FAMILY-BASED TREATMENT FOR DEPRESSED ADOLESCENTS

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DESCRIPTION (Adapted from applicant's abstract): The mental health community needs empirically validated treatments for depressed children and adolescents, particularly inner city, minority youth. Several individually focused therapy models developed for adults are being tested with children. However, these treatment approaches fail to use the potent context for family relationships as a primary focus of assessment and intervention. In the last decade, family-based interventions have increasingly proven successful in targeting specific family factors associated with child and adolescent disorders. Consequently, several prominent researchers have proposed that family treatment approaches could be efficacious in reducing child and adolescent depression. This treatment development study will finalize the techniques and instruments necessary for the empirical evaluation of Structural Family Therapy (SFT) for treating adolescents with major depression. Three specific, yet highly related studies will be conducted. In study #1, we will complete a treatment manual for treating depressed youth, focusing on inner-city minorities. We are tailoring this approach to target several family factors associated with the onset and maintenance of adolescent depression: disengagement, criticism and hostility, parental psychopathology, and ineffective parenting. Interventions are aimed at increasing family cohesion, reducing hostility, improving communication, increasing family and social supports, and teaching authoritative parenting. Large portions of this manual have been completed. In study #2, we will validate an adherence and competence measure that will be used to ensure that the treatment is accurately and effectively delivered. In study #3, we will collect pre and post-treatment data on 30 cases randomized to SFT or to a minimal contact wait list control group. Data from this study will be used to estimate treatment effect size. This will allow us to conduct power analyses and plan for future comparative study. More generally, this study will pilot new instruments, train therapists, establish implementation procedures, and test feasibility and acceptability of the treatment. These tasks have been identified as the essential foundation for a NIMH funded, randomized, clinical trial for psychosocial treatments. We will conduct the study at the Philadelphia Child Guidance Center and recruit patients form the inpatient, outpatient and crisis programs. These programs treat nearly 1000 adolescents a year, 90% of whom are inner city youth and 75% of whom are African American. About 15% of this population currently receive a diagnosis of depression. This grant will set the foundation for a programmatic investigation that compares and combines the family-based treatment with other well developed treatments at the University of Pennsylvania, Department of Psychiatry (e.g. psychopharmacology and cognitive therapy).