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

Journal of Abnormal Child Psychology volume 48, pages 1351–1365 (2020)Cite this article

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.

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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.

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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.

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  1. Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA

    Sheree L. Toth, Elizabeth D. Handley, Jody Todd Manly, Robin Sturm, Tangeria R. Adams, Elizabeth M. Demeusy & Dante Cicchetti

  2. University of Minnesota, Minneapolis, MN, USA

    Dante Cicchetti

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  1. Sheree L. Toth
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Correspondence to Sheree L. Toth.

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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

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Keywords

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