Manual-Based Intervention To Address Clinical Crises and Retain Patients in the Treatment of Adolescents With Depression Study (TADS)

• NCJ Number: 218276
• Journal: Journal of the American Academy of Child & Adolescent Psychiatry Volume: 46 Issue: 5 Dated: May 2007 Pages: 573-581
• Author(s): Diane E. May M.A.; Christopher J. Kratochvil M.D.; Susan E Puumala M.S.; Susan G. Silva Ph.D.; Amy J. Rezac B.A.; Mary J. Hallin MBA; Mark A. Reinecke Ph.D.; Benedetto Vitiello M.D.; Elizabeth B. Weller M.D.; Sanjeev Pathak M.D.; Anne D. Simons Ph.D.; John S. March M.D.
• Date Published: May 2007
• Length: 9 pages
• Grant Number(s): N01 MH80008
• Sponsoring Agency: National Institute of Mental Health
• Corporate Author: Duke University Medical Ctr
• Publication Format: Article
• Publication Type: Program/Project Description
• Language: English
• Country: United States of America

Annotation

This manual-based intervention was intended to address clinical crises and retain participants in the Treatment for Adolescents with Depression Study (TADS), which was a multisite, randomized clinical trial of adolescents with major depressive disorder.

Abstract

Of 439 participants in TADS, 17.8 percent (n=78) used adjunct services for attrition prevention (ASAP), a manual-based intervention used to address clinical emergencies and impending attrition that inevitably arise over the course of long-term studies. The authors conclude that ASAP may be useful in retaining adolescent participants and as a safety intervention in placebo-controlled trials. In clinical practice, ASAP-like procedures may be useful in encouraging adherence to protocols in long-term treatment. ASAP was used primarily for suicidal youth or those with worsening depression. Of these, 46.2 percent continued in their assigned treatment through the full 12 weeks; 47.4 percent received out-of-protocol treatment, but continued participating in TADS assessment; and 10.3 percent withdrew consent for treatment under TADS. ASAP use did not differ among treatment sites and typically occurred early in treatment. At the end of the 12 weeks, 37.2 percent of the participants who used ASAP remained in their assigned treatment, although 80.8 percent continued participating in assessments. At baseline, ASAP was associated with a higher severity of depression, substance use, and precontemplation level of change. TADS participants consisted of 439 moderately to moderately severely depressed adolescents ages 12-17. They were randomly assigned to one of four treatments for 12 weeks. The treatments were fluoxetine, cognitive-behavioral therapy, the combination of the two, or clinical management with pill placebo. Baseline measures addressed demographics, suicidality, substance use, stage of change, and parental and family psychopathology. 4 tables and 37 references