Efficacy/Effectiveness Study of Cognitive-Behavioral Treatment for Adolescents With Comorbid Major Depression and Conduct Disorder

• NCJ Number: 205763
• Journal: Child & Adolescent Psychiatry Volume: 43 Issue: 6 Dated: June 2004 Pages: 660-668
• Author(s): Paul Rohde Ph.D.; Gregory N. Clarke Ph.D.; David E. Mace Ed.D.; Jenel S. Jorgensen M.A.; John R. Seeley Ph.D.
• Date Published: June 2004
• Length: 9 pages
• Grant Number(s): MH 56238
• Sponsoring Agency: National Institute of Mental Health
• Publication Format: Article
• Publication Type: Program/Project Evaluation
• Language: English
• Country: United States of America
• Note: An earlier version of this paper was presented as a poster at the 2001 annual meeting of the American Academy of Child and Adolescent Psychiatry, October 2001, Honolulu, HI.

Annotation

This article reports on the effectiveness of a course entitled the Adolescent Coping With Depression (CWD-A), a cognitive-behavioral (CBT) group intervention for depressed adolescents with comorbid conduct disorder.

Abstract

Between 1998 and 2001, adolescents ages 13-17 were referred to the study by staff from the Department of Youth Services of Lane County, OR. All referred adolescents were under the supervision of an intake, probation, or parole officer. They were not incarcerated at the time of entry into the study. Ninety-three adolescents meeting current DSM-IV criteria for major depressive disorder (MDD) and comorbid conduct disorder (CD) were randomly assigned to either the CWD-A course (n=45) or a life skills/tutoring (LS) intervention (n=48). Nine cohorts were created and treated. Efforts were made to equate the two interventions on number of sessions, interventionist contact time, and nonspecific therapeutic factors. Mixed-gender groups of approximately 10 adolescents were treated in 16 2-hour sessions conducted over an 8-week period. The CWD-A groups consisted of 7-14 adolescents; the LS group consisted of 6-12 adolescents. Mean attendance in the two treatment groups did not significantly differ. The CWD-A course is a group intervention that combines cognitive and behavioral strategies aimed at ameliorating the types of problems that commonly characterize depressed adolescents. The treatment incorporates other elements shared by CBT, such as the focus on specific and current actions and cognitions as targets for change, structured intervention sessions, repeated practice of skills, use of rewards and contracts, homework assignments, and a relatively small number of therapy sessions. Participants were assessed posttreatment and at 6-month and 12-month follow-up. Dichotomous outcomes were analyzed with logistic regression; dimensional measures were analyzed by using random effects regression. The evaluation found that major depressive disorder (MDD) recovery rates posttreatment were greater in CWD-A (39 percent) compared with the LS control group (19 percent). CWD-A participants reported greater reductions in Beck Depression Inventory-II and Hamilton Depression Rating Scale scores and improved social functioning posttreatment. Group differences in MDD recovery rates at 6-month and 12-month follow-up were insignificant, as were difference in conduct disorder both posttreatment and during follow-up. The evaluation concludes that although the CWD-A apparently is an effective acute treatment for depression in adolescents with multiple disorders, findings indicate the need to improve long-term outcomes for depressed adolescents with psychiatric comorbidity and imply that interventions for comorbid populations should focus directly on each disorder. 3 tables, 2 figures, and 32 references