CBT, short-term psychoanalytic psychotherapy and brief interventions are all effective for adolescent depression. This summary of an NIHR-funded study includes an online self-assessment to test your understanding of the research
Depression occurs in 1-3% of children and young people in the UK. It increases the risk of suicide and failure to achieve, and is associated with chronic mental health problems.
This NIHR-funded randomised controlled trial aimed to compare outcomes of three evidence-based psychological therapies: cognitive behavioural therapy (CBT), short-term psychoanalytic psychotherapy or a brief psychosocial intervention.
The researchers recruited 557 participants aged 11-17 years from 15 NHS clinics in the UK; 465 were included in analysis. Uptake and attendance proved difficult and nearly a quarter did not complete their treatment plan. Symptoms were assessed at 52 weeks or 86 weeks after finishing one of the three therapies.
The study found no difference in outcomes between CBT and short-term psychoanalysis compared with the brief intervention. All three groups had an overall improvement in depression scores by 86 weeks, although around a quarter of participants had indication of unipolar major depression 18 months after treatment started, indicating that current interventions may not be effective in sustaining reductions in depression. The differences between therapies were not statistically significant due to the small sample.
The cost of treatment did not differ significantly between the three therapies so thinking about which is practical and preferred by the adolescent should be the main consideration. This may help improve attendance and treatment adherence.
Jenny Pinfield, programme lead, pre-registration nursing, University of Worcester
Nurses have a vital role in the detection, diagnosis and management of depression in young people, with timely intervention and treatment linked with a decrease in depressive symptoms. However, non-concordance with treatment is a recognised concern leading to increased rates of readmission to hospital and negative consequences for the patient.
The three psychological interventions compared in this study are all equally effective in reducing depressive symptoms one year post-treatment, and have similar resource implications. These findings suggest young people could be given a choice of treatment, which has the potential to increase concordance with treatment. Nurses are in an ideal position to discuss the implications of the different psychological interventions with young people and their families, taking account of their expectations and ensuring informed consent is given.
Further research is needed into the reasons for non-concordance and selecting the best treatment for individual young people.
Implications for nursing
- Treatments for depression in adolescents need to be effective in the long term, to reduce their risk of mental health problems in adulthood
- CBT, short-term psychoanalytic psychotherapy or a brief intervention appear equally likely to lead to a sustained reduction in depressive symptoms 12 months after therapy
- The antidepressant fluoxetine and a psychological therapy together can be considered; another option is to start with psychological therapy only, progressing to combined therapy if the young person is not responding
- Offering a choice of therapy could improve attendance and concordance, which was a challenge in this study
- A quarter of the participants still had major depression 86 weeks after therapy commenced. It is not clear whether these participants had engaged with therapy
- Identifying barriers to and facilitators of concordance should be a priority when working with this patient group
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- This article includes commentary from an independent expert that does not necessarily reflect the views of the NHS, the NIHR or the Department of Health.
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