Randomized controlled trial of family‐focused treatment for child depression compared to individual psychotherapy: one‐year outcomes

Abstract

Objective: Childhood-onset depression is associated with increased risk of recurrent depression and high morbidity extending into adolescence and adulthood. This multisite randomized controlled trial evaluated two active psychosocial treatments for childhood depression: family-focused treatment for childhood depression (FFT-CD) and individual supportive psychotherapy (IP). Aims were to describe effects through 52 weeks postrandomization on measures of depression, functioning, nondepressive symptoms, and harm events. Methods: Children meeting criteria for depressive disorders (N = 134) were randomly assigned to 15 sessions of FFT-CD or IP and evaluated at mid-treatment for depressive symptoms and fully at roughly 16 weeks (after acute treatment), 32 weeks, and 52 weeks/one year. See clinicaltrials.gov: NCT01159041. Results: Analyses using generalized linear mixed models confirmed the previously reported FFT-CD advantage on rates of acute depression response (≥50% Children's Depression Rating Scale reduction). Improvements in depression and other outcomes were most rapid during the acute treatment period, and leveled off between weeks 16 and 52, with a corresponding attenuation of observed group differences, although both groups showed improved depression and functioning over 52 weeks. Survival analyses indicated that most children recovered from their index depressive episodes by week 52: estimated 76% FFT-CD, 77% IP. However, by the week 52 assessment, one FFT-CD child and six IP children had suffered recurrent depressive episodes. Four children attempted suicide, all in the IP group. Other indicators of possible harm were relatively evenly distributed across groups. Conclusions: Results indicate a quicker depression response in FFT-CD and hint at greater protection from recurrence and suicide attempts. However, outcomes were similar for both active treatments by week 52/one year. Although community care received after acute treatment may have influenced results, findings suggest the value of a more extended/chronic disease model that includes monitoring and guidance regarding optimal interventions when signs of depression-risk emerge. Key pointsChildhood-onset depressive disorders are associated with substantial morbidity and mortality. This is the first large multisite RCT to evaluate two active psychosocial treatment strategies for children ages 7-14 with depressive disorders.Results indicate a quicker depression response in family-focused treatment, compared to individual psychotherapy after roughly 16 weeks of acute treatment, and a hint of greater protection from recurrence and suicide attempts. However, outcomes were similar for both treatments by week 52/one year.Although community care received after acute treatment may have influenced results, findings suggest the value of an extended/chronic disease model that includes monitoring and clinical guidance regarding optimal interventions when signs of depression-risk emerge.

Incorporating family factors into treatment planning for adolescent depression: Perceived parental criticism predicts longitudinal symptom trajectory in the Youth Partners in Care trial

“…Results from the present study can also be considered within the growing literature supporting the value of family-focused and family centered treatments for youth mood disorders (Asarnow et al, 2019;Diamond et al, 2002Diamond et al, , 2003Israel & Diamond, 2013;Miklowitz & Goldstein, 1997;Miklowitz et al, 2020;O'Donnell et al, 2020;Shaw et al, 2009;Tompson et al, 2017;Tompson et al, this issue;Zisk et al, 2019), as well as more individually focused treatments that address parentchild relationships (Mufson et al, 2004;Young & Mufson, 2003). These treatments focus on intervention strategies such as enhancing family support, decreasing family conflict, improving family communication and problem-solving, enhancing parenting skills, and increasing parent motivation to engage in treatment.…”

Editorial: Some roads less travelled—different routes to understanding the causes of child psychopathology

“…Dong et al (2020) show that a Transdiagnostic Sleep and Circadian Intervention can improve some measures of sleep and circadian functioning in adolescents compared with an active control condition involving education about sleep and health. Finally, Asarnow et al (2020) compared a family‐focused treatment targeting childhood depression with individual psychotherapy; the family‐focused treatment resulted in a more rapid easing of depressive symptoms, although there were no long‐term differences in outcome between the two groups.…”

Leveraging the developmental science of psychosocial risk to strengthen youth psychotherapy

“…One study found that traditional parent training was as effective as individual CBT in reducing depression among treatment-seeking youths with a depressed caregiver (Eckshtain, Kuppens, & Weisz, 2017). Another study, comparing family-focused treatment for child depression with individual psychotherapy, found evidence that family-focused treatment was associated with parents’ improved understanding of how to manage their children's depression and how to help their children at home (Tompson, Sugar, Langer, & Asarnow, 2017), even though the treatments were similarly effective for youth depression at 1-year follow-up (Asarnow et al, 2020). Many CBT protocols encourage transmission of treatment information to parents via parent handouts, check-ins at the end of therapy sessions, or designated therapy sessions for the parents.…”