Depressive Disorder Clinical Trial
Official title:
Family-based Treatment of Depressed Adolescents: An Empirical Study With Norwegian Adolescents in Specialty Mental Health Care
Major depressive disorder (MDD) affects about 5% of adolescents and is on the rise both
internationally and in Norway. Further, it is also associated with increased risk for
suicide. Not surprisingly, depression is the largest reason for referral to specialty mental
health services for adolescents (13-17 years) in Norway. Although anti-depressants and
Cognitive behavioral therapy are strong treatments and have received extensive research, the
best treatments show a recovery rate of only 37 %.
There is a need to develop and test alternative treatments that can stand alone or augment
anti-depressant medication. Family factors play an important role in the etiology,
maintenance and relapse of depression. A promising family-based treatment (Attachment based
family therapy- ABFT) was imported to Norway and its feasibility tested in a pilot randomized
clinical trial with 20 families. The results showed promising treatment outcomes. Although
the developers of the model have refined, adapted the model to suicidal ideation and built
strong technology to support dissemination, a definitive study of ABFT for adolescents with
major depression has not yet been conducted. Therefore the primary aim of this study is to
test if ABFT is more effective that enhanced usual care (EUC) to treat clinic-referred
adolescents with major depression. The investigators will test the hypothesis that 12 weeks
of ABFT therapy will produce a greater proportion of adolescents report remission from
depression and symptom change than 12 weeks of enhanced clinical care (EUC). Secondary
research aims are i) to test a hypothesis that parent-adolescent conflict will be more
sensitive to change for adolescents receiving ABFT that adolescents receiving EUC ii) to
explore patterns of change in suicidal ideation in the recruited sample in the acute-phase
treatment.
Central challenges to the study are i) blinding therapists/patients, which is difficult in
psychotherapy trials ii) lack of a standardized control condition, and iii) selecting and
training regular staff therapists to high adherence levels. However, with tighter control
over these factors than is normal for a typical effectiveness trial, the investigators expect
results to show what to expect under the "best of conditions" in community clinics. Benchmark
derived from the study will inform how to effectively train therapists and subsequently
implement the model into mainstream services.
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