Tompson Martha C, Sugar Catherine A, Langer David A, Asarnow Joan R
Boston University.
University of California-Los Angeles Semel Institute for Neuroscience and Human Behavior.
J Am Acad Child Adolesc Psychiatry. 2017 Jun;56(6):515-523. doi: 10.1016/j.jaac.2017.03.018. Epub 2017 Apr 7.
Despite the morbidity and negative outcomes associated with early-onset depression, few studies have examined the efficacy of psychosocial treatment for depressive disorders during childhood. Integrating family in treatment could have particularly salutary effects during this developmental period. This trial compared immediate posttreatment effects of family-focused treatment for childhood depression (FFT-CD) with those of individual supportive psychotherapy (IP) for children 7 to 14 years old with depressive disorders.
Children were randomized to 15 sessions of FFT-CD (n = 67) or IP (n = 67) over 4 months. The primary treatment outcome was adequate clinical depression response, defined as at least a 50% decrease in score on the Children's Depression Rating Scale-Revised (CDRS-R). Additional outcomes included patient-centered outcomes (parent- and child-reported treatment satisfaction), remission (defined as CDRS-R score ≤28), change in continuous CDRS-R score, and change in child and parent reports of depressive and non-depressive symptoms and social adjustment.
Significant improvement was evident across groups for depressive and non-depressive symptoms, global response, and functioning and social adjustment. Compared with children randomized to IP, children randomized to FFT-CD showed higher rates of adequate clinical depression response (77.7% versus 59.9%; number needed to treat = 5.72; odds ratio 2.29; 95% CI 1.001-5.247; t = 1.97, p = .0498). Across treatments, families reported high satisfaction; compared with IP families, FFT-CD families reported greater knowledge and skills for managing depression. There were no significant differences between treatment arms on secondary outcomes.
Results support the value of psychosocial intervention, emphasize the important role that families play, and highlight the potential for FFT-CD for supporting recovery in children with depression. Clinical trial registration information-Systems of Support Study for Childhood Depression; http://clinicaltrials.gov; NCT01159041.
尽管早发性抑郁症会导致发病并产生不良后果，但很少有研究探讨儿童期抑郁症的心理社会治疗效果。在这个发育阶段，将家庭纳入治疗可能会产生特别有益的效果。本试验比较了以家庭为中心的儿童抑郁症治疗（FFT-CD）与个体支持性心理治疗（IP）对7至14岁抑郁症儿童的即时治疗后效果。
将儿童随机分为两组，在4个月内接受15次FFT-CD治疗（n = 67）或IP治疗（n = 67）。主要治疗结果是临床抑郁症反应充分，定义为儿童抑郁评定量表修订版（CDRS-R）得分至少降低50%。其他结果包括以患者为中心的结果（家长和儿童报告的治疗满意度）、缓解（定义为CDRS-R得分≤28）、CDRS-R连续得分的变化，以及儿童和家长报告的抑郁和非抑郁症状及社会适应的变化。
各治疗组在抑郁和非抑郁症状、总体反应以及功能和社会适应方面均有显著改善。与随机接受IP治疗的儿童相比，随机接受FFT-CD治疗的儿童临床抑郁症反应充分的比例更高（77.7%对59.9%；治疗所需人数=5.72；优势比2.29；95%置信区间1.001-5.247；t = 1.97，p = 0.0498）。在所有治疗中，家庭报告的满意度都很高；与接受IP治疗的家庭相比，接受FFT-CD治疗的家庭报告在管理抑郁症方面有更多的知识和技能。各治疗组在次要结果上没有显著差异。
结果支持心理社会干预的价值，强调家庭所起的重要作用，并突出了FFT-CD在支持抑郁症儿童康复方面的潜力。临床试验注册信息——儿童抑郁症支持研究系统；http://clinicaltrials.gov；NCT01159041。
