2/2-Evaluation of Family Focused Treatment for Childhood Depression

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DESCRIPTION (provided by applicant): Childhood-onset depression is an impairing and often recurrent and persistent disorder that impacts current and later development resulting in high personal, social, and economic costs. Despite the costs of early-onset depression, the emphasis in current practice parameters on an initial course of psychosocial treatment, and extensive research on adolescent depression, we currently lack randomized controlled trials evaluating psychosocial treatments for children with depressive disorders. The present application aims to address this gap in knowledge regarding optimal psychosocial treatment strategies for children suffering from depressive disorders. We propose a 2-site randomized controlled trial to evaluate the efficacy of Family Focused Treatment (FFT), as compared to an individual client-centered psychotherapy (IP) modeled after "usual" community care. This application builds on and extends work conducted through our initial NIMH treatment development grant in which we developed and manualized the FFT and carried out a preliminary trial demonstrating that the FFT resulted in significant improvements in depression outcomes, global functioning, and reductions in parent reported internalizing, externalizing, and total problems, with gains persisting and strengthening by the 9-month post-treatment follow-up. FFT adopts an interpersonal model for understanding how depressive symptoms are maintained, emphasizes developing family skills/strategies for altering interpersonal processes, and works on building a family environment that supports recovery and enhances stress resistance and resilience. This approach may be particularly appropriate to the developmental needs of depressed children, given their dependence on parents, the potential of FFT to address the needs of multiple family members, and our data supporting benefits on depression, functioning, and other co-occurring symptoms. The proposed project will enroll 140 children (ages 8-12) with depressive disorders (major depression and/or dysthymic disorder). Children will be randomly assigned to receive a 14-week trial of either FFT or IP. At study entry, immediately post-treatment, and at a 9-month post-treatment follow-up all participants will undergo intensive evaluation of clinical state and psychosocial and family functioning. We hypothesize that FFT will be associated with quicker recovery from depression, greater improvement in symptoms and psychosocial functioning, and reduction in associated symptoms/syndromes (anxiety and oppositional disorders). Follow-up evaluations will examine maintenance of treatment gains. Potential moderating (Expressed Emotion, presence of comorbid externalizing disorder) and mediating (family functioning, parental depression) variables will be evaluated. To enhance external validity and facilitate recruitment of a large, diverse sample, the study will be conducted at two sites -- Boston University and UCLA. Childhood-onset depression is an impairing and often recurrent and persistent disorder that impacts current and later development resulting in high social and economic costs, and development of efficacious treatments is of critical importance. Family-Focused Treatment (FFT), developed to specifically target depressed pre- adolescents and their families, presents an interpersonal model for understanding how depressive symptoms are maintained, emphasizes developing family skills/strategies for altering interpersonal processes, and works on building a family environment that supports recovery and enhances stress resistance and resilience. The goal of the current application is to conduct a randomized controlled trial of FFT for the treatment of depressed school-aged youth. PUBLIC HEALTH RELEVANCE: Childhood-onset depression is an impairing and often recurrent and persistent disorder that impacts current and later development resulting in high social and economic costs, and development of efficacious treatments is of critical importance. Family-Focused Treatment (FFT), developed to specifically target depressed pre- adolescents and their families, presents an interpersonal model for understanding how depressive symptoms are maintained, emphasizes developing family skills/strategies for altering interpersonal processes, and works on building a family environment that supports recovery and enhances stress resistance and resilience. The goal of the current application is to conduct a randomized controlled trial of FFT for the treatment of depressed school-aged youth.