Trajectories of Functioning Into Emerging Adulthood Following Treatment for Adolescent Depression

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• 作者：Amy T. Peters ; M.A.^a ; Rachel H. Jacobs ; Ph.D.^a ; Claudia Feldhaus^a ; David B. Henry ; Ph.D.^a ; Anne Marie Albano ; Ph.D.^b ; Scott A. Langenecker ; Ph.D.^a ; Mark A. Reinecke ; Ph.D.^c ; Susan G. Silva ; Ph.D.^d ; John F. Curry ; Ph.D.^d ; ^{john.curry@duke.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Intervention studies ; Longitudinal studies ; Depression
• 刊名：Journal of Adolescent Health
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：58
• 期：3
• 页码：253-259
• 全文大小：497 K

文摘

It is well established that empirically supported treatments reduce depressive symptoms for most adolescents; however, it is not yet known whether these interventions lead to sustained improvements in global functioning. The goal of this study is to assess the clinical characteristics and trajectories of long-term psychosocial functioning among emerging adults who have experienced adolescent-onset major depressive disorder.

Methods

Global functioning was assessed using the Clinical Global Assessment Scale for children (participants ≤18 years), the Global Assessment of Functioning (participants ≥ 19 years) and the Health of the Nation Outcome Scales for Adolescents among 196 adolescents who elected to complete 3.5 years of naturalistic follow-up subsequent to their participation in the Treatment for Adolescents with Depression Study. The Treatment for Adolescents with Depression Study examined the efficacy of cognitive behavior therapy, fluoxetine, and the combination of cognitive behavior therapy and fluoxetine (combination treatment) over the course of 36 weeks. Mixed-effects regression models were used to identify trajectories and clinical predictors of functioning over the naturalistic follow-up.

Results

Global functioning and achievement of developmental milestones (college, employment) improved over the course of follow-up for most adolescents. Depressive relapse, initial randomization to the placebo group, and the presence of multiple psychiatric comorbidities conferred risk for relatively poorer functioning.

Conclusions

Functioning generally improves among most adolescents who have received empirically supported treatments. However, the presence of recurrent major depressive disorder and multiple psychiatric comorbidities is associated with poorer functioning trajectories, offering targets for maintenance treatment or secondary prevention.