Skip to main content
SpringerLink
Log in

Psychoeducational Psychotherapy and Omega-3 Supplementation Improve Co-Occurring Behavioral Problems in Youth with Depression: Results from a Pilot RCT

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

This pilot randomized controlled trial (RCT) investigated benefits of omega-3 fatty acid supplementation and Individual-Family Psychoeducational Psychotherapy (PEP; a family-focused, cognitive-behavioral therapy) for behavior problems among youth with depression. Participants aged 7–14 with DSM-IV-TR depressive disorders (N = 72; 56.9 % male) were randomized to 1 of 4 treatment conditions: PEP + omega-3, PEP monotherapy (with pill placebo), omega-3 monotherapy, or placebo (without active intervention). At screen, baseline, and 2, 4, 6, 9, and 12 weeks post-baseline, parents completed the SNAP-IV, which assesses attention-deficit/hyperactivity disorder symptoms, oppositional defiant disorder symptoms, and overall behavior problems. At screen, baseline (randomization), 6 and 12 weeks, parents completed the Eyberg Child Behavior Inventory (ECBI), which includes Intensity and Problem scales for child behavior problems. Youth who had a completed SNAP-IV or ECBI for at least two assessments during treatment (n = 48 and 38, respectively) were included in analyses of the respective outcome. ClinicalTrials.gov.:NCT01341925. Linear mixed effects models indicated a significant effect of combined PEP + omega-3 on SNAP-IV Total (p = 0.022, d = 0.80) and Hyperactivity/Impulsivity trajectories (p = 0.008, d = 0.80), such that youth in the combined group saw greater behavioral improvement than those receiving only placebo. Similarly, youth in combined treatment had more favorable ECBI Intensity trajectories than youth who received no active treatment (p = 0.012, d = 1.07). Results from this pilot RCT suggest that combined PEP + omega-3 is a promising treatment for co-occurring behavior symptoms in youth with depression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Ahn, J., Ahn, H. S., Cheong, J. H., & dela Pena, I. (2016). Natural product-derived treatments for attention-deficit/hyperactivity disorder: safety, efficacy, and therapeutic potential of combination therapy. Neural Plasticity. doi:10.1155/2016/1320423.

    Google Scholar 

  • Ambrosini, P. J., Metz, C., Prabucki, K., & Lee, J.-C. (1989). Videotape reliability of the third revised edition of the K-SADS. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 723–728. doi:10.1097/00004583-198909000-00013.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed., text revision ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Angold, A., & Costello, E. J. (1993). Depressive comorbidity in children and adolescents: empirical, theoretical, and methodological issues. American Journal of Psychiatry, 150, 1779–1791. doi:10.1176/ajp.150.12.1779.

    Article  PubMed  Google Scholar 

  • Antshel, K. M., Faraone, S. V., & Gordon, M. (2012). Cognitive behavioral treatment outcomes in adolescent ADHD. Focus, 10, 334–345. doi:10.1176/appi.focus.10.3.334.

    Article  Google Scholar 

  • Axelson, D., Birmaher, B. J., Brent, D., Wassick, S., Hoover, C., Bridge, J., & Ryan, N. (2003). A preliminary study of the kiddie schedule for affective disorders and schizophrenia for school-age children mania rating scale for children and adolescents. Journal of Child and Adolescent Psychopharmacology, 13, 463–470. doi:10.1089/104454603322724850.

    Article  PubMed  Google Scholar 

  • Birmaher, B., Arbelaez, C., & Brent, D. (2002). Course and outcome of child and adolescent major depressive disorder. Child and Adolescent Psychiatric Clinics of North America, 11, 619–637. doi:10.1016/S1056-4993(02)00011-1.

    Article  PubMed  Google Scholar 

  • Birmaher, B., Brent, D., & the AACAP Work Group on Quality Issues (2007). Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1503–1526. doi:10.1097/chi.0b013e318145ae1c.

    Article  PubMed  Google Scholar 

  • Bloch, M. H., & Qawasmi, A. (2011). Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 991–1000. doi:10.1016/j.jaac.2011.06.008.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bos, D. J., Oranje, B., Veerhoek, E. S., Van Diepen, R. M., Weusten, J. M., Demmelmair, H., et al. (2015). Reduced symptoms of inattention after dietary omega-3 fatty acid supplementation in boys with and without attention deficit/hyperactivity disorder. Neuropsychopharmacology, 40, 2298–2306. doi:10.1038/npp.2015.73.

    Article  PubMed  PubMed Central  Google Scholar 

  • Boylan, K., MacPherson, H. A., & Fristad, M. A. (2013). Examination of disruptive behavior outcomes and moderation in a randomized psychotherapy trial for mood disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 52, –708. doi:10.1016/j.jaac.2013.04.014.

  • Bridge, J. A., Iyengar, S., Salary, C. B., Barbe, R. P., Birmaher, B., Pincus, H. A., et al. (2007). Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA, 297, 1683–1696. doi:10.1001/jama.297.15.1683.

    Article  PubMed  Google Scholar 

  • Bussing, R., Fernandez, M., Harwood, M., Hou, W., Garvan, C. W., Eyberg, S. M., & Swanson, J. M. (2008). Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms psychometric properties and normative ratings from a school district sample. Assessment, 15, 317–328. doi:10.1177/1073191107313888.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chambers, W. J., Puig-Antich, J., Hirsch, M., Paez, P., Ambrosini, P. J., Tabrizi, M. A., & Davies, M. (1985). The assessment of affective disorders in children and adolescents by semistructured interview: test-retest reliability of the schedule for affective disorders and schizophrenia for school-age children, present episode version. Archives of General Psychiatry, 42, 696–702. doi:10.1001/archpsyc.1985.01790300064008.

    Article  PubMed  Google Scholar 

  • Clarke, G. N., Rohde, P., Lewinsohn, P. M., Hops, H., & Seeley, J. R. (1999). Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 272–279. doi:10.1097/00004583-199903000-00014.

    Article  PubMed  Google Scholar 

  • Clayton, E. H., Hanstock, T. L., Hirneth, S. J., Kable, C. J., Garg, M. L., & Hazell, P. L. (2009). Reduced mania and depression in juvenile bipolar disorder associated with long-chain omega-3 polyunsaturated fatty acid supplementation. European Journal of Clinical Nutrition, 63, 1037–1040. doi:10.1038/ejcn.2008.81.

    Article  PubMed  Google Scholar 

  • Costello, E. J., Erkanli, A., & Angold, A. (2006). Is there an epidemic of child or adolescent depression? Journal of Child Psychology and Psychiatry, 47, 1263–1271. doi:10.1111/j.1469-7610.2006.01682.x.

    Google Scholar 

  • Diamond, G. S., Reis, B. F., Diamond, G. M., Siqueland, L., & Isaacs, L. (2002). Attachment-based family therapy for depressed adolescents: a treatment development study. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1190–1196. doi:10.1097/00004583-200210000-00008.

    Article  PubMed  Google Scholar 

  • Eyberg, S. M., & Pincus, D. (1999). Eyberg child behavior inventory & sutter-eyberg student behavior inventory-revised: professional manual. Odessa: Psychological Assessment Resources.

    Google Scholar 

  • Eyberg, S. M., & Ross, A. W. (1978). Assessment of child behavior problems: the validation of a new inventory. Journal of Clinical Child Psychology, 7, 113–116. doi:10.1080/15374417809532835.

    Article  Google Scholar 

  • Feingold, A. (2009). Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric as for classical analysis. Psychological Methods, 14, 43–53. doi:10.1037/a0014699.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fristad, M. A., Verducci, J. S., Walters, K., & Young, M. E. (2009). Impact of multifamily psychoeducational psychotherapy in treating children aged 8 to 12 years with mood disorders. Archives of General Psychiatry, 66, 1013–1021. doi:10.1001/archgenpsychiatry.2009.112.

    Article  PubMed  Google Scholar 

  • Fristad, M. A., Goldberg-Arnold, J. S., & Leffler, J. M. (2011). Psychotherapy for children with bipolar and depressive disorders. New York: Guilford Press.

    Google Scholar 

  • Fristad, M. A., Young, A. S., Vesco, A. T., Nader, E. S., Healy, K. Z., Gardner, W., et al. (2015). A randomized controlled trial of individual family psychoeducational psychotherapy & omega-3 fatty acids in youth with subsyndromal bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 25, 764–774. doi:10.1089/cap.2015.0132.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fristad, M. A., Vesco, A. T., Young, A. S., Healy, K. Z., Nader, E. S., Gardner, W.,… Arnold, L. E. (2016). Pilot RCT of omega-3 and individual-family psychoeducational psychotherapy for children and adolescents with depression. Journal of Clinical Child and Adolescent Psychology (in press).

  • Gillies, D., Sinn, J., Lad, S. S., Leach, M. J., & Ross, M. J. (2012). Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database of Systematic Reviews, 7, CD007986. doi:10.1002/14651858.CD007986.pub2.

    Google Scholar 

  • Jacobs, R. H., Becker-Weidman, E. G., Reinecke, M. A., Jordan, N., Silva, S. G., Rohde, P., & March, J. S. (2010). Treating depression and oppositional behavior in adolescents. Journal of Clinical Child and Adolescent Psychology, 39, 559–567. doi:10.1080/15374416.2010.486318.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988. doi:10.1097/00004583-199707000-00021.

    Article  PubMed  Google Scholar 

  • Knapp, M., McCrone, P., Fombonne, E., Beecham, J., & Wostear, G. (2002). The Maudsley long-term follow-up of child and adolescent depression 3. Impact of comorbid conduct disorder on service use and costs in adulthood. British Journal of Psychiatry, 180, 19–23. doi:10.1192/bjp.180.1.19.

    Article  PubMed  Google Scholar 

  • Kovacs, M. (1996). Presentation and course of major depressive disorder during childhood and later years of the life span. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 705–715. doi:10.1097/00004583-199606000-00010.

    Article  PubMed  Google Scholar 

  • Lewinsohn, P. M., Clarke, G. N., Hops, H., & Andrews, J. (1990). Cognitive-behavioral treatment for depressed adolescents. Behavior Therapy, 21, 385–401. doi:10.1016/s0005-7894(05)80353-3.

    Article  Google Scholar 

  • Nemets, H., Nemets, B., Apter, A., Bracha, Z., & Belmaker, R. H. (2006). Omega-3 treatment of childhood depression: a controlled, double-blind pilot study. American Journal of Psychiatry, 163, 1098–1100. doi:10.1176/ajp.2006.163.6.1098.

    Article  PubMed  Google Scholar 

  • Owen, C., Rees, A.-M., & Parker, G. (2008). The role of fatty acids in the development and treatment of mood disorders. Current Opinion in Psychiatry, 21, 19–24. doi:10.1097/YCO.0b013e3282f29841.

    Article  PubMed  Google Scholar 

  • Pliszka, S., & AACAP Work Group on Quality Issues (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 894–921. doi:10.1097/chi.0b013e318054e724.

    Article  PubMed  Google Scholar 

  • Raine, A., Portnoy, J., Liu, J., Mahoomed, T., & Hibbeln, J. R. (2015). Reduction in behavior problems with omega-3 supplementation in children aged 8-16 years: a randomized, double-blind, placebo-controlled, stratified, parallel-group trial. Journal of Child Psychology and Psychiatry, 56, 509–520. doi:10.1111/jcpp.12314.

    Article  PubMed  Google Scholar 

  • Richardson, A. J. (2003). The importance of omega-3 fatty acids for behaviour, cognition and mood. Scandinavian Journal of Nutrition, 47, 92–98. doi:10.1080/11026480310007944.

    Article  Google Scholar 

  • Rohde, P., Clarke, G. N., Lewinsohn, P. M., Seeley, J. R., & Kaufman, N. K. (2001). Impact of comorbidity on a cognitive-behavioral group treatment for adolescent depression. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 795–802. doi:10.1097/00004583-200107000-00014.

    Article  PubMed  Google Scholar 

  • Smeets, K. C., Leeijen, A. A., van der Molen, M. J., Scheepers, F. E., Buitelaar, J. K., & Rommelse, N. N. (2015). Treatment moderators of cognitive behavior therapy to reduce aggressive behavior: a meta-analysis. European Child & Adolescent Psychiatry, 24, 255–264. doi:10.1007/s00787-014-0592-1.

    Article  Google Scholar 

  • Sonuga-Barke, E. J., Brandeis, D., Cortese, S., Daley, D., Ferrin, M., Holtmann, M., et al. (2013). Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. American Journal of Psychiatry, 170, 275–289. doi:10.1176/appi.ajp.2012.12070991.

    Article  PubMed  Google Scholar 

  • Steiner, H., Remsing, L., & AACAP Work Group on Quality Issues (2007). Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 126–141. doi:10.1097/01.chi.0000246060.62706.af.

    Article  PubMed  Google Scholar 

  • Sukhodolsky, D. G., Kassinove, H., & Gorman, B. S. (2004). Cognitive-behavioral therapy for anger in children and adolescents: a meta-analysis. Aggression and Violent Behavior, 9, 247–269. doi:10.1016/j.avb.2003.08.005.

    Article  Google Scholar 

  • Swanson, J. M. (1992). School-based assessments and interventions for ADD students. Irvine: KC Publishing.

    Google Scholar 

  • Swanson, J. M., Kraemer, H. C., Hinshaw, S. P., Arnold, L. E., Conners, C. K., Abikoff, H. B., et al. (2001). Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 168–179. doi:10.1097/00004583-200102000-00011.

    Article  PubMed  Google Scholar 

  • TADS Team (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: treatment for adolescents with depression study (TADS) randomized controlled trial. JAMA, 292, 807–820. doi:10.1001/jama.292.7.807.

    Article  Google Scholar 

  • Tammam, J. D., Steinsaltz, D., Bester, D. W., Semb-Andenaes, T., & Stein, J. F. (2016). A randomised double-blind placebo-controlled trial investigating the behavioural effects of vitamin, mineral and n-3 fatty acid supplementation in typically developing adolescent schoolchildren. British Journal of Nutrition, 115, 361–373. doi:10.1017/S0007114515004390.

    Article  PubMed  Google Scholar 

  • U.S. Food and Drug Administration (2004). FDA launches a multi-pronged strategy to strengthen safeguards for children treated with antidepressant medications. Silver Spring: U.S. Food and Drug Administration.

    Google Scholar 

  • Weisz, J. R., McCarty, C. A., & Valeri, S. M. (2006). Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychological Bulletin, 132, 132–149. doi:10.1037/0033-2909.132.1.132.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This research was supported by National Institute of Mental Health award# R34 MH85875; the content is solely the responsibility of the authors and does not necessarily represent the official views of NIH. The authors would like to thank staff who collected data and provided therapy, families who participated, and OmegaBrite, who provided study capsules.

Author information

Author notes

  1. Andrea S. Young

    Present address: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5300 Alpha Commons Drive, 4th Floor, Baltimore, MD, 21224, USA

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA

    Andrea S. Young, L. Eugene Arnold, Hannah L. Wolfson & Mary A. Fristad

Authors
  1. Andrea S. Young
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Eugene Arnold
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hannah L. Wolfson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mary A. Fristad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea S. Young.

Ethics declarations

Disclosures

Dr. Young has received research funding from Psychnostics, LLC. Dr. Arnold has received research funding from Curemark, Forest, Lilly, Neuropharm, Novartis, Noven, Shire, Supernus, and YoungLiving (as well as NIH and Autism Speaks) and has consulted with or been on advisory boards for Arbor, Gowlings, Ironshore, Neuropharm, Novartis, Noven, Organon, Otsuka, Pfizer, Roche, Seaside Therapeutics, Sigma Tau, Shire, Tris Pharma, and Waypoint. Dr. Fristad receives royalties from Guilford Press, American Psychiatric Press and CFPSI for treatment manuals, workbooks and a diagnostic instrument reported on in this study and honoraria from Physician’s Post-Graduate Press and the American Occupational Therapy Association.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent/assent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Young, A.S., Arnold, L.E., Wolfson, H.L. et al. Psychoeducational Psychotherapy and Omega-3 Supplementation Improve Co-Occurring Behavioral Problems in Youth with Depression: Results from a Pilot RCT. J Abnorm Child Psychol 45, 1025–1037 (2017). https://doi.org/10.1007/s10802-016-0203-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-016-0203-3

Keywords

Search

Navigation