Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of a Problem-Solving Therapy for Depression and Suicide Potential in Adolescents and Young Adults

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

Short-term and structured cognitive behavioral problem-solving therapy (PST) is a developmentally relevant mode of action for the treatment of emotional problems in young people. This study aimed at testing the efficacy of a problem-solving therapy in treating depression and suicide potential in adolescents and young adults. A total of 46 self-referred high school and university students who were randomly assigned to a problem-solving therapy (n = 27) and a waiting list control (n = 19) conditions completed a controlled cognitive behavioral problem-solving treatment trial. Participants were administered the measures of depression, suicide potential, problem solving, self-esteem and assertiveness. Twenty-two of the 27 participants from the PST condition could be reached after 12-months for follow-up. Participants completed depression and problem-solving measures at follow-up. Results showed that post-treatment depression and suicide risk scores of participants within the PST condition decreased significantly compared to the pre-treatment scores but post-waiting and pre-waiting depression and suicide risk scores of participants within the WLC condition were unchanged. Likewise, post-treatment self-esteem and assertiveness scores of participants within the PST condition increased significantly compared to the pre-treatment scores while post-waiting and pre-waiting self-esteem and assertiveness scores of participants within the WLC condition were unchanged. At post-treatment, 77.8% of the participants in the PST but only 15.8% of those in the WLC condition achieved full or partial recovery according to BDI scores. Similarly, 96.3% of participants in the PST but only 21.1% of those in the WLC condition achieved full or partial recovery according to HDRS scores. The improvements were maintained at 12-months follow-up. Therefore, it is concluded that problem-solving therapy should be considered as a viable option for the treatment of depression and suicide potential in adolescents and young adults.

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

Similar content being viewed by others

References

  • Akdemir, A., Örsel, S., Dağ, I., Türkçapar, M. H., Işcan, N., & Özbay, H. (1996). Hamilton depresyon derecelendirme ölçeği (HDDÖ)’nin geçerliği, güvenirliği ve klinikte kullanımı [Validity, reliability and the clinical use of Hamilton Depression Rating Scale, in Turkish]. Journal of Psychiatry, Psychology and Psychopharmacology, 4, 251–259.

    Google Scholar 

  • American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (DSM-IV). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Arean, P. A., Perri, M. G., Nezu, A. M., Schein, R. L., Christopher, F., & Joseph, T. X. (1993). Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatment for depression in older adults. Journal of Consulting and Clinical Psychology, 61, 1003–1010.

    Article  PubMed  CAS  Google Scholar 

  • Arrindell, W. A., & van der Ende, J. (1985). Cross-sample invariance of the structure self-reported distress and difficulty in assertiveness. Advances in Behavior Research and Therapy, 7, 205–243.

    Article  Google Scholar 

  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.

    Google Scholar 

  • Biggam, F. H., & Power, K. G. (2002). A controlled, problem-solving, group-based intervention with vulnerable incarcerated young offenders. International Journal of Offender Therapy and Comparative Criminology, 46, 678–698.

    Article  PubMed  Google Scholar 

  • Brener, N. D., Krug, E. G., & Simon, T. R. (2000). Trends in suicide ideation and suicidal behavior among high school students in the United States, 1991–1997. Suicide and Life-Threatening Behavior, 30, 304–312.

    PubMed  CAS  Google Scholar 

  • Brent, D. A., Kolko, D. J., Allan, M. J., & Brown R. V. (1990). Suicidality in affectively disordered adolescent inpatients. Journal for the American Academy of Child and Adolescent Psychiatry 586–593.

  • Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology, Review, 26, 17–31.

    Article  Google Scholar 

  • Chan, D. W. (1993). Components of assertiveness: Their relationships with assertive rights and depressed mood among Chinese college students in Hong Kong. Behavior Research and Therapy, 31, 529–238.

    Article  CAS  Google Scholar 

  • Chang, E. C. (2002). Predicting suicide ideation in an adolescent population: Examining the role of social problem solving as a moderator and a mediator. Personality and Individual Differences, 32, 1279–1291.

    Article  CAS  Google Scholar 

  • Clark, D. C., Gibbons, R. D., Fawcett, J., & Scheftner, W. A. (1989). What is the mechanism by which suicide attempts predispose to later suicide attempts? A mathemathical model. Journal of Abnormal Psychology, 98, 42–49.

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

  • Collishaw, S., Maughan, B., Goodman, R., & Pickles, A. (2004). Time trends in adolescent mental health. Journal of Child Psychology and Psychiatry, 45, 1350–1362.

    Article  PubMed  Google Scholar 

  • Cuhadaroglu, F. (1986). Üniversite öğrencilerinde psikiyatrik semptom dağılımı [Symptom distribution in university students, in Turkish]. In R. Saygılı (Ed.), Proceedings of the XXII national congress of psychiatric and neurological sciences (pp. 35–39) İzmir: Ege University Press.

  • Cull, J. G., & Gill, W. S. (1988). Suicide Probability Scale (SPS) manual. Los Angels: Western Psychological Services.

    Google Scholar 

  • Dixon, W. A. (2000). Problem-solving appraisal and depression: Evidence for a recovery model. Journal of Counseling & Development, 78, 87–91.

    Google Scholar 

  • Dowrick, C., Dunn, G., Ayuso-Mateos, J. L., Dalgard, O. S., Page, H., Lehtinen, V., et al. (2000). Problem solving treatment and group psychoeducation for depression: Multicentre randomized controlled trial. British Medical Journal, 321, 1450–1454.

    Article  PubMed  CAS  Google Scholar 

  • D’Zurilla, T. J., & Goldfried, M. R. (1971). Problem solving and behavior modification. Journal of Abnormal Psychology, 78, 107–126.

    Article  PubMed  CAS  Google Scholar 

  • D’Zurilla, T. J., & Nezu, A. M. (1999). Problem-solving therapy: A social competence approach to clinical intervention (2nd ed.). New York: Springer.

    Google Scholar 

  • D’Zurilla, T. J., & Nezu, A. M. (2007). Problem-solving therapy: A positive approach to clinical intervention (3rd ed.). New York: Springer.

    Google Scholar 

  • Eskin, M. (1993). Reliability of the Turkish version of the perceived social support from friends and family scales, scale for interpersonal behavior, and the suicide probability scale. Journal of Clinical Psychology, 49, 515–522.

    Article  PubMed  CAS  Google Scholar 

  • Eskin, M. (1995). Suicidal behavior as related to social support and assertiveness among Swedish and Turkish high school students: A cross-cultural investigation. Journal of Clinical Psychology, 51, 158–172.

    Article  PubMed  CAS  Google Scholar 

  • Eskin, M. (2003). Self-reported assertiveness in Swedish and Turkish adolescents: A cross-cultural comparison. Scandinavian Journal of Psychology, 44, 7–12.

    Article  PubMed  Google Scholar 

  • Eskin, M., Kaynak-Demir, H., & Demir, S. (2005). Same-sex sexual orientation, childhood sexual abuse, and suicidal behavior in university students in Turkey. Archives of Sexual Behavior, 34, 185–195.

    Article  PubMed  Google Scholar 

  • Evans, E., Hawton, K., Rodham, K., & Deeks, J. (2005). The prevalence of suicidal phenomenon in adolescents: A systematic review of population-based studies. Suicide and Life-Threatening Behavior, 35, 239–250.

    Article  PubMed  Google Scholar 

  • Ferdinand, R. F., Nijs, P. F. A., Lier, P., & Verhults, F. C. (2005). Latent class analysis of anxiety and depressive symptoms in referred adolescents. Journal of Affective Disorders, 88, 299–306.

    Article  PubMed  Google Scholar 

  • Feske, U., & Chambless, D. L. (1995). Cognitive versus exposure only treatment for social phobia: A meta analysis. Behavior Therapy, 26, 695–720.

    Article  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), clinical version [Turkish translation by A. Çorapçıoğlu]. Ankara: Hekimler Yayın Birliği.

  • Frank, E., Prien, R. F., Jarrett, R. B., Keller, M. B., Kupfer, D. J., Lavori, P. W., et al. (1991). Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Archives of General Psychiatry, 48, 851–855.

    PubMed  CAS  Google Scholar 

  • Franko, D. L., Striegel-Moore, R. H., Thompson, D., Schreiber, G. B., & Daniels, S. R. (2005). Does adolescent depression predict obesity in black and white young adult women? Psychological Medicine, 35, 1505–1513.

    Article  PubMed  Google Scholar 

  • Gath, D., & Mynors-Wallis, L. (2000). Problem-solving treatment in primary care. In D. M. Clark & C. G. Fairburn (Eds.), Science and practice of cognitive behaviour therapy (pp. 415–431). Oxford: Oxford University Press.

    Google Scholar 

  • Gröholt, B., Ekeberg, Ö., Wichström, L., & Haldorsen, T. (2000). Young suicide attempters: A comparison between a clinical and an epidemiological sample. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 868–875.

    Article  PubMed  Google Scholar 

  • Guillon, M. S., Crocq, M. A., & Bailey, P. E. (2003). The relationship between self-esteem and psychiatric disorders in adolescents. European Psychiatry 59–62.

  • Hamilton, H. (1960). A rating scale for depression. Journal of Neurological and Neurosurgical Psychiatry, 33, 56–62.

    Google Scholar 

  • Hamrin, V., & Pachler, M. C. (2005). Child and adolescent depression: Review of the latest evidence-based treatments. Journal of Psychosocial Nursing & Mental Health Services, 43, 54–63.

    Google Scholar 

  • Heppner, P. P., Neal, G. W., & Larson, L. M. (1984). Problem-solving training as prevention with college students. The Personnel and Guidance Journal, 62, 514–519.

    Google Scholar 

  • Heppner, P. P., & Petersen, C. H. (1982). The development and implications of a personal problem solving inventory. Journal of Counseling Psychology, 29, 66–75.

    Article  Google Scholar 

  • Hisli, N. (1988). Beck Depresyon Envanteri’nin geçerliği üzerine bir çalışma [A study on the validity of Beck Depression Inventory, in Turkish]. Turkish Journal of Psychology, 7, 3–13.

    Google Scholar 

  • Johnson, G. R., Krug, E. G., & Potter, L. B. (2000). Suicide among adolescents and young adults: A cross-national comparison of 34 countries. Suicide and Life-Threatening Behavior, 30, 74–82.

    PubMed  CAS  Google Scholar 

  • Joiner, T. E., Rudd, M. D., Rouleau, M. R., & Wagner, K. D. (2000). Parameters of suicidal crises vary as a function of previous suicide attempts in youth inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 876–880.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., & Nock, M. K. (2003). Delineating mechanisms of change in child and adolescent therapy: Methodological issues and research recommendations. Journal of Child Psychology and Psychiatry, 44, 1116–1129.

    Article  PubMed  Google Scholar 

  • Kim, H. Y. (2003). Correlation of mental health problems with psychological constructs in adolescence: Final results from a 2-year study. International Journal of Nursing Studies, 40, 115–124.

    Article  PubMed  Google Scholar 

  • Kisch, J., Leino, V., & Silverman, M. M. (2005). Aspects of suicidal behavior, depression, and treatment in college students: Results from the Spring 2000 National College Health Assessment Survey. Suicide and Life-Threatening Behavior, 35, 3–13.

    Article  PubMed  Google Scholar 

  • Landazabal, M. G. (2006). Psychopathological symptoms, social skills, and personality traits: A study with adolescents. Spanish Journal Psychology, 9, 182–192.

    Google Scholar 

  • Lerner, M. S., & Clum, G. A. (1990). Treatment of suicide ideators: A problem-solving approach. Behavior Therapy, 21, 403–411.

    Article  Google Scholar 

  • Levenson, M., & Neuringer, C. (1971). Problem-solving behavior in suicidal adolescents. Journal of Consulting and Clinical Psychology, 37, 433–436.

    Article  PubMed  CAS  Google Scholar 

  • Lewinsohn, P. M., Rohde, P., & Seeley J. R. (1994). Psychosocial risk factors for future adolescent suicide attempts. Journal of Consulting and Clinical Psychology, 62, 297–305.

    Article  PubMed  CAS  Google Scholar 

  • Lewinsohn, P. M., Rohde, P., & Seeley J. R. (1998). Major depressive disorders in older adolescents: Prevalence, risk factors, and clinical implications. Clinical Psychology Review, 18, 765–794.

    Article  PubMed  CAS  Google Scholar 

  • Ma, J., Lee, K. V., & Stafford, R. S. (2005). Depression treatment during outpatient visits by U.S. children and adolescents. Journal of Adolescent Health, 37, 434–442.

    Article  PubMed  Google Scholar 

  • MacPhee, A. R., & Andrews, J. J. (2006). Risk factors for depression in early adolescence. Adolescence, 41, 435–466.

    PubMed  Google Scholar 

  • Malouff, J. M., Thorsteinsson, E. B., & Schutte, N. S. (2007). The efficacy of problem-solving therapy in reducing mental and physical health problems: A meta-analysis. Clinical Psychology Review, 27, 46–57.

    Article  PubMed  Google Scholar 

  • Marx, E. M., Williams, J. M. G., & Claridge, G. C. (1992). Depression and social problem solving. Journal of Abnormal Psychology, 101, 78–86.

    Article  PubMed  CAS  Google Scholar 

  • McAuliffe, C., Keeley, H. S., & Corcoran, P. (2002). Problem solving and repetition of parasuicide. Behavioural and Cognitive Psychotherapy, 30, 385–397.

    Article  Google Scholar 

  • Newman, T. B. (2004). A black-box warning for antidepressants in children? New England Journal of Medicine, 35, 1595–1598.

    Article  Google Scholar 

  • Nezu, A. M. (1986). Efficacy of a social problem-solving therapy approach for unipolar depression. Journal of Consulting and Clinical Psychology, 54, 196–202.

    Article  PubMed  CAS  Google Scholar 

  • Nezu, A. M., & Perri, M. G. (1989). Social problem-solving therapy for unipolar depression: An initial dismantling investigation. Journal of Consulting and Clinical Psychology, 57, 408–413.

    Article  PubMed  CAS  Google Scholar 

  • Nezu, A. M., & Ronan, G. F. (1988). Social problem solving as a moderator of stress-related depressive symptoms: A prospective analysis. Journal of Counseling Psychology, 35, 134–138.

    Article  Google Scholar 

  • Pelkonen, M., Marttunen, M., & Aro, H. (2003). Risk for depression: A 6-year follow-up of Finnish adolescents. Journal of Affective Disorders, 77, 41–51.

    Article  PubMed  Google Scholar 

  • Pollock, L. R., & Williams, J. M. G. (2004). Problem-solving in suicide attempters. Psychological Medicine, 34, 163–167.

    Article  PubMed  CAS  Google Scholar 

  • Priester, M. J., & Clum, G. A. (1993). Perceived problem-solving ability as a predictor of depression, hopelessness, and suicide ideation in a college population. Journal of Counseling Psychology, 40, 79–85.

    Article  Google Scholar 

  • Reinecke, M. A., DuBois, D. L., & Schultz, T. M. (2001). Social problem solving, mood, and suicidality among inpatient adolescents. Cognitive Therapy and Research, 25, 743–756.

    Article  Google Scholar 

  • Richmond, T. K., & Rosen, D. S. (2005). The treatment of adolescent depression in the era of the black box warning. Current Opinion in Pediatrics, 17, 466–472.

    Article  PubMed  Google Scholar 

  • Rosenberg, M. (1965). Society and the adolescent self-image. New Jersey: Princeton University Press.

    Google Scholar 

  • Rudd, M. D., Joiner, T., & Rajab, M. H. (1996). Relationship among suicide ideators, attempts, and multiple attempters in a young-adult sample. Journal of Abnormal Psychology, 105, 541–550.

    Article  PubMed  CAS  Google Scholar 

  • Ryan, N. (2005). Treatment of depression in children and adolescents. The Lancet, 366, 933–940.

    Article  CAS  Google Scholar 

  • Sadowski, C., & Kelley, M. L. (1993). Social problem solving in suicidal adolescents. Journal of Consulting and Clinical Psychology, 61, 121–127.

    Article  PubMed  CAS  Google Scholar 

  • Şahin, N., Şahin, N. H., & Heppner, P. P. (1993). Psychometric properties of the problem solving inventory in a group of Turkish university students. Cognitive Therapy and Research, 17, 379–396.

    Article  Google Scholar 

  • Salkovskis, P. M., Atha, C., & Storer, D. (1990). Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide: A controlled trial. British Journal of Psychiatry, 157, 871–876.

    Article  PubMed  CAS  Google Scholar 

  • Schichor, A., Bernstein, B., & King, S. (1994). Self-reported depressive symptoms in inner-city adolescents seeking routine health care. Adolescence, 29, 379–388.

    PubMed  CAS  Google Scholar 

  • Schotte, D. E., & Clum, G. A. (1987). Problem-solving skills in suicidal psychiatric patients. Journal of Consulting and Clinical Psychology, 55, 49–54.

    Article  PubMed  CAS  Google Scholar 

  • Shaw, B., Vallis, M., & McCabe, S. (1985). The assessment of the severity and symptom patterns in depression. In E. Beckham & W. Leber (Eds.), Handbook of Depression. Homewood, IL: Dorsey Press.

    Google Scholar 

  • Sourander, A., Helstelä, L., Haavisto, A., & Bergroth, L. (2001). Suicidal thoughts and attempts among adolescents: A longitudinal 8-year follow-up study. Journal of Affective Disorders, 63, 59–66.

    Article  PubMed  CAS  Google Scholar 

  • Speckens, A. E. M., & Hawton, K. (2005). Social problem solving in adolescents with suicidal behavior: A systematic review. Suicide and Life-Threatening Behavior, 35, 365–387.

    Article  PubMed  Google Scholar 

  • Spence, S. H., Sheffield, J. K., & Donovan, C. L. (2003). Preventing adolescent depression: An evaluation of the problem solving for life program. Journal of Consulting and Clinical Psychology, 71, 3–13.

    Article  PubMed  Google Scholar 

  • Steinhausen, H. C., Haslimeier, C., & Winkler-Metzke, C. (2006). The outcome of episodic versus persistent adolescent depression in young adulthood. Journal of Affective Disorders, 96, 49–57.

    Article  PubMed  Google Scholar 

  • Thompson, E. A., Mazza, J. J., Herting, J. R., Randell, B. P., & Eggert, L. L. (2005). The mediating roles of anxiety, depression, and hopelessness on adolescent suicidal behaviors. Suicide and Life-Threatening Behavior, 35, 14–34.

    Article  PubMed  Google Scholar 

  • Townsend, E., Hawton, K., Altman, D. G., Arensman, E., Gunnell, D., Hazell, P., et al. (2001). The efficacy of problem-solving treatments after deliberate self-harm: Meta-analysis of randomized controlled trials with respect to depression, hopelessness and improvements in problems. Psychological Medicine, 31, 979–988.

    Article  PubMed  CAS  Google Scholar 

  • Wilcox, H. C., & Anthony, J. C. (2004). Child and adolescent clinical features as forerunners of adult-onset major depressive disorder: Retrospective evidence from an epidemiological sample. Journal of Affective Disorders, 82, 9–20.

    Article  PubMed  Google Scholar 

  • Wild, L. G., Flisher, A. J., & Lombard, C. (2004). Suicidal ideation and attempts in adolescents: Associations with depression and six domains of self-esteem. Journal of Adolescence, 27, 611–624.

    Article  PubMed  Google Scholar 

  • Wohlfarth, T. D., Zwieten, B. J., Lekkerkerker, F. J., Wied, C. C. G., Ruis, J. R., Elferink, A. J. A., et al. (2006). Antidepressants use in children and adolescents and the risk of suicide. European Neuropsychopharmacology, 16, 79–83.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to offer their deep appreciation to Dr. Rick E. Ingram (Editor) and the two anonymous reviewers for their valuable comments and suggestions.

Author information

Authors and Affiliations

  1. Department of Psychiatry, School of Medicine, Adnan Menderes University, Aydin, Turkey

    Mehmet Eskin

  2. NP Hospital, Istanbul, Turkey

    Kamil Ertekin

  3. Middle East Technical University Health Center, Ankara, Turkey

    Hadiye Demir

Authors
  1. Mehmet Eskin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kamil Ertekin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hadiye Demir
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehmet Eskin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eskin, M., Ertekin, K. & Demir, H. Efficacy of a Problem-Solving Therapy for Depression and Suicide Potential in Adolescents and Young Adults. Cogn Ther Res 32, 227–245 (2008). https://doi.org/10.1007/s10608-007-9172-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-007-9172-8

Keywords

Search

Navigation