Clinical and Psychosocial Predictors of Suicide Attempts and Nonsuicidal Self-Injury in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT)

Wilkinson, Paul; Kelvin, Raphael; Roberts, Chris; Dubicka, Bernadka; Goodyer, Ian

doi:10.1176/appi.ajp.2010.10050718

Cited by 517 publications

(434 citation statements)

References 26 publications

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“…One such approach, Attachment Based Family Therapy (ABFT) (Diamond, Reis, Diamond, Siqueland, & Isaacs, 2002), which focuses on improving communication and support in child‐parent relationships, has been shown to be effective among adolescents at reducing both depression and suicidality (Diamond et al., 2010). As depression and suicidality are both closely related to NSSI (Wilkinson et al., 2011), the efficacy of ABFT on reducing the risk of NSSI seems theoretically promising and should be investigated with larger randomized control trials.…”

Section: Discussionmentioning

confidence: 99%

Poor family functioning mediates the link between childhood adversity and adolescent nonsuicidal self‐injury

Cassels

Harmelen

Neufeld

et al. 2018

Child Psychology Psychiatry

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BackgroundNon‐suicidal self‐injury (NSSI) is a common harmful behavior during adolescence. Exposure to childhood family adversity (CFA) is associated with subsequent emergence of NSSI during adolescence. However, the pathways through which this early environmental risk may operate are not clear.AimsWe tested four alternative hypotheses to explain the association between CFA and adolescent‐onset NSSI.MethodsA community sample of n = 933 fourteen year olds with no history of NSSI were followed up for 3 years.ResultsPoor family functioning at age 14 mediated the association between CFA before age 5 and subsequent onset of NSSI between 14 and 17 years.ConclusionsThe findings support the cumulative suboptimal environmental hazards (proximal family relationships as a mediator) hypothesis. Improving the family environment at age 14 may mitigate the effects of CFA on adolescent onset of NSSI.

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Section: Discussionmentioning

confidence: 99%

Poor family functioning mediates the link between childhood adversity and adolescent nonsuicidal self‐injury

Cassels

Harmelen

Neufeld

et al. 2018

Child Psychology Psychiatry

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“…115 Furthermore, the presence of non-suicidal self-injury at randomisation may be a predictor DISCUSSION NIHR Journals Library www.journalslibrary.nihr.ac.uk of increased suicidality and, therefore, a risk for treatment non-response. 116 These observations require replication and further investigation than they have received hitherto as identifying patients unlikely to respond to available therapies is an important clinical priority. The process of recovery may also be of interest.…”

Section: Brief Psychosocial Interventionmentioning

confidence: 99%

Cognitive–behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial

Goodyer

Reynolds

Barrett

et al. 2017

Health Technol Assess

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BackgroundAlthough there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years.ObjectiveTo determine whether or not either of two specialist psychological treatments, cognitive–behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief psychosocial intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment.DesignObserver-blind, parallel-group, pragmatic superiority randomised controlled trial.SettingA total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London.ParticipantsAdolescents aged 11–17 years withDiagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses.InterventionsIn total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up.Main outcome measuresMean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation.ResultsThere were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = –0.578, 95% confidence interval (CI) –2.948 to 4.104;p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = –1.898, 95% CI –4.922 to 1.126;p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49–52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome.ConclusionsThe three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings.LimitationsNeither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data.Trial registrationCurrent Controlled Trials ISRCTN83033550.FundingThis project was funded by the National Institute for Heath Research Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 12. See the National Institute for Heath Research Journals Library website for further project information. Funding was also provided by the Department of Health. The funders had no role in the study design, patient recruitment, data collection, analysis or writing of the study, any aspect pertinent to the study or the decision to submit toThe Lancet.

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“…Other studies are needed to replicate this finding. There is likewise a need for future studies in this area to also consider other important factors such as family functioning (Wilkinson et al 2011) and peer influences (Prinstein et al 2010) to more fully determine whether sleep problems have a unique effect on adolescents' NSSI, suicidal ideation, and suicidal behaviors.…”

Section: Suicidal Ideation and Behaviormentioning

confidence: 99%

Advancing a Biopsychosocial and Contextual Model of Sleep in Adolescence: A Review and Introduction to the Special Issue

Becker

Langberg

Byars

2015

J Youth Adolescence

154

130

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Sleep problems in adolescence have been identified as an international public health issue. Over the past few decades, notable advances have been made in our understanding of the patterns and consequences of sleep in adolescence. Despite these important gains, there is much about the role of sleep in adolescence that remains to be understood. This Special Issue brings together studies that examine sleep as it specifically pertains to adolescent development and adjustment. In this introductory article, we argue for the importance of grounding the study of sleep and adolescence in developmental science and a developmental psychopathology framework. First, a review of the literature is used to outline a biopsychosocial and contextual model of sleep in adolescence. Second, attention-deficit/hyperactivity disorder (ADHD) is used as an exemplar of the proposed model given the pervasiveness of sleep problems among youth with ADHD and the likelihood that sleep problems and ADHD symptoms are interconnected in complex ways. Finally, a brief introduction to the empirical articles included in the Special Issue is provided, with particular attention given to how these articles fit within the proposed biopsychosocial and contextual model. Along with the framework proposed in this article, the studies included in this Special Issue advance the current literature and point to critical directions for future research.

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Clinical and Psychosocial Predictors of Suicide Attempts and Nonsuicidal Self-Injury in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT)

Cited by 517 publications

References 26 publications

Poor family functioning mediates the link between childhood adversity and adolescent nonsuicidal self‐injury

Poor family functioning mediates the link between childhood adversity and adolescent nonsuicidal self‐injury

Cognitive–behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial

Advancing a Biopsychosocial and Contextual Model of Sleep in Adolescence: A Review and Introduction to the Special Issue

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