Interpersonal Counseling (IPC) for Treatment of Depression in Adolescents: Implementation and Effectiveness Study in School Health Care
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 120
- 试验地点
- 2
- 主要终点
- Change from Baseline in Adolescent Depression Rating Scale after six scheduled treatment sessions
研究概览
简要总结
The aim of this cluster randomized trial is to investigate whether the brief, 1+6 session psychosocial intervention, Interpersonal Counseling (IPC) is more effective than standard professional treatment (ST) in the treatment of mild or moderate depression among 12 to 17-year-old adolescents in services provided by school health care and counseling professionals (school nurses, school psychologists and school social workers). The clients are identified from the pool of adolescents routinely seen in school health care and counseling services.
A total of 54 school nurses, social workers, and psychologists from all public secondary schools in the standard education system of City of Espoo, Finland will be trained in IPC in a three-day workshop in two waves. Each school (plus the one primary care level health care unit for adolescents in Espoo) is represented by 1-3 trial IPC counselors. In the first wave the schools are cluster randomized to provide either A) 1+6 sessions of IPC, or B) 1+6 sessions of standard treatment (ST), which consists of psychosocial work as guided by the workers' own standard professional principles and methods. The workers randomized to deliver IPC get the IPC training immediately. In the second wave those who delivered ST in the first wave will be trained in IPC. The data for this trial will be collected from the first wave. The data collection period is one school year plus follow-up of clients after 3 and 6 months.
The clients are adolescents who have either self-referred themselves, are referred by other school personnel, or by parents to the services offered in the school due to emotional symptoms in the school year 2016 -2017 in the participating schools. They are screened with the BDI at the initial visit to identify depressive symptoms. A diagnostic interview will be administered to those exceeding a clinical cutoff. Main inclusion criterion is DSM-5 depressive disorder of either mild or moderate severity. Those with current harmful alcohol use, acute suicidal ideation or behavior, severe depression or anxiety disorder, psychotic symptoms or very low global level of functioning are excluded and offered other treatment.
The clients will complete self-report questionnaires (BDI) as outcome measures. Their level of depression symptoms will also be assessed with ADRS scale and their level of global psychosocial functioning with the CGAS by the project IPC counselors / ST providers. Moreover, the clients will complete the Young Person's Clinical Outcomes for Routine Evaluation (YP-CORE) as a measure of global symptomatology after each session. A follow-up interview at 3 months and 6 months after treatment termination will be arranged. The K-SADS-PL will be used for diagnostic evaluation, the ADRS and the C-GAS to assess level of depressive symptoms and global functioning, and the adolescent completes both the BDI and YP-CORE as self-reports of symptomatology.
详细描述
Background:
The incidence of depression increases in adolescence. Depression is one of the most common and clinically mental health disorder in this age group. In total, 5-10 % of adolescents experience depression episodes, and among 1-2% of the age group depressive symptoms are persistent and long-term (Costello et al., 2011; Marttunen & Karlsson, 2010). Depression causes significant distress and functional impairment to those affected by it. Furthermore, depressions symptoms with onset in adolescents tend to predict symptom continuation or new episodes in adulthood, and they associate with increased risk of suicide, hospital treatment, psychosocial problems and concurrent anxiety, substance use, and conduct disorders (Weissman et al., 1999; Marttunen et al., 2015).
However, only a minority of adolescents with mental health disorders seek help. Possible reasons include lack of recognition of symptoms, stigma related to being referred to mental health services, and lack of expertise in treating hold mental health resources. Research also shows that intervening in the early phases of symptom expression is important (Horowitz & Garber, 2006) and that the longer the duration of a depressive episode is the poorer the outcome to even an evidence based treatment is (Curry et al., 2006). Thus, many factors support developing brief and effective interventions for treating mild/moderate depression in the immediate surroundings of adolescents, e.g. schools.
Interpersonal psychotherapy for adolescents (IPT-A; see Mufson, 2004a) is one of the evidence -based treatments for adolescent depression (Zhou et al., 2015). It is a 12-session treatment, which focuses in the interpersonal relationships of adolescents and their significance in relation to symptoms of depression. It has been shown to be effective in school-based mental health clinics (Mufson et al., 2004b). IPT-A is a 12-session treatment focusing on problems on one problematic area in interpersonal relationships (grief, interpersonal/role disputes, role transition, or interpersonal deficits/social isolation).
A short form of IPT, the one plus six-session interpersonal counseling (IPC) has been developed to address needs of depressive individuals in contexts where a brief intervention offers advantages (Weissmann et al., 2014). It has been shown to be effective when treating depressive symptoms of adults in primary level of care (Kontunen et al., 2015; Menchetti ym. 2014). IPC can be provided by healthcare workers and counseling personnel without mental health training (Weissman et al., 2014). IPC may also be suited especially well for adolescents with milder symptoms depression. Due to its brevity it may be especially suitable to be implemented in schools, where barriers formed by school curriculum and multiple tasks required of the school health care workers must be taken in account.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 12 Years 至 17 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Clinical diagnosis of DSM-5 Depressive Disorder (severity mild or moderate)
排除标准
- •current harmful alcohol use
- •acute suicidal ideation or behavior
- •severe depressive disorder
- •severe anxiety disorder
- •psychotic symptoms
- •very low global level of functioning
结局指标
主要结局
Change from Baseline in Adolescent Depression Rating Scale after six scheduled treatment sessions
时间窗: 6 weeks
Change from Baseline in Children's Global Assessment of Functioning after six scheduled treatment sessions
时间窗: 6 weeks
Change from Baseline in Beck Depression Inventory after six scheduled treatment sessions
时间窗: 6 weeks
Change from Baseline in Young Person's Clinical Outcomes for Routine Evaluation after six scheduled treatment sessions
时间窗: one, two, three, four, five, and six weeks
次要结局
- Change from Baseline in diagnostic status regarding depressive disorder assessed with Kiddie-Sads-Present and Lifetime Version 3 months after treatment termination(3 months after treatment termination)
- Change from Baseline in diagnostic status regarding depressive disorder assessed with Kiddie-Sads-Present and Lifetime Version 6 months after treatment termination(6 months after treatment termination)
- Change from Baseline in Adolescent Depression Rating Scale 3 months after treatment termination(3 months after treatment termination)
- Change from Baseline in Adolescent Depression Rating Scale 6 months after treatment termination(6 months after treatment termination)
- Change from Baseline in Beck Depression Inventory 3 months after treatment termination(3 months after treatment termination)
- Change from Baseline in Beck Depression Inventory 6 months after treatment termination(6 months after treatment termination)
- Change from Baseline in Children's Global Assessment Scale 3 months after treatment termination(3 months after treatment termination)
- Change from Baseline in Children's Global Assessment Scale 6 months after treatment termination(6 months after treatment termination)
- Change from Baseline in Young Person's Clinical Outcomes for Routine Evaluation 3 months after treatment termination(3 months after treatment termination)
- Change from Baseline in Young Person's Clinical Outcomes for Routine Evaluation 6 months after treatment termination(6 months after treatment termination)
研究者
Dr. Klaus Ranta
Head of Department, Department of Adolescent Psychiatry, Helsinki University Central Hospital
Hospital District of Helsinki and Uusimaa