J Am Acad Child Adolesc Psychiatry. 2023 Apr 26:S0890-8567(23)00231-9. doi: 10.1016/j.jaac.2023.03.017. Online ahead of print.

ABSTRACT

This review paper summarizes the results of the IMPACT study and their implications for psychological treatment of adolescents with moderate to severe unipolar major depression. IMPACT (Improving Mood with Psychoanalytic and Cognitive Therapies) was a pragmatic, superiority randomized controlled trial, conducted in the UK, which compared the clinical and cost effectiveness of short-term psychoanalytic therapy (STPP), cognitive behavior therapy (CBT) and a brief psychosocial intervention (BPI) in reducing depression symptoms in 465 adolescents with unipolar major depression, aged 11 to 17 years. Although a clinically heterogeneous group of adolescents, some symptoms (e.g., sleep and concentration difficulties, irritability/anger) were common and disabling. The trial reported no significant difference between the three treatments in reducing depression symptoms. One-year after treatment, 84% of participants showed improvement in depressive symptoms (<50% of baseline symptoms) and improved psychosocial functioning, achieving this through different symptom reduction trajectories. Although participants attended fewer treatment sessions than planned, the three treatments were delivered with fidelity to their respective models. Ending treatment without therapist agreement occurred in 37% of cases. This was not associated with outcomes by treatment group. Adolescents emphasized the importance of the therapeutic relationship in all three treatments. Results suggest that although most adolescents respond to time-limited, structured psychological therapy, sub-groups of depressed adolescents are likely to need additional treatment or support. These include adolescents who live in complex circumstances and/or who feel their needs are not met in therapy, some who stop treatment early, and the 16-18% of adolescents who do not respond to treatment.

PMID:37121393 | DOI:10.1016/j.jaac.2023.03.017