In order to offer early and accessible treatment for adolescents with depression, brief and effective treatments in adolescents' everyday surroundings are needed. This randomized controlled trial studied the preliminary effectiveness, feasibility, and acceptability of interpersonal counseling (IPC) and brief psychosocial support (BPS) in school health and welfare services. The study was conducted in the 28 lower secondary schools of a large city in Southern Finland, randomized to provide either IPC or BPS. Help-seeking 12-16-year-old adolescents with mild-to-moderate depression, with and without comorbid anxiety, were included in the study. Fifty-five adolescents received either 6 weekly sessions of IPC or BPS and two followup sessions. Outcome measures included self-and clinician-rated measures of depression, global functioning, and psychological distress/well-being. To assess feasibility and acceptability of the treatments, adolescents' and counselors' treatment compliance and satisfaction with treatment were assessed. Both treatments were effective in reducing depressive disorders and improving adolescents' overall functioning and well-being. At post-treatment, in both groups, over 50% of adolescents achieved recovery based on self-report and over 70% based on observer report. Effect sizes for change were medium or large in both groups at post-treatment and increased at 6-month follow-up. A trend indicating greater baseline symptom severity among adolescents treated in the IPC-providing schools was observed. Adolescents and counselors in both groups were satisfied with the treatment, and 89% of the adolescents completed the treatments and follow-ups. This trial suggests that both IPC and BPS are feasible, acceptable, and effective treatments for mild-to-moderate depression in the school setting. In addition, IPC seems effective even if comorbid anxiety exists. Our study shows that brief, structured interventions, such as IPC and BPS, are beneficial in treating mild-to-moderate depression in school settings and can be administered by professionals working at school. Trial registration http://www.clini caltr ials.gov. Unique identifier: NCT03001245.

No abstract

Objective: We sought to explore how the process between the counsellor and patient for arriving at a case formulation may predict the outcome of manualized interpersonal counselling (IPC) for depression in primary care. Method: Qualitative content analysis and applied conversation analysis (CA) were used to achieve depth in the understanding of case formulation process among five patients who recovered and five who were unchanged according to quantitative post-treatment change rates derived from Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). Results: Interaction in the case formulations for the recovered group was generally characterized by a joint construction effort between the counsellor and the patient centred on one problem area. The ability to delimit problems to one area was associated with the patient's role disputes in social relationships. For the unchanged patients, the case formulation typically reflected unilateral construction of the problem area, and more than one problem area was selected as the focus. The problem areas in the unchanged group were associated with complicated grief or loneliness. Conclusions: The process between counsellor and patient of arriving at and agreeing on a case formulation might potentially contribute to recovery, and it deserves greater attention in training counsellors and conducting research.

No abstract