Skip to main content

The Moderating Role of Child Maltreatment in Treatment Efficacy for Adolescent Depression

Abstract

Adolescent girls are at heightened risk of depression, and because adolescent depression may initiate a negative developmental cascade, intervention early in adolescence has potential for altering a negative developmental trajectory. Identifying risk factors that impact response to intervention may inform decisions about the type of treatment to provide for adolescent girls with depression. Understanding moderators of outcomes in evidence-based treatment is critical to the delivery of timely and effective interventions. Matching patients effectively with optimal intervention will not only expedite the alleviation of patients’ distress, but will also reduce unnecessary time and resources spent on less advantageous interventions. The current investigation examines the efficacy of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) in a racially and ethnically diverse sample of 120 low-income adolescent girls age 13–15 with and without histories of child maltreatment. Adolescent and parent report of depressive symptoms were assessed at the beginning and end of treatment and a diagnosis of subsyndromal symptoms of depression or depression were required for purposes of inclusion. Results indicated that among adolescent girls who had experienced two or more subtypes of maltreatment, IPT-A was found to be more efficacious than Enhanced Community Standard (ECS) treatment. Importantly, when the subtype of maltreatment experienced was further probed, among girls with a history of sexual abuse, we found preliminary evidence that IPT-A was significantly more effective than ECS in reducing depressive symptoms, and the effect size was large. Thus, if a history of maltreatment is present, especially including sexual abuse, specifically addressing the interpersonal context associated with depressive symptoms may be necessary.

This is a preview of subscription content, access via your institution.

Fig. 1

Notes

  1. It is worth noting that in the situation of two active intervention arms, such as the current study, the number of potential strata (compliance) increases, making identification of the principal effects very difficult, if not impossible. We selected to model compliance with IPT-A, rather than ECS, given IPT-A’s central importance to the study aims.

References

  • Adams, T. R., Handley, E. D., Manly, J. T., Cicchetti, D., & Toth, S. L. (2019). Intimate partner violence as a mechanism underlying the intergenerational transmission of maltreatment among economically disadvantaged mothers and their adolescent daughters. Development and Psychopathology, 31, 83–93.

    Google Scholar 

  • Alloy, L. B., Abramson, L. Y., Whitehouse, W. G., Hogan, M. E., Tashman, N. A., Steinberg, D. L., et al. (1999). Depressogenic cognitive styles: Predictive validity, information processing and personality characteristics, and developmental origins. Behaviour Research and Therapy, 37(6), 503–531.

    PubMed  Google Scholar 

  • American Psychological Association (2019). Clinical practice guideline for treatment depressive across three age cohorts.. Retrieved from https://www.apa.org/depression-guideline/guideline.pdf.

  • Angold, A., & Costello, E. J. (2006). Puberty and depression. Child and Adolescent Psychiatric Clinics, 15(4), 919–937.

    Google Scholar 

  • Avenevoli, S., Knight, E., Kessler, R. C., & Merikangas, K. R. (2008). Epidemiology of depression in children and adolescents. In J. R. Z. Abela & B. L. Hankin (Eds.), Handbook of depression in children and adolescents (pp. 6–32). New York, NY: Guilford Press.

    Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck depression inventory—II. San Antonio, TX: Psychological Corporation.

    Google Scholar 

  • Bernstein, D. P., & Fink, L. A. (1998). CTQ: Childhood trauma questionnaire: A retrospective self-report. San Antonio, TX: Psychological Corp.

    Google Scholar 

  • Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., Stokes, J., Handelsman, L., Medrano, M., Desmond, D., & Zule, W. (2003). Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse & Neglect, 27(2), 169–190.

    Google Scholar 

  • Bowlby, J. (1978). Attachment theory and its therapeutic implications. Adolescent Psychiatry, 6, 5–33.

    PubMed  Google Scholar 

  • Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York, NY: Basic Books.

    Google Scholar 

  • Bringewatt, E. H., & Gershoff, E. T. (2010). Falling through the cracks: Gaps and barriers in the mental health system for America’s disadvantaged children. Children and Youth Services Review, 32, 1291–1299.

    Google Scholar 

  • Brown, J., Cohen, P., Johnson, J. G., & Smailes, E. M. (1999). Childhood abuse and neglect: Specificity of effects on adolescent and young adult depression and suicidality. Journal of American Academy of Child & Adolescent Psychiatry, 38(12), 1490–1496.

    Google Scholar 

  • Cicchetti, D., & Rogosch, F. A. (2002). A developmental psychopathology perspective on adolescence. Journal of Consulting and Clinical Psychology, 70(1), 6–20.

    PubMed  Google Scholar 

  • Cicchetti, D., & Toth, S. L. (2016). Child maltreatment and developmental psychopathology: A multilevel perspective. Developmental psychopathology: Maladaptation and psychopathology (3rd ed., Vol. 3, pp. 457-512). Hoboken, NJ: Wiley & Sons.

  • Cicchetti, D., & Toth, S. L. (2009). A developmental psychopathology perspective on adolescent depression. In S. Nolen-Hoeksema & L. Hilt (Eds.), Handbook of adolescent depression (pp. 3–31). New York: Taylor & Francis.

    Google Scholar 

  • Cicchetti, D., & Valentino, K. (2006). An ecological-transactional perspective on child maltreatment: Failure of the average expectable environment and its influence on child development. In D. Cicchetti & D. Cohen (Eds.), Developmental psychopathology: Risk, disorder, and adaptation (Vol. 3, 2nd ed., pp. 129–201). Hoboken, NJ: Wiley & Sons.

    Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Cohen, J. R., McNeil, S. L., Shorey, R. C., & Temple, J. R. (2018). Maltreatment subtypes, depressed mood, and anhedonia: A longitudinal study with adolescents. Psychological Trauma: Theory, Research, Practice, and Policy, 11(7), 704–712.

    Google Scholar 

  • Collins, K. A., & Dozois, D. J. (2008). What are the active ingredients in preventative interventions for depression? Clinical Psychology: Science and Practice, 15(4), 313–330.

    Google Scholar 

  • Connell, A. M. (2009). Employing complier average causal effect analytic methods to examine effects of randomized encouragement trials. The American Journal of Drug and Alcohol Abuse, 35(4), 253–259.

    PubMed  PubMed Central  Google Scholar 

  • Duberstein, P. R., Ward, E. A. A., Chaudron, L. H., He, H., Toth, S. L., Wang, W., Var Orden, K. A., Gamble, S. A., & Talbot, N. L. (2018). Effectiveness of interpersonal psychotherapy-trauma for depressed women with childhood abuse histories. Journal of Consulting and Clinical Psychology, 86((10)), 868–878 PMID: 30265045: PMCID: PMC6167992.

    PubMed  PubMed Central  Google Scholar 

  • Duffy, F., Sharpe, H., & Schwannauer, M. (2019). The effectiveness of interpersonal psychotherapy for adolescents with depression–a systematic review and meta-analysis. Child and Adolescent Mental Health, 24(4), 307–317.

    PubMed  Google Scholar 

  • Goodman, W. K., Murphy, T. K., & Storch, E. A. (2007). Risk of adverse behavioral effects with pediatric use of antidepressants. Psychopharmacology, 191, 87–96.

    PubMed  Google Scholar 

  • Hammen, C., & Rudolph, K. D. (2003). Childhood mood disorders. Child Psychopathology, 2, 233–278.

    Google Scholar 

  • Harkness, K. L., Bruce, A. E., & Lumley, M. N. (2006). The role of childhood abuse and neglect in the sensitization to stressful life events in adolescent depression. Journal of Abnormal Psychology, 115(4), 730–741.

    PubMed  Google Scholar 

  • Hyman, S. M., Garcia, M., Kemp, K., Mazure, C. M., & Sinha, R. (2005). A gender specific psychometric analysis of the early trauma inventory short form in cocaine dependent adults. Addictive Behaviors, 30(4), 847–852.

    PubMed  PubMed Central  Google Scholar 

  • Jo, B. (2002). Estimation of intervention effects with noncompliance: Alternative model specifications. Journal of Educational and Behavioral Statistics, 27(4), 385–409.

    Google Scholar 

  • Kaufman, J., Birmaher, B., Brent, D., Rao, U. M. A., 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 & Adolescent Psychiatry, 36(7), 980–988.

    Google Scholar 

  • Kaufman, J., Birmaher, B., Brent, D. A., Ryan, N. D., & Rao, U. (2000). K-SADS-PL. Journal of the American Academy of Child & Adolescent Psychiatry, 39(10), 1208.

    Google Scholar 

  • Kendler, K. S., Thornton, L. M., & Prescott, C. A. (2001). Gender differences in the rates of exposure to stressful life events and sensitivity to their depressogenic effects. American Journal of Psychiatry, 158(4), 587–593.

    PubMed  Google Scholar 

  • Kim, J., & Cicchetti, D. (2003). Social self-efficacy and behavior problems in maltreated and nonmaltreated children. Journal of Clinical Child and Adolescent Psychology, 32(1), 106–117.

    PubMed  Google Scholar 

  • Kim-Cohen, J., Caspi, A., Moffitt, T. E., Harrington, H., Milne, B. J., & Poulton, R. (2003). Prior juvenile diagnoses in adults with mental disorder: Developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 60(7), 709–717.

    PubMed  Google Scholar 

  • Klerman, G. L., Weissman, M. M., Rounsaville, B., & Chevron, E. (1984). Interpersonal therapy of depression (IPT). New York, NY: Basic Books.

    Google Scholar 

  • Klomek, A. B., & Mufson, L. (2006). Interpersonal psychotherapy for depressed adolescents. Child and Adolescent Psychiatric Clinics, 15(4), 959–975.

    Google Scholar 

  • Kraemer, H. C. (2013). Discovering, comparing, and combining moderators of treatment on outcome after randomized clinical trials: A parametric approach. Statistics in Medicine, 32(11), 1964–1973.

    PubMed  Google Scholar 

  • Lauth, B., Arnkelsson, G. B., Magnusson, P., Skarphéðinsson, G. Á., Ferrari, P., & Petursson, H. (2010). Validity of K-SADS-PL (schedule for affective disorders and schizophrenia for school-age children—Present and lifetime version) depression diagnoses in an adolescent clinical population. Nordic Journal of Psychiatry, 64(6), 409–420.

    PubMed  Google Scholar 

  • Lumley, M. N., & Harkness, K. L. (2007). Specificity in the relations among childhood adversity, early maladaptive schemas, and symptom profiles in adolescent depression. Cognitive Therapy and Research, 31(5), 639–657.

    Google Scholar 

  • Maalouf, F. T., & Brent, D. A. (2012). Child and adolescent depression intervention overview: What works, for whom and how well? Child and Adolescent Psychiatric Clinics, 21(2), 299–312.

    Google Scholar 

  • Markowitz, J. C., Petkova, E., Neria, Y., Van Meter, P. E., Zhao, Y., Hembree, E., et al. (2015). Is exposure necessary? A randomized clinical trial of interpersonal psychotherapy for PTSD. American Journal of Psychiatry, 172(5), 430–440.

    PubMed  Google Scholar 

  • Markowitz, J. C., Neria, Y., Lovell, K., Van Meter, P. E., & Petkova, E. (2017). History of sexual trauma moderates psychotherapy outcome for posttraumatic stress disorder. Depression and Anxiety, 34(8), 692–700.

    PubMed  PubMed Central  Google Scholar 

  • Masten, A. S. (2004). Regulatory processes, risk, and resilience in adolescent development. Annals of the New York Academy of Sciences, 1021(1), 310–319.

    PubMed  Google Scholar 

  • McCrae, J. S., Barth, R. P., & Guo, S. (2010). Changes in maltreatment children’s emotional-behavioral problems following typically provided mental health services. American Journal of Orthopsychiatry, 80(3), 350–361.

    PubMed  Google Scholar 

  • Meyer, A. (1957). Psychobiology: A science of man. Oxford, England: Charles C Thomas.

    Google Scholar 

  • Mufson, L., Clougherty, K., Young, J., & Verdeli, H. (2004a). IPT-A supervision checklist. New York Psychiatric Institute: Columbia University College of Physicians and Surgeons.

    Google Scholar 

  • Mufson, L., Dorta, K. P., Moreau, D., & Weissman, M. M. (2004b). Interpersonal psychotherapy for depressed adolescents. New York, NY: The Guilford Press.

    Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (1998-2018). Mplus user’s guide [computer software]. Los Angeles, CA: Author.

    Google Scholar 

  • Mychailyszyn, M. P., & Elson, D. M. (2018). Working through the blues: A meta-analysis on interpersonal psychotherapy for depressed adolescents (IPT-A). Children and Youth Services Review, 87, 123–129.

    Google Scholar 

  • Nanni, V., Uher, R., & Danese, A. (2012). Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: A meta-analysis. American Journal of Psychiatry, 169(2), 141–151.

    PubMed  Google Scholar 

  • Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos, T. (2012). The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLoS Medicine, 9(11), e1001349.

    PubMed  PubMed Central  Google Scholar 

  • Post, R. M. (1992). Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. The American Journal of Psychiatry, 149(8), 999–1010.

    PubMed  Google Scholar 

  • Pu, J., Zhou, X., Liu, L., Zhang, Y., Yang, L., Yuan, S., Zhang, H., Han, Y., Zou, D., & Xie, P. (2017). Efficacy and acceptability of interpersonal psychotherapy for depression in adolescents: A meta-analysis of randomized controlled trials. Psychiatry Research, 253, 226–232.

    PubMed  Google Scholar 

  • Rafaeli, A. K., & Markowitz, J. C. (2011). Interpersonal psychotherapy (IPT) for PTSD: A case study. American Journal of Psychotherapy, 65(3), 205–223.

    PubMed  PubMed Central  Google Scholar 

  • Roth, A., & Fonagy, P. (2005). What works for whom?: A critical review of psychotherapy research (2nd ed.). New York, NY: Guilford Press.

    Google Scholar 

  • Rushton, J. L., Forcier, M., & Schectman, R. M. (2002). Epidemiology of depressive symptoms in the National Longitudinal Study of adolescent health. Journal of the American Academy of Child & Adolescent Psychiatry, 41(2), 199–205.

    Google Scholar 

  • Shenk, C. E., Noll, J. G., Putnam, F. W., & Trickett, P. K. (2010). A prospective examination of the role of childhood sexual abuse and physiological asymmetry in the development of psychopathology. Child Abuse & Neglect, 34(10), 752–761.

    Google Scholar 

  • Stapleton, L. M., Sander, J. B., & Stark, K. D. (2007). Psychometric properties of the Beck depression inventory for youth in a sample of girls. Psychological Assessment, 19(2), 230–235.

    PubMed  Google Scholar 

  • Steinberg AM, Brymer MJ, Kim S, Ghosh C, Ostrowski SA, Gulley K, , Briggs, EC, Pynoos, RS (2013). Psychometric properties of the UCLA PTSD reaction index: Part 1, Journal of Traumatic Stress, 26, 1–9.

    PubMed  Google Scholar 

  • Steinberg, A. M., Brymer, M., Decker, K., & Pynoos, R. S. (2004). The UCLA PTSD reaction index. Current Psychiatry Reports, 6, 96–100.

    PubMed  Google Scholar 

  • Steinberg, L., Dahl, R., Keating, D., Kupfer, D. J., Masten, A. S., & Pine, D. S. (2006). The study of developmental psychopathology in adolescence. Development and Psychopathology, 2, 710–742.

    Google Scholar 

  • Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York, NY: WW Norton.

    Google Scholar 

  • Toth, S. L., Rogosch, F. A., Oshri, A., Gravener-Davis, J., Sturm, R., & Morgan-López, A. A. (2013). The efficacy of interpersonal psychotherapy for depression among economically disadvantaged mothers. Development and Psychopathology, 25((4pt1)), 1065–1078.

    PubMed  PubMed Central  Google Scholar 

  • Vachon, D. D., Krueger, R. F., Rogosch, F. A., & Cicchetti, D. (2015). Assessment of the harmful psychiatric and behavioral effects of different forms of child maltreatment. JAMA Psychiatry, 72(11), 1135–1142.

    PubMed  PubMed Central  Google Scholar 

  • Walker, E. A., Unutzer, J., Rutter, C., Gelfand, A., Saunders, K., VonKorff, M., Koss, M. P., & Katon, W. (1999). Costs of health care use by women HMO members with a history of childhood abuse and neglect. Archives of General Psychiatry, 56(7), 609–613.

    PubMed  Google Scholar 

  • Warmingham, J. M., Handley, E. D., Rogosch, F. A., Manly, J. T., & Cicchetti, D. (2019). Identifying maltreatment subgroups with patterns of maltreatment subtype and chronicity: A latent class analysis approach. Child Abuse & Neglect, 87, 28–39.

    Google Scholar 

  • Weersing, V. R., Jeffreys, M., Do, M. C. T., Schwartz, K. T., & Bolano, C. (2017). Evidence base update of psychosocial treatments for child and adolescent depression. Journal of Clinical Child & Adolescent Psychology, 46(1), 11–43.

    Google Scholar 

  • Weersing, V. R., Schwartz, K. T., & Bolano, C. A. R. L. (2015). Moderators and mediators of treatments for youth with depression. In M. Maric, P. J. M. Prins, & T. H. Ollendick (Eds.), Moderators and mediators of youth treatment outcomes (pp. 65–96). New York, NY: Oxford University Press.

    Google Scholar 

  • Weersing, V. R., Shamseddeen, W., Garber, J., Hollon, S. D., Clarke, G. N., Beardslee, W. R., Gladstone, T. R., Lynch, F. L., Porta, G., Iyengar, S., & Brent, D. A. (2016). Prevention of depression in at-risk adolescents: Predictors and moderators of acute effects. Journal of American Academy of Child and Adolescent Psychiatry, 55(3), 219–226.

    Google Scholar 

  • Weisz, J. R., & Hawley, K. M. (2002). Developmental factors in the treatment on adolescents. Journal of Consulting and Clinical Psychology, 70(1), 21–43.

    PubMed  Google Scholar 

  • Weisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., et al. (2017). What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice. American Psychologist, 72(2), 79–117.

    PubMed  Google Scholar 

  • Wichstrøm, L. (1999). The emergence of gender difference in depressed mood during adolescence: The role of intensified gender socialization. Developmental Psychology, 35(1), 232–245.

    PubMed  Google Scholar 

  • Widom, C. S., DuMont, K., & Czaja, S. J. (2007). A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up. Archives of General Psychiatry, 64(1), 49–56.

    PubMed  Google Scholar 

  • Yoshikawa, H., Aber, J. L., & Beardslee, W. R. (2012). The effects of poverty on the mental, emotional, and behavioral health of children and youth: Implications for prevention. American Psychologist, 67(4), 272–284.

    PubMed  Google Scholar 

  • Young, J. F., Mufson, L., & Davies, M. (2006). Efficacy of interpersonal psychotherapy-adolescent skills training: An indicated preventive intervention for depression. Journal of Child Psychology and Psychiatry, 47(12), 1254–1262.

    PubMed  Google Scholar 

  • Yuan, K. H., & Bentler, P. M. (2000). 5. Three likelihood-based methods for mean and covariance structure analysis with nonnormal missing data. Sociological Methodology, 30(1), 165–200.

    Google Scholar 

  • Zhou, X., Hetrick, S. E., Cuijpers, P., Qin, B., Barth, J., Whittington, C. J., et al. (2015). Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis. World Psychiatry, 14(2), 207–222.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work was supported by the National Institute of Mental Health (grant number R01MH091070). We thank the research staff for all aspects of data collection, and the adolescents and their families, without whom the project would not have been possible, for their willingness to share their experiences with us.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sheree L. Toth.

Ethics declarations

Disclosure of Potential Conflicts of Interest

The corresponding author certifies that neither she nor any of the contributing authors have any conflict of interest to disclose.

Ethical approval

All aspects of the research were approved by the University of Rochester Research Subjects Review Board.

Informed Consent

Informed written consent was provided by the participants’ parent/guardian and informed written assent was obtained from the adolescent participants.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Toth, S.L., Handley, E.D., Manly, J.T. et al. The Moderating Role of Child Maltreatment in Treatment Efficacy for Adolescent Depression. J Abnorm Child Psychol 48, 1351–1365 (2020). https://doi.org/10.1007/s10802-020-00682-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-020-00682-z

Keywords

  • Depression
  • Adolescence
  • Child maltreatment
  • Intervention
  • Developmental psychopathology
  • Interpersonal psychotherapy