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BACKGROUND Major depression is clinically heterogeneous. We aimed to identify classes of depressed adolescents with different symptom presentations and examine if these were differentially associated with illness severity, functioning,... more
BACKGROUND Major depression is clinically heterogeneous. We aimed to identify classes of depressed adolescents with different symptom presentations and examine if these were differentially associated with illness severity, functioning, engagement with treatment, and clinical outcomes. METHOD Baseline depression symptoms of 454 depressed adolescents (age 11-17) from the IMPACT trial were subjected to latent class analysis. We compared classes on self-reported symptoms and social impairment at baseline and follow-up and their engagement in treatment. RESULTS We identified three classes of participants which differed in the number and pattern of depression symptoms; Class 1-Severe- (37.2%)-endorsed almost all symptoms and were most functionally impaired; Class 2-Moderate- (41.9%)-endorsed fewer symptoms with high suicidal ideation, self-harm, and worthlessness; Class 3-Somatic (20.9%)-endorsed fewest symptoms, with high somatic symptoms. Groups did not differ on engagement, therapeutic alliance, or post-treatment symptom reduction. Adolescents in the severe and moderate subgroups reported symptom reductions after treatment ended, whilst those in the somatic subgroup did not. CONCLUSIONS At presentation, high somatic features in depressed adolescents, rather than severity, or impairment levels, may indicate lower liability for responding to psychological treatment.
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Research Interests: Aphasia, Community Participation, Adolescent, Dysarthria, Hepatitis C, and 15 moreFemale, Feasibility Studies, Cognitive Therapy, Cost effectiveness, HTA, Health Technology Assessment, Clinical Sciences, Aged, Great Britain, Adult, Cost Benefit Analysis, Disease Management, chronic hepatitis C, Clinical Pharmacology and Therapeutics, and Chronic hepatitis
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ObjectiveFatigue is a common and debilitating symptom of major depressive disorder (MDD). Cognitive behavioural therapy (CBT) is a recommended psychological treatment for adolescents with moderate to severe depression. This study explored... more
ObjectiveFatigue is a common and debilitating symptom of major depressive disorder (MDD). Cognitive behavioural therapy (CBT) is a recommended psychological treatment for adolescents with moderate to severe depression. This study explored the experience of CBT in fatigued adolescents with MDD.DesignA qualitative study was conducted using existing data from the qualitative arm of a large randomized control trial, the IMPACT study.MethodsData were obtained from semi‐structured interviews conducted after therapy. Participants were 18 adolescents (aged 13–18 years) who reached the clinical threshold for fatigue on diagnostic assessment before starting treatment. The data were analysed using thematic framework analysis.ResultsThree themes and seven sub‐themes were developed. Adolescents appeared to find taking part in initial sessions, engaging in ongoing sessions and completing homework challenging. Perceiving the therapist as genuine seemed to provide a sense of safety which enabled ad...
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Background: Parents are key to helping their adolescent child access psychological therapy for mental health problems such as depression. However, little is known about how parents experience their child’s psychological therapy. We aimed... more
Background: Parents are key to helping their adolescent child access psychological therapy for mental health problems such as depression. However, little is known about how parents experience their child’s psychological therapy. We aimed to explore parents’ experiences of their adolescent child’s cognitive behaviour therapy for depression. Method: We applied Thematic Analysis (TA) to qualitative data from in-depth interviews with parents ( N = 16) whose adolescent child was randomly allocated to CBT in a large multisite RCT for adolescent depression (the IMPACT trial). Interviews were conducted at the end of treatment. Results: We generated two main themes: parents’ perceptions of the adolescent’s journey through therapy, and parents’ perceptions of the therapeutic setting and process. Each included four sub-themes. Parents talked about key factors that impacted on their child’s progress through treatment, including the adolescent’s readiness for therapy and the adolescent-therapist...
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Research Interests: Psychology, Mental Health, Adolescent, Medicine, Humans, and 15 moreChild, Affective Disorders, Loneliness, Social distance, Social Isolation, Closeness, Interpersonal Relations, Feeling, Pandemics, Communicable disease control, Cross Sectional Studies, Psychology and Cognitive Sciences, CoVid, SARS-CoV-2, and Medical and Health Sciences
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Adolescence is an important period for cognitive maturation and emotional regulation, and this age group is particularly vulnerable to developing depression. Diets rich in fruits and vegetables have been associated with decreased risk of... more
Adolescence is an important period for cognitive maturation and emotional regulation, and this age group is particularly vulnerable to developing depression. Diets rich in fruits and vegetables have been associated with decreased risk of developing depressive disorders across the lifespan, maybe due to the high flavonoid content of these foods. Previously, we have shown increases in transient positive affect (PA) in both children and young adults 2 h after administration of a wild blueberry (WBB) intervention. Here, using a randomised double-blind, placebo-controlled trial, we investigated the effects of 4 weeks, daily WBB supplementation (containing about 253 mg anthocyanins) on transient and chronic mood in adolescents. Healthy 12–17-year old (n 64, thirty-five females) participants were randomly assigned to receive either a WBB or matched placebo supplementation. Depression and anxiety symptoms were assessed before and after the intervention period using the Mood and Feeling Ques...
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Objectives Adolescence represents a significant period of vulnerability for the development of depression. Whilst research has begun to explore factors associated with the development, maintenance and outcomes of adolescent depression,... more
Objectives Adolescence represents a significant period of vulnerability for the development of depression. Whilst research has begun to explore factors associated with the development, maintenance and outcomes of adolescent depression, there is little research investigating this experience from a parental viewpoint. The aim of this study was to explore mothers’ experiences of having an adolescent child with depression. Methods Eight mothers of depressed adolescents were recruited following their child’s clinical assessment at a Child and Adolescent Mental Health Service and participated in semi-structured interviews. The transcripts of the interviews were analysed using interpretative phenomenological analysis. Results The analysis revealed five interlinked superordinate themes: Finding a reason, something to blame; Living with uncertainty; Feelings of helplessness and frustration; Depression causes change; Hiding own emotions and needs. A key finding across the themes was the emoti...
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ObjectiveTo classify a cohort of depressed adolescents recruited to the UK IMPACT trial, according to trajectories of symptom change. We examined for predictors and compared the data‐driven categories of patients with a priori operational... more
ObjectiveTo classify a cohort of depressed adolescents recruited to the UK IMPACT trial, according to trajectories of symptom change. We examined for predictors and compared the data‐driven categories of patients with a priori operational definitions of treatment response.MethodSecondary data analysis using growth mixture modelling (GMM). Missing data were imputed. Trajectories of self‐reported depressive symptoms were plotted using scores taken at six nominal time points over 86 weeks from randomisation in all 465 patients.ResultsA piecewise GMM categorised patients into two classes with initially similar and subsequently distinct trajectories. Both groups had a significant decline in depressive symptoms over the first 18 weeks. Eighty‐four per cent (84.1%, n = 391) of patients were classed as ‘continued‐improvers’ with symptoms reducing over the duration of the study. A further class of 15.9% (n = 74) of patients were termed ‘halted‐improvers’ with higher baseline depression score...
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There is an increasing evidence base for the effectiveness of Behavioural Activation in treating adult depression; however, there has been little investigation of using this approach with adolescents. This article reports on the... more
There is an increasing evidence base for the effectiveness of Behavioural Activation in treating adult depression; however, there has been little investigation of using this approach with adolescents. This article reports on the adaptation of brief Behavioural Activation for Depression (BATD) for adolescents (BATD-A). A case study is reported to illustrate the brief structured approach, treatment response as indicated by routine outcome measures, and the family's view of the intervention. The adaptations made to the adult BATD manual are discussed including parental input, adapted values and activities, and engagement issues. It is hoped that following further evaluation, BATD-A could be successfully delivered as a low-intensity intervention for depression.
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Background The Mood and Feelings Questionnaire (MFQ) is a widely used screening tool for child and adolescence depression but has not been validated with young people in Thailand. This study aimed to assess the reliability and validity... more
Background The Mood and Feelings Questionnaire (MFQ) is a widely used screening tool for child and adolescence depression but has not been validated with young people in Thailand. This study aimed to assess the reliability and validity and to determine the optimal clinical cut-off of the Thai MFQ. Methods The Thai MFQ was evaluated in two parts. In part 1, The MFQ was translated and back translated into the Thai language and piloted on a small number of Thai adolescents. Then 1275 young people aged 12–18 years from three secondary schools in Thailand completed the MFQ and related measures of depression. In part 2, 138 students were invited to take part in a structured diagnostic interview (the Thai translation of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children -Present and Lifetime Version (the K-SADS-PL). Of those, 103 students were interviewed and completed the Thai MFQ a second time to assess test–retest reliability. Receiver Operating Charac...
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Aims: This paper reports on a feasibility study of delivering Brief Behavioural Activation in schools, focusing on acceptability, demand, implementation, practicality, adaptation and integration. Rationale: Depression in adolescence is a... more
Aims: This paper reports on a feasibility study of delivering Brief Behavioural Activation in schools, focusing on acceptability, demand, implementation, practicality, adaptation and integration. Rationale: Depression in adolescence is a common and serious mental health problem, with long-term negative impacts on social and academic functioning. In the UK, access to evidence based psychological treatments is limited and training and employing therapists to deliver these is expensive. Treatments are typically offered in specialist Child and Adolescent Mental Health services (CAMHs) following a General Practitioner (GP) referral, yet few depressed young people seek help from their GP or other health professionals. In the UK there are current proposals to significantly increase the role of schools in providing access to mental health treatment for children and young people but currently there is little evidence that this is acceptable, feasible or effective. Behavioural Activation (BA)...
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Epidemiological evidence suggests that consumption of flavonoids (usually via fruits and vegetables) is associated with decreased risk of developing depression. One plausible explanation for this association is the well-documented... more
Epidemiological evidence suggests that consumption of flavonoids (usually via fruits and vegetables) is associated with decreased risk of developing depression. One plausible explanation for this association is the well-documented beneficial effects of flavonoids on executive function (EF). Impaired EF is linked to cognitive processes (e.g., rumination) that maintain depression and low mood; therefore, improved EF may reduce depressionogenic cognitive processes and improve mood. Study 1: 21 young adults (18-21 years old) consumed a flavonoid-rich blueberry drink and a matched placebo in a counterbalanced cross-over design. Study 2: 50 children (7-10 years old) were randomly assigned to a flavonoid-rich blueberry drink or a matched placebo. In both studies, participants and researchers were blind to the experimental condition, and mood was assessed using the Positive and Negative Affect Schedule before and 2 h after consumption of the drinks. In both studies, the blueberry interventi...
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Magnetic resonance imaging of a randomized controlled trial investigating predictors of recovery following psychological treatment in adolescents with moderate to severe unipolar depression: study protocol for Magnetic Resonance-Improving Mood with Psychoanalytic and Cognitive Therapies (MR-IMPACT)more
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Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler's informative article raised... more
Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler's informative article raised several issues worthy of comment. His choice of the word distinctive (p. 98) in describing aspects of psychodynamic technique is open to at least two interpretations. On the one hand, distinctive can have a qualitative meaning and indicate the presence of a characteristic that is not shared. For example, a sign in the Bronx Zoo distinguishes birds from all other creatures as follows: "If it has feathers it's a bird, if it doesn't, it isn't." On the other hand, distinctive can have a quantitative meaning and indicate that one practice has more of a common element than another practice. Careful reading of Shedler's article and the article by Blagys and Hilsenroth (2000) that forms the basis of the "seven features [that] reliably distinguished psychodynamic therapies from other therapies" (Shedler, 2010, p. 98) shows that Shedler subscribes to the latter, quantitative, definition of distinctive. In other words, the seven features he presented are present in both psychodynamic therapies and the cognitive-behavioral therapies to which he compares them. For example, although Shedler did not mention it, dialectical behavior therapy explicitly focuses on six of the seven features, namely, "focus on affect and expression of emotion," "exploration of attempts to avoid distressing thoughts and feelings," "identification of recurring themes and patterns," "discussion of past experience," "focus on interpersonal relations," and "focus on the therapy relationship" (Shedler, 2010, p. 99). However, in the articles that Blagys and Hilsenroth reviewed, psychodyamic therapists engaged in more of these behaviors than did cognitive-behavioral therapists.
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PurposeCognitive Behavioural Therapy (CBT) is an evidence-based treatment for common mental health problems that affect children, young people and adults. The suitability of CBT for children has been questioned because it requires... more
PurposeCognitive Behavioural Therapy (CBT) is an evidence-based treatment for common mental health problems that affect children, young people and adults. The suitability of CBT for children has been questioned because it requires children to think about their thoughts, feelings and behaviours. The purpose of this paper is to investigate which cognitive and affective capacities predict children’s ability to relate thoughts, feelings and behaviours.Design/methodology/approachA total of 59 typically developing children aged between 8 and 11 years took part in the study. CBT skills were assessed on a story task that required children to relate the character’s thoughts to their feelings and behaviours. Children also completed an assessment of IQ, a feeling-of-knowing metamemory task that assessed metacognition, and a higher-order theory of mind task. Furthermore, parents rated their child’s empathy on the children’s empathy quotient.FindingsThe findings suggest that CBT is developmental...