Predicting Patterns of Treatment Response and Outcome for Adolescents Who Are Suicidal and Depressed

Abbott, Caroline H.; Zisk, Abigail; Bounoua, Nadia; Diamond, Guy; Kobak, Roger

doi:10.1016/j.jaac.2018.12.013

Cited by 20 publications

(18 citation statements)

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“…Across these 81 publications, a wide range of variables were tested as predictors, moderators, and mediators associated with depression outcome. Fifty-one publications (63%) 29,31,[33][34][35]39,41,43,[45][46][47]49,50,53,54,65,66,68,71,[73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88]95,96,98,[100][101][102][103]105,[107][108][109][110][111][113][114][115] tested baseline predictors, 45 (56%) 28,30,…”

Section: Resultsmentioning

confidence: 99%

Predictors, Moderators, and Mediators Associated With Treatment Outcome in Randomized Clinical Trials Among Adolescents With Depression

et al. 2022

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IMPORTANCEThe application of precision medicine principles for the treatment of depressive disorders in adolescents requires an examination of the variables associated with depression outcomes in randomized clinical trials (RCTs). OBJECTIVE To describe predictors, moderators, and mediators associated with outcomes in RCTs for the treatment of depressive disorders in adolescents. EVIDENCE REVIEWA scoping review of RCTs for the treatment of depression in adolescents was conducted. Databases searched included MEDLINE, Embase, APA PsycInfo, and CINAHL. Included publications tested predictors, moderators, and/or mediators associated with depression symptom outcomes (eg, symptom reduction, response, remission) in RCTs pertaining to the treatment of adolescents, ages 13 to 17 years. Predictors were defined as variables that were associated with depression outcomes, independent of treatment group. Moderators were defined as baseline variables that were associated with differential outcomes between treatment groups. Mediators were defined by a formal mediation analysis. In duplicate, variables were extracted and coded with respect to analysis type (univariable or multivariable), statistical significance, direction of effect size, reporting of a priori hypotheses, and adjustment for multiple comparisons. Aggregated results were summarized by variable domain and RCT sample.FINDINGS Eighty-one articles reporting on variables associated with outcomes across 33 RCTs were identified, including studies of biological (10 RCTs), psychosocial (18 RCTs), and combined (4 RCTs) treatments as well as a service delivery model (1 RCT). Fifty-three variable domains were tested as baseline predictors of depression outcome, 41 as moderators, 19 as postbaseline predictors, and 5 as mediators. Variable domains that were reported as significant in at least 3 RCTs included age, sex/gender, baseline depression severity, early response to treatment, sleep changes, parent-child conflict, overall psychopathology, suicidal ideation, hopelessness, functional impairment, attendance at therapy sessions, and history of trauma. Two publications reported a priori hypotheses and adjustment for multiple comparisons, both finding that baseline depression severity and family conflict were associated with poorer outcomes. CONCLUSIONS AND RELEVANCEThis review identified commonly researched variables requiring more scrutiny as well as underresearched variables to inform future study designs. Further efforts to discover predictors, moderators, and mediators associated with treatment response have great potential to optimize care for adolescents with depression.

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Section: Resultsmentioning

confidence: 99%

Predictors, Moderators, and Mediators Associated With Treatment Outcome in Randomized Clinical Trials Among Adolescents With Depression

et al. 2022

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“…The need for effective interventions targeting reduction in suicidal behavior during the transition from psychiatric hospitalization is clear, particularly as vulnerability to suicide risk is heightened in the first weeks following discharge (Chung et al, 2019). Importantly, as not all suicidal adolescents respond to interventions in a uniform fashion (Abbott, Zisk, Bounoua, Diamond, & Kobak, 2019; Harrington et al, 1998), and show markedly varying levels of postdischarge risk (Berona, Horwitz, Czyz, & King, 2017; Goldston et al, 2016), a single intervention approach may not be efficacious for all suicidal youths. Instead, more flexible interventions that dynamically match intervention components to individuals may hold promise for maximizing intervention effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Adaptive intervention for prevention of adolescent suicidal behavior after hospitalization: a pilot sequential multiple assignment randomized trial

Czyz

King

Prouty

et al. 2021

Child Psychology Psychiatry

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Background The need for effective interventions for psychiatrically hospitalized adolescents who have varying levels of postdischarge suicide risk calls for personalized approaches, such as adaptive interventions (AIs). We conducted a nonrestricted pilot Sequential, Multiple Assignment, Randomized Trial (SMART) to guide the development of an AI targeting suicide risk after hospitalization. Methods Adolescent inpatients (N = 80; ages 13–17; 67.5% female) were randomized in Phase 1 to a Motivational Interview‐Enhanced Safety Plan (MI‐SP), delivered during hospitalization, alone or in combination with postdischarge text‐based support (Texts). Two weeks after discharge, participants were re‐randomized in Phase 2 to added telephone booster calls or to no calls. Mechanisms of change were assessed with daily diaries for four weeks and over a 1‐ and 3‐month follow‐up. This trial is registered with clinicaltrials.gov (identifier: NCT03838198). Results Procedures were feasible and acceptable. Mixed effects models indicate that adolescents randomized to MI‐SP + Texts (Phase 1) and those randomized to booster calls (Phase 2) experienced significant improvement in daily‐level mechanisms, including safety plan use, self‐efficacy to refrain from suicidal action, and coping by support seeking. Those randomized to MI‐SP + Texts also reported significantly higher coping self‐efficacy at 1 and 3 months. Although exploratory, results were in the expected direction for MI‐SP + Texts, versus MI‐SP alone, in terms of lower risk of suicide attempts (Hazard ratio = 0.30; 95% CI = 0.06, 1.48) and suicidal behavior (Hazard ratio = 0.36; 95% CI = 0.10, 1.37) three months after discharge. Moreover, augmentation with booster calls did not have an overall meaningful impact on suicide attempts (Hazard ratio = 0.65; 95% CI = 0.17, 3.05) or suicidal behavior (Hazard ratio = 0.78; 95% CI = 0.23, 2.67); however, boosters benefited most those initially assigned to MI‐SP + Texts. Conclusions The current SMART was feasible and acceptable for the purpose of informing an AI for suicidal adolescents, warranting additional study. Findings also indicate that postdischarge text‐based support offers a promising augmentation to safety planning delivered during hospitalization.

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“…n this issue of the Journal, Abbott et al 1 present findings from an important secondary analysis of a randomized controlled trial that identifies predictors of treatment response. Previous research has highlighted the importance of varying trajectories of treatment response.…”

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confidence: 99%

“…Similarly, psychosocial factors (lower levels of family stress and less negative cognitions, such as hopelessness) are also predictive of improved outcome. 4 The study by Abbott et al 1 is a secondary analysis of a randomized clinical trial (RCT) comparing Attachment Based Family Therapy (ABFT) to a control condition of Family-Enhanced Non-Directive Supportive Therapy (FE-NST) in 120 adolescents (aged 12À18 years) with severe suicidal ideation and clinically significant depression. Primary outcomes presented previously showed that both groups improved with treatment-with reductions in suicidal ideation and depressive symptoms.…”

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confidence: 99%

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Editorial: Identifying Predictors of Treatment Response Trajectories of Suicidal Adolescents

Kennard

Zullo

2019

Journal of the American Academy of Child & Adolescent Psych

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Predicting Patterns of Treatment Response and Outcome for Adolescents Who Are Suicidal and Depressed

Cited by 20 publications

References 47 publications

Predictors, Moderators, and Mediators Associated With Treatment Outcome in Randomized Clinical Trials Among Adolescents With Depression

Predictors, Moderators, and Mediators Associated With Treatment Outcome in Randomized Clinical Trials Among Adolescents With Depression

Adaptive intervention for prevention of adolescent suicidal behavior after hospitalization: a pilot sequential multiple assignment randomized trial

Editorial: Identifying Predictors of Treatment Response Trajectories of Suicidal Adolescents

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