were still in the clinical range after 16 weeks of treatment. ABFT was not associated with more favorable outcomes than TAU. Findings must be interpreted with caution given the study limitations.

Moderation of treatment effects by parent-adolescent conflict in a randomised controlled trial of Attachment-Based Family Therapy for adolescent depression.

BACKGROUND: Conflict with parents is frequent in adolescent depression, and has been shown to predict poor treatment outcomes. Attachment Based Family Therapy (ABFT) is a manualised treatment for adolescent depression that may be robust to parent-adolescent conflict. OBJECTIVE: To evaluate the hypothesis that parent-adolescent conflict moderates the outcome of Attachment-Based Family Therapy compared with treatment as usual. METHODS: Data were obtained from a randomised trial comparing 16 weeks of ABFT to treatment as usual, in Norwegian Child and Adolescent Mental Health Services. Sixty adolescents with moderate to severe depression and their parents were recruited. Change in Grid-Hamilton Depression Rating Scale scores from baseline to week 16 was modelled using linear mixed models, and a three-way interaction of time, treatment allocation and a continuous measure of parent-adolescent conflict was fitted to estimate a moderator effect. The moderator model was compared to simpler models using leave-one-out cross-validation. RESULTS: Better outcomes were predicted for Attachment-Based Family Therapy at high levels of mother-adolescent conflict, and for treatment as usual at low levels of mother-adolescent conflict, giving preliminary support to the moderator hypothesis. Findings for father-adolescent conflict were mixed. Cross-validation did not clearly support the moderator model over a simple effect of time, indicating that the replicability of these findings is uncertain. CONCLUSION: The results suggest that parent-adolescent conflict should be further studied as a moderator of outcome in Attachment-Based Family Therapy. The trial did not meet its recruitment target and had high attrition, limiting the conclusions that may be drawn.