National Basic Research Program of China (973 Program).

Previous meta-analyses of psychotherapies for child and adolescent depression were limited because of the small number of trials with direct comparisons between two treatments. A network meta-analysis, a novel approach that integrates direct and indirect evidence from randomized controlled studies, was undertaken to investigate the comparative efficacy and acceptability of psychotherapies for depression in children and adolescents. Systematic searches resulted in 52 studies (total N53805) of nine psychotherapies and four control conditions. We assessed the efficacy at post-treatment and at follow-up, as well as the acceptability (all-cause discontinuation) of psychotherapies and control conditions. At post-treatment, only interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) were significantly more effective than most control conditions (standardized mean differences, SMDs ranged from 20.47 to 20.96). Also, IPT and CBT were more beneficial than play therapy. Only psychodynamic therapy and play therapy were not significantly superior to waitlist. At follow-up, IPT and CBT were significantly more effective than most control conditions (SMDs ranged from 20.26 to 21.05), although only IPT retained this superiority at both short-term and long-term follow-up. In addition, IPT and CBT were more beneficial than problem-solving therapy. Waitlist was significantly inferior to other control conditions. With regard to acceptability, IPT and problem-solving therapy had significantly fewer all-cause discontinuations than cognitive therapy and CBT (ORs ranged from 0.06 to 0.33). These data suggest that IPT and CBT should be considered as the best available psychotherapies for depression in children and adolescents. However, several alternative psychotherapies are understudied in this age group. Waitlist may inflate the effect of psychotherapies, so that psychological placebo or treatment-as-usual may be preferable as a control condition in psychotherapy trials.Key words: Psychotherapies, depression, children, adolescents, cognitive-behavioral therapy, interpersonal therapy, psychodynamic therapy, problem-solving therapy, play therapy, waitlist, network meta-analysis (World Psychiatry 2015;14:207-222) Depression in young people has significant developmental implications, and accounts for the greatest burden of disease in this age group (1). The point prevalence of depression ranges from 1.9 to 3.4% among primary school children and from 3.2 to 8.9% among adolescents, and the incidence peaks around puberty (2-4). The average duration of a depressive episode in children and adolescents is about nine months, and 70% of patients whose depression remits will subsequently develop another depressive episode within five years, which suggests a substantial continuity between child and adolescent depression and depression in adulthood (3,4). Moreover, due to the atypical presentation and the high frequency of comorbidities (5,6), many cases of child and adolescent depression remain undetected, and do not receive the treat...

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The present research examined the latent structure of self-injurious behavior (SIB) to determine whether suicidal self-injury (SSI) and nonsuicidal self-injury (NSSI) reflect categorically distinct types of SIB or dimensional variations of the same construct. Participants consisted of 1,525 female undergraduates across several universities in the United States who completed the Survey of College Mental Health and Well Being and endorsed a history of SIB. Empirically derived indicators representing intent to die, suicidal history, frequency of SIB, severity of SIB, and number of methods of SIB were submitted to three mathematically independent taxometric procedures. Results of multiple consistency tests converged to indicate that the latent structure of SIB is continuous, with individuals who engage in SSI and NSSI differing in degree rather than kind. The implications of these dimensional findings for the theoretical conceptualization, assessment, and treatment of SIB are discussed.

Attention-deficit/hyperactivity disorder (ADHD) has previously been associated with less satisfaction and success in romantic relationships. This study compares conflict resolution and problem-solving behaviors in young adult romantic couples either having one partner with ADHD combined type (C-couples), having one partner identified with ADHD inattentive type (IA-couples), or in which neither partner has an ADHD diagnosis (nondiagnosed [ND] couples). Self-reports of current and childhood ADHD symptoms corroborated diagnostic status and speaker and listener behaviors, coded via the Rapid Couples Interaction Scoring System (Gottman, 1996), were the primary dependent variables. Analyses revealed greater negativity and less positivity in C-couples' behavior during a conflict resolution task, relative to IA and ND couples, and this corresponded with couples' relational satisfaction. IA-couples emitted relational behavior that was largely similar to ND couples. Findings support that relational impairment exists in C-couples, and to some degree, contrast with previous research suggesting that individuals with predominant inattention experience greater social impairment in adulthood than those with other types of ADHD.

BackgroundCurrent guidelines for treatment-resistant depression in adolescents remain inadequate. This study aimed to systematically review the management of treatment-resistant depression in adolescent patients.MethodsWe conducted an electronic database search of PUBMED, EMBASE, Cochrane, Web of Science and PsycINFO for studies with adolescent treatment-resistant depression published up to January 2014. Treatment-resistant depression was defined as failure to respond to at least one course of psychological or pharmacological treatment for depression with an adequate dosage, duration, and appropriate compliance during the current illness episode. The Cochrane risk-of-bias method was used to assess the quality of randomized controlled trials. A meta-analysis of all active treatments was conducted.ResultsEight studies with 411 depressed adolescents that fit predetermined criteria investigated pharmacological treatments and psychotherapies. Six were open-label studies, and two were randomized controlled trials. The overall response rate for all active treatments investigated was 46% (95% CI 33 to 59; N = 411) with a moderately high degree of heterogeneity (I2 = 76.1%, 95% CI = 47%-86%). When only the two randomized trials were included, the overall response rate of active treatment was 53% (95% CI = 38-67; N = 347). In these randomized trials, SSRI therapy plus CBT was significantly more effective than SSRI therapy alone, while amitriptyline was not more effective than placebo.ConclusionsApproximately half of the adolescents who presented with treatment-refractory depression responded to active treatment, which suggests that practitioners should remain persistent in managing these challenging cases. The combination of antidepressant medication and psychotherapy should be recommended for adolescents who present with treatment-resistant depression.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0340-6) contains supplementary material, which is available to authorized users.

The availability of near real-time data from Crisis Text Line (CTL) and other technology-based platforms on crisis events provides an opportunity for targeted interventions prior to serious mental health outcomes (e.g., suicide, self-harm). This study examined the association between the release of the popular Netflix series 13 Reasons Why ( 13RW ) and CTL usage in a national sample of youth in the US. We implemented interrupted time-series, autoregressive integrated moving average (ARIMA) modeling to examine this association at a daily scale. We observed a significant but momentary rise in CTL conversation volume following the release of 13RW on April 5 and 6, 2017 followed by a significant reduction (12.7%) in conversation volume for the overall study period. This reduction in call volume was sustained for 49 days and is the most sustained reduction in conversation volume in the 365 day dataset. This unexpected trough in conversation volume is concerning in light of elevated search engine volume for terms indicating an increase in suicidal thoughts in the days following the release of the show (Ayers et al., 2017). CTL was featured by the show as a resource for viewers in the recently released Season 2, and our results highlight the reasoning and need for such promotion. Future work should explore whether the promotion of CTL in Season 2 positively impacted conversation volume, as there is a clear need to harness the power of these digital technologies to detect population-based trends in mental health and expand the reach of life saving services.

Attention-deficit/hyperactivity disorder (ADHD) is often diagnosed in childhood but persists into adulthood in many cases. This disorder, which is defined by the core symptoms of IA and HI, is also associated with impairment in academic settings, interpersonal relationships, and behavioral risk taking. While ADHD is most often treated with medication (e.g., stimulants), brief psychosocial treatments have also been shown to produce improvement in adults with ADHD, although these have not been adequately tested in college-age populations. The current study tested a brief, eight-session cognitive-behavioral protocol in a case-series design with four college students with ADHD. Participants completed measures tapping ADHD symptoms, anxiety, depression, and general impairment in academic, social, and employment domains. The findings indicate that the protocol may be useful as a short-term treatment option for college students with ADHD, warranting further study in controlled trials.