Objective To conduct a randomized controlled trial to evaluate the preliminary efficacy of family-based interpersonal psychotherapy (FB-IPT) for treating depression in preadolescents (ages 7–12) as compared to child-centered therapy (CCT), a supportive and nondirective treatment that closely approximates the standard of care for pediatric depression in community mental health. Method Preadolescents with depression (N=42) were randomly assigned FB-IPT or CCT. Pre- and posttreatment assessments included clinician-administered measures of depression, parent- and child-reported depression and anxiety symptoms, and parent-child conflict and interpersonal impairment with peers. Results Preadolescents receiving FB-IPT had higher rates of remission (66.0% vs. 31%), a greater decrease in depressive symptoms from pre- to posttreatment, and lower depressive symptoms at posttreatment (R2=0.35, Δ R2 = 0.22; B= -8.15, SE= 2.61, t(37)= -3.13, p=0.002, F2=0.28) than did preadolescents with depression receiving CCT. Furthermore, preadolescents in the FB-IPT condition reported significant reductions in anxiety and interpersonal impairment than did preadolescents in the CCT condition. Changes in social and peer impairment from pre- to posttreatment were associated with preadolescents’ posttreatment depressive symptoms. There was a significant indirect effect for decreased social impairment accounting for the association between the FB-IPT and preadolescents’ posttreatment depressive symptoms. Conclusion Findings indicate FB-IPT is an effective treatment for preadolescent depression and support further investigation of interpersonal mechanisms by which FB-IPT may reduce preadolescent depression. Clinical trial registration information Phase II Study of Family Based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents; http://clinicaltrials.gov/show/NCT02054312; NCT02054312.

BackgroundMore research on sustainment of interventions is needed, especially return on investment (ROI) studies to determine cost-benefit trade-offs for effort required to sustain and how much is gained when effective programs are sustained. The ROSE sustainment (ROSES) study uses a sequential multiple assignment randomized (SMART) design to evaluate the effectiveness and cost-effectiveness of a stepwise approach to sustainment of the ROSE postpartum depression prevention program in 90 outpatient clinics providing prenatal care to pregnant women on public assistance. Postpartum depression (PPD) is common and can have lasting consequences. Outpatient clinics offering prenatal care are an opportune place to provide PPD prevention because most women visit while pregnant. The ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) program is a group educational intervention to prevent PPD, delivered during pregnancy. ROSE has been found to reduce cases of PPD in community prenatal settings serving low-income pregnant women.MethodsAll 90 prenatal clinics will receive enhanced implementation as usual (EIAU; initial training + tools for sustainment). At the first time at which a clinic is determined to be at risk for failure to sustain (i.e., at 3, 6, 9, 12, and 15 months), that clinic will be randomized to receive either (1) no additional implementation support (i.e., EIAU only), or (2) low-intensity coaching and feedback (LICF). If clinics receiving LICF are still at risk at subsequent assessments, they will be randomized to either (1) EIAU + LICF only, or (2) high-intensity coaching and feedback (HICF). Additional follow-up interviews will occur at 18, 24, and 30 months, but no implementation intervention will occur after 18 months. Outcomes include (1) percent sustainment of core program elements at each time point, (2) health impact (PPD rates over time at each clinic) and reach, and (3) ROI (costs and cost-effectiveness) of each sustainment step. Hypothesized mechanisms include sustainment of capacity to deliver core elements and engagement/ownership.DiscussionThis study is the first randomized trial evaluating the ROI of a stepped approach to sustainment, a critical unanswered question in implementation science. It will also advance knowledge of implementation mechanisms and clinical care for an at-risk population.Trial registrationClinicaltrials.gov, NCT03267563. Registered June 14, 2018.

Objective To examine the relationship between body mass index (BMI) in bereaved youth and nonbereaved controls 5 years after a parent’s death. The study was conducted from August 9, 2002, through December 31, 2013. Design A prospective, longitudinal, controlled study of the effects of sudden parental death on youth. Setting Bereaved families were recruited through coroner records and by advertisement. Nonbereaved families were recruited using random-digit dialing and by advertisement. Participants 123 parentally bereaved offspring were compared with 122 nonbereaved control offspring, all of whom were aged 11–25 years at the 5-year assessment. Main Exposure Bereavement status, type of parental death (accident, suicide, or sudden natural death), and history of depression in caregivers prior to parental death. Outcome Measures BMI categories (normal, overweight, and obese), according to International Obesity Task Force guidelines for adults and Centers for Disease Control and Prevention guidelines for children, and DSM-IV psychiatric disorder in offspring and caregivers before and after time of parental death. Results Bereaved offspring were more likely to have a BMI in the obese range compared to nonbereaved controls (χ22 = 7.13, P <.01). There were no differences in BMI category by death type among bereaved offspring. Caregiver history of depression was a significant correlate of offspring obesity in nonbereaved youth but had a protective effect on the BMI of bereaved youth. Conclusions Bereaved youth were more likely to be obese than nonbereaved youth 5 years after parental death, and caregiver history of depression was associated with increased risk for obesity in nonbereaved youth only. Future studies are necessary to identify mechanisms that increase risk for obesity in parentally bereaved youth.

Chapter 2 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents presents the basic principles of interpersonal psychotherapy (IPT) and of interpersonal psychotherapy for depressed adolescents (IPT-A), empirically supported interventions for depression in adults and adolescents. IPT is a structured, time-limited treatment for depression that identifies one of four interpersonal problem areas (i.e., grief, role transitions, role disputes, and interpersonal deficits) that may be related to an individual’s onset of symptoms. IPT seeks to reduce depression by helping patients improve their relationships with others through effective communication and interpersonal problem-solving. IPT-A is a developmental adaptation that is designed to treat adolescents, ages 12 to 18 years, with depression. Both models include three phases of treatment (initial, middle, and termination), as well as a large psych educational component and a focus on helping depressed patients acquire better communication and problem-solving skills.

Chapter 4 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents reviews techniques and strategies for the clinical assessment of depression in preadolescents. The therapist begins by setting a collaborative tone with preadolescent and parent to explain the goals and the format of the initial meeting. The therapist then meets with the preadolescent individually to assess symptoms of depression, anxiety, non-suicidal self-injury, and suicidality. The therapist explores the preteen’s relationships with friends and family, and school functioning to begin to develop an understanding of the interpersonal context of depressive symptoms. Next, the therapist meets with the parent individually to obtain his or her perspective on the child’s symptoms and to gather more information about relevant family circumstances and family history of depression or other psychiatric illnesses. The therapist concludes the clinical assessment by meeting with the preadolescent and the parents together to provide diagnostic impressions and develop a treatment and safety plan.