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Am Fam Physician. 2005;71(7):1410-1412

Adolescent depression is a common mental health issue in the United States. If left untreated, it can lead to school dropout, teenage pregnancy, suicide, and substance abuse. In addition, depression increases health care costs in this age group. Unfortunately, a significant number of adolescents who need mental health treatment receive none. Because of the large gap between the need for mental health services and use of these services, various school-based programs have been developed as treatment options. Effective treatments for depression in this age group include selective serotonin reuptake inhibitors, cognitive behavior therapy, interpersonal psychotherapy, and group therapy. Most studies of these therapies have been done in medical centers under controlled conditions. Mufson and associates evaluated the impact of interpersonal psychotherapy modified for depressed adolescents in school-based health clinics.

The trial was a randomized study of adolescents who were referred to school-based mental health clinicians. Those who participated were randomly assigned to receive interpersonal psychotherapy or usual care. The interpersonal psychotherapy was done in 12 sessions over 12 to 16 weeks and focused on the current problems of the adolescent. It was performed by a mental health worker who had specific training in this form of psychotherapy. The adolescents in the usual-care group were treated by a mental health worker who had not received special training in interpersonal psychotherapy. To participate, the adolescents had to have scores of 10 or higher on the Hamilton Depression Rating Scale and a score of 65 or lower on the Children’s Global Assessment Scale. They also had to meet the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., criteria for major depression, dysthymia, adjustment disorder with depressed mood, or depressive disorder not otherwise specified. The participants were evaluated at baseline and weeks 4, 8, 12, and 16 of the study. The evaluation included multiple scales for depression and global and social functioning. These assessments were performed by persons who were blinded to the participant’s treatment assignment.

Thirty-four adolescents participated in the interpersonal psychotherapy group, and 29 received usual care. The interpersonal psychotherapy group had fewer clinician-reported depression symptoms on the Hamilton Depression Scale compared with the usual-care group. At weeks 8 and 12, a significant difference was noted in depression scale scores between the treatment groups, although this difference was not present at week 4. In addition, adolescents who received interpersonal psychotherapy had significantly better global and social functioning compared with the usual-care group. The interpersonal therapy group had a significantly greater clinical improvement and greater reduction in clinical symptom severity.

The authors conclude that interpersonal psychotherapy delivered by school-based health clinics can effectively treat adolescent depression. They add that this program is a viable and effective model for organizing treatment delivery in the adolescent population and in a school-based setting.

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Copyright © 2005 by the American Academy of Family Physicians.

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