CBT vs, CBT + Parent Training for Girls with Depression

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Depressive disorders during childhood are especially virulent, long-lasting disorders that are a risk factor for the development of future depressive episodes and other psychiatric difficulties. There are multiple pathways to the development of depression. One possible pathway is a dysfunctional family environment. Consistencies are emerging from research suggesting that an unsupportive, conflictual environment, poor communication, low levels of pleasant activities, and maladaptive parenting behaviors are related to depressive disorders. These disturbances may have both direct effects on the child's emotional adjustment and an indirect effect through their impact on the child's developing sense of self, world, and future. The family environment is an especially salient context for the development of preadolescent girls. During childhood, the prevalence of depressive disorders across genders is similar. Between the ages of 13 to 15 y.o. the number of girls who become depressed increases relative to boys until it reaches a 2-to-1 ratio. Gender differences have been found in the expression of depression between girls and boys and in the variables that are associated with depression. Girls may not benefit as much as boys from standard CBT because the treatments may not target disturbances and skills that are critical for preadolescent girls. To date a paucity of research has been conducted into the treatment of depressive disorders during childhood. While the importance of the family in the adjustment of children is generally recognized, the existing treatment outcome research for depressed children is noteworthy for the failure of investigators to intervene in the family environment. This would appear to place the youngsters back into the stressful environment that may have contributed to the development and maintenance of the disorder. The primary objectives of this investigation are to evaluate the efficacy of CBT and CBT plus Parent Training (PT) vs. minimal contact control (MCC) condition for the treatment of depressive disorders among preadolescent girls. Children who have been diagnosed with a depressive disorder through a multiple-gate screening and assessment procedure in their schools will be randomly assigned to CBT, CBT+PT, or MCC. The school- based treatment is designed to be gender and age sensitive. Multiple measures will be completed by multiple raters at pre, post, and annual follow-ups for up to four years. Three booster sessions are provided each school semester to program for maintenance. The ability of the interventions to prevent future episodes of depression through the high-risk 13-15 y.o. period will be evaluated. The practical impact of the interventions on the youngsters' school performance and home environments will be evaluated. The impact of the interventions on the parent's adjustment be evaluated. Variables that may mediate treatment outcome will be systematically evaluated.