Social Problem-Solving Among Depressed Adolescents Treated with Interpersonal Psychotherapy

• In Event: Poster Session 05
  In Poster Session: PS 05 Topic - Prevention and Interventions

Abstract

A primary component of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) involves teaching adolescents interpersonal problem-solving skills to help them resolve interpersonal difficulties and reduce depressive symptoms. Mufson et al. (1999) found that adolescents who received IPT-A reported greater improvement in constructive problem-solving cognition (positive problem orientation) and deliberate application of effective problem-solving strategies (rational problem-solving). However, no studies have yet examined whether specific dimensions of social problem-solving at baseline predict depression outcome with IPT-A or whether change in problem-solving is related to change in depression. This knowledge can help identify subgroups of depressed adolescents who may be particularly likely to benefit from IPT-A and can inform personalized treatment selection. The goal of this study was to examine whether specific dimensions of social problem-solving significantly improved with IPT-A, and to evaluate 1) if changes in social problem-solving were associated with changes in depressive symptoms, and 2) if baseline social problem-solving predicted depressive symptoms post- treatment.

The study included a sample of 40 (77.5% female) adolescents (age 12-17, M = 14.8, SD = 1.7) who participated in a 16-week randomized trial examining the effectiveness of four adaptive treatment strategies for adolescent depression that begin with 12 sessions of IPT-A, and augment treatment for insufficient responders by adding additional IPT-A sessions or the antidepressant medication, fluoxetine (Gunlicks-Stoessel et al, 2019). Children’s Depression Rating Scale-Revised (CDRS-R) and the Social Problem-Solving Inventory–Revised (SPSI-R) were administered at baseline and week 16. The SPSI-R subscales include positive problem orientation (PPO; constructive problem-solving cognition [e.g. optimism, commitment]), negative problem orientation (NPO; inhibitory cognitive/emotional orientation toward problems [e.g. pessimism, self-blame]), rational problem-solving (RPS; deliberate application of effective problem-solving strategies), impulsivity-carelessness style (ICS; deficient problem-solving pattern described as impulsive and careless), and avoidant style (AS; procrastination, passivity, inaction, and dependency).

Adolescents demonstrated significantly lower negative problem orientation at week 16 compared to baseline (t=3.26, p=.003), while other subscales did not show a significant difference. Changes in negative problem orientation (b = .66, t = 3.92, p=.001) and avoidant style (b = .43, t = 2.42, p = .023) were significantly correlated with changes in CDRS-R score from baseline to week 16 (controlling for medication status), indicating that greater reduction in these problem-solving deficits was associated with greater reduction in depression. Finally, avoidant style at baseline negatively predicted CDRS-R score at week 16 (b = -.38, t = -2.57, p = .016), controlling for baseline CDRS-R and medication status.

Negative problem orientation improved significantly with treatment, and reductions in negative problem orientation and avoidant style were associated with reductions in depressive symptoms. These results suggest that IPT-A engages the treatment targets of negative problem orientation and avoidant problem-solving style. Additionally, adolescents who had a higher avoidant style at baseline demonstrated fewer depressive symptoms at week 16, indicating that adolescents with higher avoidant style are more likely to benefit from IPT-A.

Authors

• Jocelyn Teng, University of Minnesota - Twin Cities
  Presenting Author

• Rucha Markale, University of Minnesota - Twin Cities
  Non-Presenting Author

• Chenwei Yan, University of Minnesota
  Non-Presenting Author

• Meredith Gunlicks-Stoessel, University of Minnesota - Twin Cities
  Non-Presenting Author