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

the IMPACT Consortium

doi:10.1016/j.jaac.2023.03.017

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

the IMPACT Consortium

Department of Psychology

Research output: Contribution to journal › Review article › peer-review

4 Citations (SciVal)

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 language	English
Pages (from-to)	122-135
Number of pages	14
Journal	Journal of the American Academy of Child and Adolescent Psychiatry
Volume	63
Issue number	2
Early online date	28 Apr 2023
DOIs	https://doi.org/10.1016/j.jaac.2023.03.017
Publication status	Published - 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.

Funding

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. Disclosure: Prof. Reynolds is a company director for CBTReach Ltd. and has received fees for training and teaching CBT for adolescents. Between April 2021 and January 2023, she was employed by the British Association of Behavioural and Cognitive Psychotherapies. Prof. Goodyer is a company director of CambridgeBPI Ltd. and has received fees for teaching and training BPI. Dr. Loades, Prof. Midgley, Dr. O'Keeffe, and Ms. Herring have reported no biomedical financial interests or potential conflicts of interest. 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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jaac.2023.03.017Licence: CC BY

Cite this

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

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.",

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author = "{the IMPACT Consortium} and Loades, {Maria E.} and Nick Midgley and Herring, {Georgia T.} and Sally O'Keeffe and Goodyer, {Ian M.} and Barbara Barrett and Sarah Byford and Bernadka Dubicka and Jonathan Hill and Fiona Holland and Raphael Kelvin and Chris Roberts and Rob Senior and Mary Target and Barry Widmer and Paul Wilkinson and Peter Fonagy and Shirley Reynolds",

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. ",

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AU - Herring, Georgia T.

AU - O'Keeffe, Sally

AU - Goodyer, Ian M.

AU - Barrett, Barbara

AU - Byford, Sarah

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N1 - 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.

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N2 - 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.

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

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Improving access to timely evidence-based help for youth mental health using single session interventions

DSE application

Cite this

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

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Projects

Improving access to timely evidence-based help for youth mental health using single session interventions

DSE application

Cite this