A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents
A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents
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DOI：
10.1001/archpsyc.61.6.577
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发表时间：
2004-06-01
影响因子：
--
通讯作者：
Weissman, MM
中科院分区：
文献类型：
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作者：
Mufson, L;Dorta, KP;Weissman, MM
背景：青少年抑郁症非常普遍，发病率很高，包括自杀未遂、辍学和药物滥用，但许多抑郁的青少年得不到治疗。以学校为基础的健康诊所提供了可获得和有效治疗的潜力，尽管目前尚不清楚学校的临床医生是否可以接受培训，在日常护理中实施基于证据的抑郁症心理疗法。目的：比较校本心理健康诊所人际心理治疗改良疗法（IPT-A）与常规治疗（TAU）的效果。设计：从1999年4月1日至2002年7月31日进行了为期16周的随机临床试验。地点：纽约州纽约市五个校本心理健康诊所。患者：63名符合资格标准的青少年被转介进行精神健康就诊。符合条件的患者汉密尔顿抑郁评定量表平均得分为18.6分（SD, 5.5），儿童总体评估量表平均得分为52.6分（SD, 5.5），符合DSM-IV的重度抑郁障碍、心境恶劣、未另行说明的抑郁障碍或伴有抑郁情绪的适应障碍的标准。平均年龄15.1岁（SD， 1.9岁）。样本主要为女性（n = 53[84%]），西班牙裔（n = 45[71%]），社会经济地位较低。干预：患者被随机分配接受学校卫生诊所临床医生的IPT-A （n = 34）或TAU （n = 29）。主要结果测量：汉密尔顿抑郁评定量表、贝克抑郁量表、儿童整体评估量表、临床整体印象量表和社会适应量表-自我报告。结果：青少年与TAU治疗相比，IPT-A治疗表现出更大的症状减轻和整体功能改善。协方差分析显示，与TAU组相比，IPT-A组汉密尔顿抑郁评定量表临床报告抑郁症状显著减少（P = 0.04），儿童整体评估量表功能显著改善（P = 0.04），社会适应量表-自我报告整体社会功能显著改善（P = 0.01），临床改善显著显著（P = 0.03）。在临床总体印象量表上，临床严重程度显著降低（P = .03）。结论：校本卫生所提供的人际心理治疗是治疗青少年抑郁症的有效方法。这一努力是朝着缩小实验室和社区诊所治疗之间差距迈出的重要一步。
Context: Adolescent depression is highly prevalent and has substantial morbidity, including suicide attempts, school dropout, and substance abuse, but many depressed adolescents are untreated. The school-based health clinic offers the potential for accessible and efficient treatment, although it is unknown whether school-based clinicians can be trained to implement evidence-based psychotherapies for depression in routine care.Objective: To assess the effectiveness of interpersonal psychotherapy modified for depressed adolescents (IPT-A) compared with treatment as usual (TAU) in school-based mental health clinics.Design: A 16-week randomized clinical trial was conducted from April 1, 1999, through July 31, 2002.Setting: Five school-based mental health clinics in New York City, NY.Patients: Sixty-three adolescents referred for a mental health intake visit who met eligibility criteria. Eligible patients had a mean Hamilton Depression Rating Scale score of 18.6 (SD, 5.5) and a mean Children's Global Assessment Scale score of 52.6 (SD, 5.5) and met DSM-IV criteria for major depressive disorder, dysthymia, depression disorder not otherwise specified, or adjustment disorder with depressed mood. Mean age was 15.1 years (SD, 1.9 years). The sample was predominantly female (n = 53 [84%]), Hispanic (n = 45 [71%]), and of low socioeconomic status.Intervention: Patients were randomly assigned to receive IPT-A (n = 34) or TAU (n = 29) from school-based health clinic clinicians.Main Outcome Measures: The Hamilton Depression Rating Scale, Beck Depression Inventory, Children's Global Assessment Scale, Clinical Global Impressions scale, and the Social Adjustment Scale-Self-Report.Results: Adolescents treated with IPT-A compared with TAU showed greater symptom reduction and improvement in overall functioning. Analysis of covariance showed that compared with the TAU group, the IPT-A group showed significantly fewer clinician-reported depression symptoms on the Hamilton Depression Rating Scale (P = .04), significantly better functioning on the Children's Global Assessment Scale (P = .04), significantly better overall social functioning on the Social Adjustment Scale-Self-Report (P = .01), significantly greater clinical improvement (P = .03), and significantly greater decrease in clinical severity (P = .03) on the Clinical Global Impressions scale.Conclusions: Interpersonal psychotherapy delivered in school-based health clinics is an effective therapy for adolescent depression. This effort is a significant step toward closing the gap between treatment conducted in the laboratory and community clinic.