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

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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.

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Notes

  1. Mixed models including race and SES in addition to age and gender as covariates yielded similar results. Because of the smaller sample size from missing data in race and SES, results using only age and gender as covariates are reported.

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Authors and Affiliations

  1. Department of Psychiatry, University of Minnesota, 2450 Riverside Ave, F256/2B West, Minneapolis, MN, 55454, USA

    Meredith Gunlicks-Stoessel & Kristina Reigstad

  2. Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA

    Dikla Eckshtain

  3. Institute for Translational Research in Children’s Mental Health, University of Minnesota, 1100 Washington Avenue S, Suite 102, Minneapolis, MN, 55415, USA

    Susanne Lee

  4. Division of Child & Adolescent Psychiatry, Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA

    Laura Mufson

  5. Department of Psychology, Harvard University, 1030 William James Hall, Cambridge, MA, 02138, USA

    John Weisz

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  1. Meredith Gunlicks-Stoessel
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Correspondence to Meredith Gunlicks-Stoessel.

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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.

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

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Gunlicks-Stoessel, M., Eckshtain, D., Lee, S. et al. Latent Profiles of Cognitive and Interpersonal Risk Factors for Adolescent Depression and Implications for Personalized Treatment. J Abnorm Child Psychol 47, 1957–1967 (2019). https://doi.org/10.1007/s10802-019-00552-3

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