1999 — 2001 |
Tompson, Martha C. |
R21Activity Code Description: To encourage the development of new research activities in categorical program areas. (Support generally is restricted in level of support and in time.) |
Family Treatment of Childhood Onset Depressive Disorders
While recent research has yielded advances in the psycho-social treatment of depression among adults, few studies have addressed adolescent depression and none have specifically targeted depressed pre-adolescents. Given that earlier onset may be associated with longer time to recovery and greater family history of affective disorders, development of effective treatments for depression in pre-adolescents children is critical. The goal of this project is to adapt family-focused intervention strategies, which have proven efficacy with adult mood disorders, to target school-aged children with depression. The project would consist of two phases. In the first phase, 10 children (ages 8-13) with a diagnosis of major depressive and/or dysthymic disorder (assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children) and their parents would participate in a treatment development phage, in which they would receive 8-10 sessions of a family based treatments using a preliminary treatment manual. Goals of treatment development include evaluating the utility of specific treatment components, designing flexible strategies for age-developmental level, developing specific procedures for addressing diagnostic co-morbidity, and determining appropriate treatment length. In the second phase, 24 children with major depressive and/or dysthymic disorders and their parents would participate in a small clinical trial and be randomly assigned to either family-focused treatment or a wait-list control group (to receive family-focused treatment after a three-month interval). Goals in Phase 2 include evaluating the relative efficacy of the new treatment (as compared to the control condition), assessing its impact on psycho-social functioning, and identifying variables potentially mediating treatment effects At study entry, immediately post-treatment (3 months) and at 6- and 12- month follow-up points, participants in both phases would undergo intensive evaluation of clinical state. Psycho-social functioning, cognitive processes, family functioning and environmental context. It is hypothesized that children receiving the family-focused intervention will demonstrate greater improvement in symptoms and psycho-social functioning and be more likely to recover from their depressive episodes than children in the comparison condition. Exploratory analyses will examine changes on potential mediating variables, particularly measures of family functioning.
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2004 — 2008 |
Tompson, Martha C. |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Families'and Children's Adjustment
[unreadable] DESCRIPTION (provided by applicant): Examining risk factors and mechanisms that contribute to vulnerability to psychopathology allows for exploration of underlying processes. Risk research distinguishes between risk factors, which increase the statistical likelihood of a disorder, and vulnerability factors, which are more proximal to the child and represent causal mechanisms in the chain of events leading to the onset of psychopathology. Risk factors for depression include both biological and environmental factors. Parent-proband and child-proband family studies demonstrate clustering of depression in families. Thus, parental depression represents a risk factor for depression in youth. Vulnerability factors for child depression have also been examined. Social information-processing models specify cognitive factors -- including a pessimistic explanatory style and negative cognitive errors -- as potential vulnerabilities; whereas, interpersonal/attachment models specify dysfunctional internal working models as potential vuinerabilities. Parental depression may increase depression vulnerability through a number of potential mechanisms, both biological and psychosocial. Psychosocial risk mechanisms include negative life events and family stress. [unreadable] [unreadable] Family expressed emotion (EE), a measure of family emotional climate, strongly predicts outcome among adults with mood disorders. More recent work indicates that depressed children may be particularly likely to live with a high EE parent; high EE predicts more negative one-year outcome in children following hospitalization for depression; and parental depression increases the likelihood that parents will be high EE. Thus, parental EE may represent one mechanism by which parental depression increases depression vulnerability; however, its' relationship to depression onset in youth has not yet been established. Only recently have researchers begun to explore the links between risk and vulnerability in child depression. Utilizing a longitudinal design in a sample of pre-adolescents with and without a depressed mother, we propose to examine the links between a known risk factor (parental depression), a potentially important psychosocial mechanism (EE), the development of cognitive-interpersonal vulnerability, and the manifestation of both depressive symptoms and disorders during a critical period in the development of coping and self-concept. [unreadable] [unreadable]
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2009 — 2013 |
Tompson, Martha C. |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
1/2-Two-Site Evaluation of Family Focused Treatment For Childhood Depression @ Boston University (Charles River Campus)
DESCRIPTION (provided by applicant): Childhood-onset depression is an impairing and often recurrent and persistent disorder that impacts current and later development resulting in high personal, social, and economic costs. Despite the costs of early-onset depression, the emphasis in current practice parameters on an initial course of psychosocial treatment, and extensive research on adolescent depression, we currently lack randomized controlled trials evaluating psychosocial treatments for children with depressive disorders. The present application aims to address this gap in knowledge regarding optimal psychosocial treatment strategies for children suffering from depressive disorders. We propose a 2-site randomized controlled trial to evaluate the efficacy of Family Focused Treatment (FFT), as compared to an individual client-centered psychotherapy (IP) modeled after "usual" community care. This application builds on and extends work conducted through our initial NIMH treatment development grant in which we developed and manualized the FFT and carried out a preliminary trial demonstrating that the FFT resulted in significant improvements in depression outcomes, global functioning, and reductions in parent reported internalizing, externalizing, and total problems, with gains persisting and strengthening by the 9-month post-treatment follow-up. FFT adopts an interpersonal model for understanding how depressive symptoms are maintained, emphasizes developing family skills/strategies for altering interpersonal processes, and works on building a family environment that supports recovery and enhances stress resistance and resilience. This approach may be particularly appropriate to the developmental needs of depressed children, given their dependence on parents, the potential of FFT to address the needs of multiple family members, and our data supporting benefits on depression, functioning, and other co-occurring symptoms. The proposed project will enroll 140 children (ages 8-12) with depressive disorders (major depression and/or dysthymic disorder). Children will be randomly assigned to receive a 14-week trial of either FFT or IP. At study entry, immediately post-treatment, and at a 9-month post-treatment follow-up all participants will undergo intensive evaluation of clinical state and psychosocial and family functioning. We hypothesize that FFT will be associated with quicker recovery from depression, greater improvement in symptoms and psychosocial functioning, and reduction in associated symptoms/syndromes (anxiety and oppositional disorders). Follow-up evaluations will examine maintenance of treatment gains. Potential moderating (Expressed Emotion, presence of comorbid externalizing disorder) and mediating (family functioning, parental depression) variables will be evaluated. To enhance external validity and facilitate recruitment of a large, diverse sample, the study will be conducted at two sites -- Boston University and UCLA. Childhood-onset depression is an impairing and often recurrent and persistent disorder that impacts current and later development resulting in high social and economic costs, and development of efficacious treatments is of critical importance. Family-Focused Treatment (FFT), developed to specifically target depressed pre- adolescents and their families, presents an interpersonal model for understanding how depressive symptoms are maintained, emphasizes developing family skills/strategies for altering interpersonal processes, and works on building a family environment that supports recovery and enhances stress resistance and resilience. The goal of the current application is to conduct a randomized controlled trial of FFT for the treatment of depressed school-aged youth. PUBLIC HEALTH RELEVANCE: Childhood-onset depression is an impairing and often recurrent and persistent disorder that impacts current and later development resulting in high social and economic costs, and development of efficacious treatments is of critical importance. Family-Focused Treatment (FFT), developed to specifically target depressed pre- adolescents and their families, presents an interpersonal model for understanding how depressive symptoms are maintained, emphasizes developing family skills/strategies for altering interpersonal processes, and works on building a family environment that supports recovery and enhances stress resistance and resilience. The goal of the current application is to conduct a randomized controlled trial of FFT for the treatment of depressed school-aged youth.
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