No abstract

This study evaluated the treatment effects of Behavioral Activation (BA) on adolescents with major depressive disorder (MDD). A total of 28 adolescents (M age = 15.43) participated in this 18-week study. Semi-structured diagnostic interviews were used to determine depression status. Multiple informant methods (participants, parents, therapists, independent assessors) evaluated clinical change. Assessments were conducted at baseline, midpoint, end of treatment, and 3-and 6-month follow-ups. Results suggested that BA was an effective treatment for depressed adolescents. At the end of treatment, 90.9% of completers no longer met criteria for MDD, with 54.5% classified as fully remitted, 36.4% classified as responders, and only 9.1% classified as nonresponders. Follow-up assessments indicated that treatment effects were sustained. Conclusions and future directions are discussed.

Background Hispanics, particularly those with limited English proficiency, are underrepresented in psychiatric clinical research studies. We developed a bilingual and bicultural research clinic dedicated to the recruitment and treatment of Spanish-speaking subjects in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study, a large clinical trial of treatment-naïve subjects with major depressive disorder (MDD). Methods Demographic and clinical data derived from screening evaluations of the first 1,174 subjects presenting for participation were compared between the Spanish-speaking site (N=275) and the primary English-speaking site (N=899). Reasons for ineligibility (N=888) for the PReDICT study were tallied for each site. Results Compared to English-speakers, Spanish-speakers had a lower level of education and were more likely to be female, uninsured, and have uncontrolled medical conditions. Clinically, Spanish-speakers demonstrated greater depression severity, with higher mean symptom severity scores, and a greater number of previous suicide attempts. Among the subjects who were not randomized into the PReDICT study, Spanish-speaking subjects were more likely to have an uncontrolled medical condition or refuse participation, whereas English-speaking subjects were more likely to have bipolar disorder or a non-MDD depressive disorder. Conclusion Recruitment of Hispanic subjects with MDD is feasible and may enhance efforts at signal detection, given the higher severity of depression among Spanish-speaking participants presenting for clinical trials. Specific approaches for the recruitment and retention of Spanish-speaking participants are required.

Background Personality disorders (PDs) and major depressive disorder (MDD) are both significant public health burdens. They are frequently comorbid, and this comorbidity predicts poorer treatment outcomes and lower maintenance of treatment effects. Although there is growing consensus on the structure of personality pathology in non-depressed individuals, there is limited research on the structure of personality pathology in individuals experiencing MDD. Method As part of the Predictors of Remission in Depression to Individual and Combined Treatment (PReDICT) randomized controlled trial, 192 treatment-naïve subjects meeting DSM-IV-TR criteria for MDD completed the International Personality Disorder Examination (IPDE). Using this sample, a principal components analysis explored the factor structure of the IPDE. Results A three-factor model comprised three factors labeled “NADA” (Negative Affectivity, Disinhibition, and Antagnoism),” “Social Anxiety,” and “Antisociality.” Factor intercorrelations were small-to-moderate, and the sum score of the three factors was highly correlated (r = .94) with the total IPDE score. Limitations Personality pathology was assessed with one instrument, and sample size was smaller than ideal for factor analytic research. \ Conclusions Consistent with prior factor-analytic findings, a three-factor solution provided the most clinically and theoretically useful model. This finding lends support for the personality disorders retained in DSM-5 and some support for a model of personality pathology aligned with the personality traits found in the leading nonclinical models of personality. The obtained factors are potential moderators of clinical interventions and may serve as an avenue to personalizing treatments.