In Context: Lessons About Adolescent Unipolar Depression From the Improving Mood With Psychoanalytic and Cognitive Therapies Trial

the IMPACT Consortium

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Abstract

This paper summarizes the results of the Improving Mood with Psychoanalytic and Cognitive Therapies (IMPACT) study and its implications for psychological treatment of adolescents with moderate to severe unipolar major depression. IMPACT was a pragmatic, superiority, randomized controlled trial conducted in the United Kingdom, which compared the clinical and cost-effectiveness of short-term psychoanalytic therapy (STPP), cognitive−behavioral therapy (CBT), and a brief psychosocial intervention (BPI) in reducing depression symptoms in 465 adolescents with unipolar major depression, aged 11 to 17 years. Although this was a clinically heterogeneous group of adolescents, some symptoms (eg, sleep and concentration difficulties, irritability/anger) were common and disabling. The trial reported no significant difference among the 3 treatments in reducing depression symptoms. One year after treatment, 84% of participants showed improvement in depressive symptoms (<50% of baseline symptoms) and improved psychosocial functioning, achieving this through different symptom reduction trajectories. Although participants attended fewer treatment sessions than planned, the 3 treatments were delivered with fidelity to their respective models. Ending treatment without therapist agreement occurred in 37% of cases. This was not associated with outcomes by treatment group. Adolescents emphasized the importance of the therapeutic relationship in all 3 treatments. Results suggest that although most adolescents respond to time-limited, structured psychological therapy, subgroups of depressed adolescents are likely to need additional treatment or support. These include adolescents who live in complex circumstances and/or who believe that their needs are not met in therapy, some who stop treatment early, and the 16% to 18% of adolescents who do not respond to treatment. Clinical trial registration information: Improving Mood and Preventing Relapse With Psychoanalytic Psychotherapy and Cognitive Behaviour Therapy; https://www.isrctn.com; ISRCTN83033550.

Original languageEnglish
Pages (from-to)122-135
Number of pages14
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume63
Issue number2
Early online date28 Apr 2023
DOIs
Publication statusPublished - 1 Feb 2024

Bibliographical note

Funding Information:
Dr. Loades (Development and Skills Enhancement Award, 302367) is funded by the National Institute for Health Research (NIHR) for this research project. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS, or the UK Department of Health and Social Care. None of the other authors received any funding for work on this manuscript. The Improving Mood With Psychoanalytic and Cognitive Therapies (IMPACT) study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project number 06/05/01). The IMPACT-ME study was funded by the Monument Trust. The IMPACT-MR study was funded by a Medical Research Council award (grant no: G0802226). This report is independent research. The views expressed in this publication are those of the authors(s) and not necessarily those of the HTA programme, NHS, the Monument Trust, the National Institute for Health Research, or the Department of Health. The IMPACT trial is registered under Current Controlled Trials: ISRCTN83033550.

Keywords

  • adolescent
  • depression
  • psychological therapy
  • randomized controlled trial
  • treatment

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

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