Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents / Madison AITKEN in Journal of Child Psychology and Psychiatry, 61-9 (September 2020)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 61-9 (September 2020) . - p.998-1008 Titre : Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents Type de document : Texte imprimé et/ou numérique Auteurs : Madison AITKEN, Auteur ; John D. HALTIGAN, Auteur ; Peter SZATMARI, Auteur ; Bernadka DUBICKA, Auteur ; Peter FONAGY, Auteur ; Raphael KELVIN, Auteur ; Nick MIDGLEY, Auteur ; Shirley REYNOLDS, Auteur ; Paul O. WILKINSON, Auteur ; Ian M. GOODYER, Auteur Année de publication : 2020 Article en page(s) : p.998-1008 Langues : Anglais (eng) Mots-clés : Bifactor models  adolescent  depression  psychopathology  psychotherapy Index. décimale : PER Périodiques Résumé : BACKGROUND: The longitudinal course of multiple symptom domains in adolescents treated for major depression is not known. Revealing the temporal course of general and specific psychopathology factors, including potential differences between psychotherapies, may aid therapeutic decision-making. METHODS: Participants were adolescents with major depressive disorder (aged 11-17; 75% female; N = 465) who were part of the IMPACT trial, a randomized controlled trial comparing cognitive behavioral therapy, short-term psychoanalytic psychotherapy, and brief psychosocial intervention. Self-reported symptoms at baseline and 6, 12, 36, 52, and 86 weeks postrandomization were analyzed with bifactor modeling. RESULTS: General psychopathology factor scores decreased across treatment and one-year follow-up. Specific melancholic features and depressive cognitions factors decreased from baseline to 6 weeks. Conduct problems decreased across treatment and follow-up. Anxiety increased by 6 weeks and then reverted to baseline levels. Obsessions-compulsions did not change. Changes in general and specific factors were not significantly different between the three psychotherapies during treatment. During follow-up, however, conduct problems decreased more in brief psychosocial intervention versus cognitive behavioral therapy (1.02, 95% Bayes credible interval 0.25, 1.96), but not versus short-term psychoanalytic psychotherapy. CONCLUSIONS: The clinical response signature in this trial is best revealed by rapid reductions in depression symptoms and general psychopathology. Protracted improvements in general psychopathology and conduct problems subsequently occur. Psychosocial treatments for adolescent depression have comparable effects on general and specific psychopathology, although a psychoeducational, goal-focused approach may be indicated for youth with comorbid conduct problems. En ligne : http://dx.doi.org/10.1111/jcpp.13194 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=430 [article] Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents [Texte imprimé et/ou numérique] / Madison AITKEN, Auteur ; John D. HALTIGAN, Auteur ; Peter SZATMARI, Auteur ; Bernadka DUBICKA, Auteur ; Peter FONAGY, Auteur ; Raphael KELVIN, Auteur ; Nick MIDGLEY, Auteur ; Shirley REYNOLDS, Auteur ; Paul O. WILKINSON, Auteur ; Ian M. GOODYER, Auteur . - 2020 . - p.998-1008. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 61-9 (September 2020) . - p.998-1008 Mots-clés : Bifactor models  adolescent  depression  psychopathology  psychotherapy Index. décimale : PER Périodiques Résumé : BACKGROUND: The longitudinal course of multiple symptom domains in adolescents treated for major depression is not known. Revealing the temporal course of general and specific psychopathology factors, including potential differences between psychotherapies, may aid therapeutic decision-making. METHODS: Participants were adolescents with major depressive disorder (aged 11-17; 75% female; N = 465) who were part of the IMPACT trial, a randomized controlled trial comparing cognitive behavioral therapy, short-term psychoanalytic psychotherapy, and brief psychosocial intervention. Self-reported symptoms at baseline and 6, 12, 36, 52, and 86 weeks postrandomization were analyzed with bifactor modeling. RESULTS: General psychopathology factor scores decreased across treatment and one-year follow-up. Specific melancholic features and depressive cognitions factors decreased from baseline to 6 weeks. Conduct problems decreased across treatment and follow-up. Anxiety increased by 6 weeks and then reverted to baseline levels. Obsessions-compulsions did not change. Changes in general and specific factors were not significantly different between the three psychotherapies during treatment. During follow-up, however, conduct problems decreased more in brief psychosocial intervention versus cognitive behavioral therapy (1.02, 95% Bayes credible interval 0.25, 1.96), but not versus short-term psychoanalytic psychotherapy. CONCLUSIONS: The clinical response signature in this trial is best revealed by rapid reductions in depression symptoms and general psychopathology. Protracted improvements in general psychopathology and conduct problems subsequently occur. Psychosocial treatments for adolescent depression have comparable effects on general and specific psychopathology, although a psychoeducational, goal-focused approach may be indicated for youth with comorbid conduct problems. En ligne : http://dx.doi.org/10.1111/jcpp.13194 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=430

Trajectories of depression symptom change during and following treatment in adolescents with unipolar major depression / Sian Emma DAVIES in Journal of Child Psychology and Psychiatry, 61-5 (May 2020)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 61-5 (May 2020) . - p.565-574 Titre : Trajectories of depression symptom change during and following treatment in adolescents with unipolar major depression Type de document : Texte imprimé et/ou numérique Auteurs : Sian Emma DAVIES, Auteur ; Sharon A. S. NEUFELD, Auteur ; Eleonore VAN SPRANG, Auteur ; Lizanne SCHWEREN, Auteur ; Rogier KEIVIT, Auteur ; Peter FONAGY, Auteur ; Bernadka DUBICKA, Auteur ; Raphael KELVIN, Auteur ; Nick MIDGLEY, Auteur ; Shirley REYNOLDS, Auteur ; Mary TARGET, Auteur ; Paul WILKINSON, Auteur ; Anne Laura VAN HARMELEN, Auteur ; Ian Michael GOODYER, Auteur Article en page(s) : p.565-574 Langues : Anglais (eng) Mots-clés : Depression  longitudinal studies  outcome  therapy Index. décimale : PER Périodiques Résumé : OBJECTIVE: To classify a cohort of depressed adolescents recruited to the UK IMPACT trial, according to trajectories of symptom change. We examined for predictors and compared the data-driven categories of patients with a priori operational definitions of treatment response. METHOD: Secondary data analysis using growth mixture modelling (GMM). Missing data were imputed. Trajectories of self-reported depressive symptoms were plotted using scores taken at six nominal time points over 86 weeks from randomisation in all 465 patients. RESULTS: A piecewise GMM categorised patients into two classes with initially similar and subsequently distinct trajectories. Both groups had a significant decline in depressive symptoms over the first 18 weeks. Eighty-four per cent (84.1%, n = 391) of patients were classed as 'continued-improvers' with symptoms reducing over the duration of the study. A further class of 15.9% (n = 74) of patients were termed 'halted-improvers' with higher baseline depression scores, faster early recovery but no further improvement after 18 weeks. Presence of baseline comorbidity somewhat increased membership to the halted-improvers class (OR = 1.40, CI: 1.00-1.96). By end of study, compared with classes, a clinical remission cut-off score (/=50%) indexing treatment response misclassified 15% and 31% of cases, respectively. CONCLUSIONS: A fast reduction in depressive symptoms in the first few weeks of treatment may not indicate a good prognosis. Halted improvement is only seen after 18 weeks of treatment. Longitudinal modelling may improve the precision of revealing differential responses to treatment. Improvement in depressive symptoms may be somewhat better in the year after treatment than previously considered. En ligne : http://dx.doi.org/10.1111/jcpp.13145 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=422 [article] Trajectories of depression symptom change during and following treatment in adolescents with unipolar major depression [Texte imprimé et/ou numérique] / Sian Emma DAVIES, Auteur ; Sharon A. S. NEUFELD, Auteur ; Eleonore VAN SPRANG, Auteur ; Lizanne SCHWEREN, Auteur ; Rogier KEIVIT, Auteur ; Peter FONAGY, Auteur ; Bernadka DUBICKA, Auteur ; Raphael KELVIN, Auteur ; Nick MIDGLEY, Auteur ; Shirley REYNOLDS, Auteur ; Mary TARGET, Auteur ; Paul WILKINSON, Auteur ; Anne Laura VAN HARMELEN, Auteur ; Ian Michael GOODYER, Auteur . - p.565-574. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 61-5 (May 2020) . - p.565-574 Mots-clés : Depression  longitudinal studies  outcome  therapy Index. décimale : PER Périodiques Résumé : OBJECTIVE: To classify a cohort of depressed adolescents recruited to the UK IMPACT trial, according to trajectories of symptom change. We examined for predictors and compared the data-driven categories of patients with a priori operational definitions of treatment response. METHOD: Secondary data analysis using growth mixture modelling (GMM). Missing data were imputed. Trajectories of self-reported depressive symptoms were plotted using scores taken at six nominal time points over 86 weeks from randomisation in all 465 patients. RESULTS: A piecewise GMM categorised patients into two classes with initially similar and subsequently distinct trajectories. Both groups had a significant decline in depressive symptoms over the first 18 weeks. Eighty-four per cent (84.1%, n = 391) of patients were classed as 'continued-improvers' with symptoms reducing over the duration of the study. A further class of 15.9% (n = 74) of patients were termed 'halted-improvers' with higher baseline depression scores, faster early recovery but no further improvement after 18 weeks. Presence of baseline comorbidity somewhat increased membership to the halted-improvers class (OR = 1.40, CI: 1.00-1.96). By end of study, compared with classes, a clinical remission cut-off score (/=50%) indexing treatment response misclassified 15% and 31% of cases, respectively. CONCLUSIONS: A fast reduction in depressive symptoms in the first few weeks of treatment may not indicate a good prognosis. Halted improvement is only seen after 18 weeks of treatment. Longitudinal modelling may improve the precision of revealing differential responses to treatment. Improvement in depressive symptoms may be somewhat better in the year after treatment than previously considered. En ligne : http://dx.doi.org/10.1111/jcpp.13145 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=422

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