Effect of Treatment Expectations on Treatment Outcome for Depressed Adolescents Receiving IPT-A

• In Event: Poster Session 08
  In Poster Session: PS 08 Topic - Prevention and Interventions

Abstract

This study examined the characteristics of depressed adolescents that are associated with adolescents’ expectations for improvement with Interpersonal Psychotherapy (IPT-A) and the effect of treatment expectations on treatment outcomes with IPT-A. Treatment expectations have been shown to influence depression treatment outcomes in adults (Poston & Hanson, 2010). However, the results of studies focusing on adolescents have been mixed (Watsford & Rickwood, 2014). One clinical trial for adolescents with depression found that adolescents’ treatment expectations predicted response to CBT, anti-depression medication (fluoxetine), and combination treatment (Curry, et al., 2006). However, this finding was not replicated by other studies. In addition, most treatment expectation studies have focused on CBT and/or medication. By examining treatment expectations for IPT-A, we can broaden knowledge of how to guide optimal treatment selection for adolescent depression, while also understanding the potential impact of addressing patient expectations on prognosis.

The sample consisted of 40 (77.5% female) adolescents (age 12-17, M = 14.8, SD = 1.7) enrolled in a 16-week randomized clinical trial examining the effectiveness of four adaptive treatment strategies for adolescent depression that begin with IPT-A, and augment treatment for insufficient responders by adding additional IPT-A sessions or fluoxetine (Gunlicks-Stoessel et al, 2019). Adolescents and parents reported on their expectations for treatment by responding separately to the question: "How much do you think you/your teen will improve with treatment?" using a 1-7 point scale (1 = very much improved to 7 = very much worse). Adolescents also completed the Social Adjustment Scale - Self Report (SAS-SR), Beck Hopeless Scale (BHS), and the Conflict Behavioral Questionnaire-44 (CBQ) report for mother and father. Independent evaluators administered the Children’s Depression Rating Scale-Revised (CDRS-R) and the Global Assessment Scale for Children (C-GAS).

Baseline adolescent characteristics associated with more negative treatment expectations included: feelings of hopelessness (BHS, r = -.409, p < 0.05), conflict with mother (CBQ-20 on mother, r = -0.438, p < 0.05), and social adjustment with family (SAS-SR, r = -0.361, p < 0.05) and friends (SAS-SR, r = -0.071, p < 0.05). Adolescents’ treatment expectations predicted lower depression (CDRS-R, b = -.45, t = -2.67, p = .01), controlling for baseline depression, antidepressant medication status, and parent treatment expectation. Additionally, adolescents’ treatment expectations positively predicted global psychosocial functioning (C-GAS, b = -.57, t = -3.70, p < .01) and negatively predicted social problems with friends post-treatment (SAS, t = -2.319, p = 0.03).

Adolescents’, but not parents’, treatment expectations predicted depression, psychosocial functioning, and peer relationship outcomes for depressed adolescents treated with IPT-A. These findings suggest that adolescents’ treatment expectations are important for providers to assess and may be useful for guiding treatment recommendations. Poor relationships with family members and higher conflict with mothers at baseline were associated with lower expectations for improvement with IPT-A. Interestingly, these are variables that have been found in previous research to predict a more favorable outcome with IPT-A (Gunlicks-Stoessel et al, 2010). Providing adolescents with information about the empirical support for interventions may be useful for amplifying treatment expectations, and thereby outcomes.

Authors

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

• Chenwei Yan, University of Minnesota
  Non-Presenting Author

• Madeleine Rondestvedt, University of Minnesota - Twin Cities
  Non-Presenting Author

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