Rognli Erling W, Waraan Luxsiya, Czajkowski Nikolai O, Aalberg Marianne
Department of Psychology, University of Oslo, Norway.
Department of Child and Adolescent Mental Health Services, Akershus University Hospital, Norway.
Scand J Child Adolesc Psychiatr Psychol. 2020 Sep 3;8:110-122. doi: 10.21307/sjcapp-2020-011. eCollection 2020.
Conflict with parents is frequent in adolescent depression, and has been shown to predict poor treatment outcomes. Attachment Based Family Therapy (ABFT) is a manualised treatment for adolescent depression that may be robust to parent-adolescent conflict.
To evaluate the hypothesis that parent-adolescent conflict moderates the outcome of Attachment-Based Family Therapy compared with treatment as usual.
Data were obtained from a randomised trial comparing 16 weeks of ABFT to treatment as usual, in Norwegian Child and Adolescent Mental Health Services. Sixty adolescents with moderate to severe depression and their parents were recruited. Change in Grid-Hamilton Depression Rating Scale scores from baseline to week 16 was modelled using linear mixed models, and a three-way interaction of time, treatment allocation and a continuous measure of parent-adolescent conflict was fitted to estimate a moderator effect. The moderator model was compared to simpler models using leave-one-out cross-validation.
Better outcomes were predicted for Attachment-Based Family Therapy at high levels of mother-adolescent conflict, and for treatment as usual at low levels of mother-adolescent conflict, giving preliminary support to the moderator hypothesis. Findings for father-adolescent conflict were mixed. Cross-validation did not clearly support the moderator model over a simple effect of time, indicating that the replicability of these findings is uncertain.
The results suggest that parent-adolescent conflict should be further studied as a moderator of outcome in Attachment-Based Family Therapy. The trial did not meet its recruitment target and had high attrition, limiting the conclusions that may be drawn.
在青少年抑郁症中，与父母的冲突很常见，并且已被证明可预测治疗效果不佳。基于依恋的家庭治疗（ABFT）是一种针对青少年抑郁症的手册化治疗方法，可能对亲子冲突具有较强的适应性。
评估与常规治疗相比，亲子冲突是否会调节基于依恋的家庭治疗的效果这一假设。
数据来自挪威儿童和青少年心理健康服务机构的一项随机试验，该试验将16周的ABFT与常规治疗进行比较。招募了60名患有中度至重度抑郁症的青少年及其父母。使用线性混合模型对从基线到第16周的格里德 - 汉密尔顿抑郁评定量表得分变化进行建模，并拟合时间、治疗分配和亲子冲突连续测量值的三向交互作用以估计调节效应。使用留一法交叉验证将调节模型与更简单的模型进行比较。
在亲子冲突程度较高时，基于依恋的家庭治疗的效果更佳；在亲子冲突程度较低时，常规治疗的效果更佳，这为调节假设提供了初步支持。关于父子冲突的结果则好坏参半。交叉验证并未明确支持调节模型优于简单的时间效应，这表明这些结果的可重复性尚不确定。
结果表明，应进一步研究亲子冲突作为基于依恋的家庭治疗效果调节因素的作用。该试验未达到招募目标且流失率高，限制了可得出的结论。
