Abstract
BackgroundThere is increasing community and government recognition of the magnitude and impact of adolescent depression. Family based interventions have significant potential to address known risk factors for adolescent depression and could be an effective way of engaging adolescents in treatment. The evidence for family based treatments of adolescent depression is not well developed. The objective of this clinical trial is to determine whether a family based intervention can reduce rates of unipolar depressive disorders in adolescents, improve family functioning and engage adolescents who are reluctant to access mental health services.Methods/DesignThe Family Options study will determine whether a manualized family based intervention designed to target both individual and family based factors in adolescent depression (BEST MOOD) will be more effective in reducing unipolar depressive disorders than an active (standard practice) control condition consisting of a parenting group using supportive techniques (PAST). The study is a multicenter effectiveness randomized controlled trial. Both interventions are delivered in group format over eight weekly sessions, of two hours per session. We will recruit 160 adolescents (12 to 18 years old) and their families, randomized equally to each treatment condition. Participants will be assessed at baseline, eight weeks and 20 weeks. Assessment of eligibility and primary outcome will be conducted using the KID-SCID structured clinical interview via adolescent and parent self-report. Assessments of family mental health, functioning and therapeutic processes will also be conducted. Data will be analyzed using Multilevel Mixed Modeling accounting for time x treatment effects and random effects for group and family characteristics. This trial is currently recruiting. Challenges in design and implementation to-date are discussed. These include diagnosis and differential diagnosis of mental disorders in the context of adolescent development, non-compliance of adolescents with requirements of assessment, questionnaire completion and treatment attendance, breaking randomization, and measuring the complexity of change in the context of a family-based intervention.Trial registrationAustralia and New Zealand Clinical Trials Registry Title: engaging youth with high prevalence mental health problems using family based interventions; number 12612000398808. Prospectively registered on 10 April 2012.
Highlights
There is increasing community and government recognition of the magnitude and impact of adolescent depression
Adolescent suicide victims are approximately six and a half times more likely to have been struggling with alcohol or drug abuse, and 27 times more likely to have been suffering from a major depressive disorder at the time of their death; compared with demographically matched community control participants [7]
Both interventions are for families of youth who present with a unipolar mood disorder, here defined as major or minor adolescent depression or dysthymia
Summary
There is increasing community and government recognition of the magnitude and impact of adolescent depression in Australia and worldwide. Adolescent suicide victims are approximately six and a half times more likely to have been struggling with alcohol or drug abuse, and 27 times more likely to have been suffering from a major depressive disorder at the time of their death; compared with demographically matched community control participants [7] These multifaceted and complex mental health problems, occurring within a developmental context and interacting with family factors, means that the traditional mental health service delivery and intervention models have limited success. The current randomized controlled trial was designed to evaluate the capacity of family based interventions to: i) reduce the depressive symptoms of young people (12 to 18 years) and improve the mental health of their parents; ii) engage adolescents reluctant to use mental health services individually by working therapeutically with the whole family unit; and (iii) improve family functioning in the context of adolescent depression. This paper describes the design of an RCT to evaluate BEST MOOD
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