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Latent Profiles of Cognitive and Interpersonal Risk Factors for Adolescent Depression and Implications for Personalized Treatment

  • Meredith Gunlicks-StoesselEmail author
  • Dikla Eckshtain
  • Susanne Lee
  • Kristina Reigstad
  • Laura Mufson
  • John Weisz
Article
  • 78 Downloads

Abstract

A personalized approach to treatment with patients being matched to the best-fit treatment has been proposed as one possible solution to the currently modest treatment response rates for adolescent depression. Personalized treatment involves identifying and characterizing subgroups likely to respond differently to different treatments. We investigated the feasibility of this approach, by focusing on two key risk factors that are the purported treatment targets of cognitive behavioral therapy (CBT) and interpersonal psychotherapy for depressed adolescents (IPT-A): negative unrealistic cognitions and interpersonal relationship difficulties, respectively. We sought to learn whether subgroups high and low on the two risk factors, respectively, might be identified in a large sample of depressed, treatment-seeking adolescents. Latent class analysis (LCA) was conducted on measures of the two risk factors among 431 adolescents (age 12–17) in the Treatment for Adolescents with Depression Study. LCA identified three classes: (1) adolescents with high levels of problems in both family relationships and cognitions (21.6% of sample), (2) adolescents with moderate levels of problems in both domains (52.4%), and (3) adolescents with low levels of problems in both domains (26.0%). These subgroups did not predict treatment outcome with CBT or CBT + fluoxetine (COMB). The results challenge a current assumption about how treatments could be personalized, and they support a multi-causal model of depression rather than a risk-factor-specific model. Strategies other than risk factor-based personalizing for case assignment to CBT vs. IPT-A are discussed.

Keywords

Adolescents Depression Treatment Cognitions Family 

Notes

Compliance with Ethical Standards

Conflict of Interest

There are no conflicts of interest to report.

Ethical Approval

The coordinating center at Duke University Medical Center and the Institutional Review Board at each site approved and monitored the study. The Data and Safety Monitoring Board of the National Institute of Mental Health performed quarterly review.

Informed Consent

Adolescents and at least one parent/caregiver provided written informed consent and assent.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of MinnesotaMinneapolisUSA
  2. 2.Division of Child and Adolescent PsychiatryMassachusetts General HospitalBostonUSA
  3. 3.Institute for Translational Research in Children’s Mental HealthUniversity of MinnesotaMinneapolisUSA
  4. 4.Division of Child & Adolescent PsychiatryColumbia University College of Physicians & Surgeons and New York State Psychiatric InstituteNew YorkUSA
  5. 5.Department of PsychologyHarvard UniversityCambridgeUSA

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