Context Major Depressive Disorder (MDD) in adolescents is common and impairing. Efficacious treatments have been developed, but little is known about longer term outcomes, including recurrence. Objectives To determine whether adolescents who responded to acute treatments, or who received the most efficacious acute treatment, would have lower recurrence rates, and to identify predictors of recovery and recurrence. Design Naturalistic follow-up study. Setting Twelve academic sites in the United States. Participants One hundred ninety-six adolescents (86 males and 110 females) randomized to one of four acute interventions (fluoxetine (FLX), cognitive behavior therapy (CBT), their combination (COMB), or placebo (PBO)) in the Treatment for Adolescents with Depression Study (TADS) were followed for five years after study entry (44.6% of the original TADS sample). Main Outcome Measure Recovery was defined as absence of clinically significant MDD symptoms on the K-SADS-P/L interview for at least eight weeks, and recurrence as a new episode of MDD following recovery. Results Almost all participants (96.4%) recovered from their index episode of MDD during the follow-up period. Recovery by two years was significantly more likely for acute treatment responders (96.2%) than for partial or non-responders (79.1%) (p < .001), but was not associated with having received the most efficacious acute treatment (COMB). Of the 189 participants who recovered, 88 (46.6%) had a recurrence. Recurrence was not predicted by full acute treatment response or by original treatment. However, full or partial responders were less likely to have a recurrence (42.9%) than were non-responders (67.6%) (p = .03). Gender predicted recurrence (57.0% among females and 32.9% among males) (p = .024). Conclusions Almost all depressed adolescents recovered. However, recurrence occurs in almost half of recovered adolescents, with higher probability in females in this age range. Further research should identify and address the vulnerabilities to recurrence that are more common among young women.

Context:The Treatment for Adolescents With Depression Study evaluates the effectiveness of fluoxetine hydrochloride therapy, cognitive behavior therapy (CBT), and their combination in adolescents with major depressive disorder.Objective: To report effectiveness outcomes across 36 weeks of randomized treatment.Design and Setting: Randomized, controlled trial conducted in 13 academic and community sites in the United States. Cognitive behavior and combination therapies were not masked, whereas administration of placebo and fluoxetine was double-blind through 12 weeks, after which treatments were unblinded. Patients assigned to placebo were treated openly after week 12, and the placebo group is not included in these analyses by design.Participants: Three hundred twenty-seven patients aged 12 to 17 years with a primary DSM-IV diagnosis of major depressive disorder.Interventions: All treatments were administered per protocol. Main Outcome Measures:The primary dependent measures rated blind to treatment status by an independent evaluator were the Children's Depression Rating ScaleRevised total score and the response rate, defined as a Clinical Global Impressions-Improvement score of much or very much improved.Results: Intention-to-treat analyses on the Children's Depression Rating Scale-Revised identified a significant time ϫ treatment interaction (P Ͻ .001). Rates of response were 73% for combination therapy, 62% for fluoxetine therapy, and 48% for CBT at week 12; 85% for combination therapy, 69% for fluoxetine therapy, and 65% for CBT at week 18; and 86% for combination therapy, 81% for fluoxetine therapy, and 81% for CBT at week 36. Suicidal ideation decreased with treatment, but less so with fluoxetine therapy than with combination therapy or CBT. Suicidal events were more common in patients receiving fluoxetine therapy (14.7%) than combination therapy (8.4%) or CBT (6.3%). Conclusions:In adolescents with moderate to severe depression, treatment with fluoxetine alone or in combination with CBT accelerates the response. Adding CBT to medication enhances the safety of medication. Taking benefits and harms into account, combined treatment appears superior to either monotherapy as a treatment for major depression in adolescents.

Objectives-We analyzed the Treatment for Adolescents with Depression Study (TADS) database to determine whether suicidal events (attempts and ideation) occurred early in treatment, could be predicted by severity of depression or other clinical characteristics, and were preceded by clinical deterioration or symptoms of increased irritability, akathisia, sleep disruption, or mania.Methods-TADS was a 36-week randomized controlled clinical trial of pharmacological and psychotherapeutic treatments involving 439 youths with major depressive disorder. Suicidal events were defined according to the Columbia Classification Algorithm of Suicidal Assessment.Results-Forty-four patients (10.0%) had at least one suicidal event (no suicide occurred). Events occurred 0.4-31.1 weeks (mean 11.9 ± 8.2) after starting TADS treatment, with no difference in event timing for patients receiving medication versus those not on medication. Severity of self-rated pre-treatment suicidal ideation (Suicidal Ideation Questionnaire for Adolescents score ≥ 31) and depressive symptoms (Reynolds Adolescent Depression Scale score ≥91), predicted occurrence of suicidal events during treatment (p<0.05). Patients with suicidal event were on average still moderately ill prior to the event (Clinical Global Impression-severity score 4.0 ± 1.3), and only minimally improved (Clinical Global Impression-improvement score 3.2 ± 1.1). Events were not preceded by increased irritability, akathisia, sleep disturbance, or manic signs. Specific inter-personal stressors were identified in 73% of cases. Of the events, 55% resulted in overnight hospitalization.Address correspondence to: Dr. Benedetto Vitiello, NIMH Room 7147, 6001 Executive Blvd., Bethesda, MD 20892-9633; e-mail: Email: bvitiell@mail.nih.gov. Financial Disclosure: Susan Silva is a consultant with Pfizer. Christopher Kratochvil receives research support from Eli Lilly, Somerset, Abbott, Shire, McNeil, and Cephalon, is a consultant for Eli Lilly, Pfizer, Cephalon, AstraZeneca, Organon, and Shire, and is on the Speaker's Bureau of Eli Lilly. Dr. Posner has been consultant and/or received research support from GlaxoSmithKline, Forest, Eisai, AstraZeneca, Johnson&Johnson, Abbott, Wyeth, Organon, Bristol-Myers Squibb, Sanofi-Aventis, Cephalon, Novartis, Shire, and UCB Pharma. John March is a consultant or scientific advisor to Pfizer, Lilly, Wyeth, GSK, Jazz, and MedAvante and holds stock in MedAvante; he receives research support from Lilly and study drug for an NIMH-funded study from Lilly and Pfizer. The other authors have no financial relationships to disclose. Conclusions-Most suicidal events occurred in the context of persistent depression and insufficient improvement, without evidence of medication-induced behavioral activation as a precursor. Severity of self-rated suicidal ideation and depressive symptoms predicted emergence of suicidality during treatment. Risk for suicidal events did not decrease after the first month of treatment, suggesting the need for careful clinical monitoring for se...

This article explores aspects of family environment and parent–child conflict that may predict or moderate response to acute treatments among depressed adolescents (N = 439) randomly assigned to fluoxetine, cognitive behavioral therapy, their combination, or placebo. Outcomes were Week 12 scores on measures of depression and global impairment. Of 20 candidate variables, one predictor emerged: Across treatments, adolescents with mothers who reported less parent–child conflict were more likely to benefit than their counterparts. When family functioning moderated outcome, adolescents who endorsed more negative environments were more likely to benefit from fluoxetine. Similarly, when moderating effects were seen on cognitive behavioral therapy conditions, they were in the direction of being less effective among teens reporting poorer family environments.

Purpose -The purpose of this paper is to empirically investigate the effects of cultural values on gender gap. Design/methodology/approach -First, by relying on the extant literature, the concepts of cultural values and gender gap are framed and variables are defined. Then, the relationships among variables are hypothesized and the theoretical model is constructed. Finally, empirical tests are conducted, the results are analyzed, and theoretical/practical implications are discussed. Findings -The results show that controlling for the effects of socio-economic variables, culture still has important implications for gender gap. More specifically, it is found that conservatism value dimension is associated with higher levels of gender gap, but autonomy cultural dimension may lead to gender equality. Research limitations/implications -This study is limited to three pairs of cultural values as proposed by Schwartz. Another major limitation of this study resides in the theoretical model and linear data analysis techniques used to investigate the relationship between culture and gender gap. Practical implications -The findings of this study could have important practical implications in many areas of social sciences such as political science, management and organizational studies, education, international law, and human resource management. Social implications -By considering the implications of cultural values, policy makers and business leaders may adopt effective strategies to promote gender equalities at the societal and organizational levels.Originality/value -While many studies have focused on some narrow aspects such as gender-based differences in labour, employment, remuneration, political representation, education, and leadership, in this study, the authors relied on a comprehensive conceptualization of the gender gap. Considering the reliability of data and the variety of countries/cultures included, the results seem very significant.