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Effectiveness and cost effectiveness of cognitive behavioral therapy (CBT) in clinically depressed adolescents: individual CBT versus treatment as usual (TAU).

Stikkelbroek Y, Bodden DH, Deković M, van Baar AL - BMC Psychiatry (2013)

Bottom Line: The targeted population is 140 clinically referred depressed adolescents aged 12 to 21 years old.Primary outcome measure is depression diagnosis based on a semi-structured interview namely the K-SADS-PL.Secondary outcome measures include depressive symptoms, severity and improvement of the depression, global functioning, quality of life, suicide risk, comorbidity, alcohol and drug use, parental depression and psychopathology, parenting and conflicts.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Child and Adolescent Studies, Utrecht University, PO Box 80,140, NL-3508 TC Utrecht, Netherlands. Y.Stikkelbroek@uu.nl.

ABSTRACT

Background: Depressive disorders occur in 2 to 5% of the adolescents and are associated with a high burden of disease, a high risk of recurrence and a heightened risk for development of other problems, like suicide attempts. The effectiveness of cognitive behaviour therapy (CBT), cost-effectiveness of this treatment and the costs of illness of clinical depression in adolescents are still unclear. Although several Randomized Controlled Trials (RCT) have been conducted to establish the efficacy of CBT, the effectiveness has not been established yet. Aim of this study is to conduct a RCT to test the effectiveness of CBT and to establish the cost-effectiveness of CBT under rigorous conditions within routine care provided by professionals already working in mental health institutions.

Method/design: CBT is investigated with a multi-site, RCT using block randomisation. The targeted population is 140 clinically referred depressed adolescents aged 12 to 21 years old. Adolescents are randomly assigned to the experimental (N = 70, CBT) or control condition (N = 70, TAU). Four assessments (pre, post, follow up at 6 and 12 months) and two mediator assessments during treatment are conducted. Primary outcome measure is depression diagnosis based on a semi-structured interview namely the K-SADS-PL. Secondary outcome measures include depressive symptoms, severity and improvement of the depression, global functioning, quality of life, suicide risk, comorbidity, alcohol and drug use, parental depression and psychopathology, parenting and conflicts. Costs and treatment characteristics will also be assessed. Furthermore, moderator and mediator analyses will be conducted.

Discussion: This trial will be the first to compare CBT with TAU under rigorous conditions within routine care and with a complex sample. Furthermore, cost-effectiveness of treatment and cost-of-illness of clinical depression are established which will provide new insights on depression as a disorder and its treatment.

Trial registration: Dutch Trial register number NTR2676. The study was financially supported by a grant from ZonMw, the Netherlands organization for health research and development, grant number 157004005.

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Aims, conditions, potential moderators and mediators evaluated in this study.
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Figure 1: Aims, conditions, potential moderators and mediators evaluated in this study.

Mentions: The aim of this study is to investigate the effectiveness and the cost-effectiveness of the individual CBT program the “D(o)epression course” in a sample of referred adolescents with a Depressive Disorder according to DSM-IV-TR [25] in a randomized controlled trial. We expect that CBT will be more effective than TAU (without CBT). Furthermore, cost-effectiveness of CBT and the cost of illness of clinical depression in adolescents will be established. Potential moderators (comorbidity, severity of depression, age, ethnicity, gender, suicidal thoughts and psychopathology in parents) and mediators (negative automatic thoughts, cognitive emotion regulation and attribution style) for the effectiveness of CBT will be studied. The role of non-specific treatment variables (therapeutic alliance, client expectancy, client satisfaction, treatment adherence) will be taken into account as well (see Figure 1).


Effectiveness and cost effectiveness of cognitive behavioral therapy (CBT) in clinically depressed adolescents: individual CBT versus treatment as usual (TAU).

Stikkelbroek Y, Bodden DH, Deković M, van Baar AL - BMC Psychiatry (2013)

Aims, conditions, potential moderators and mediators evaluated in this study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222498&req=5

Figure 1: Aims, conditions, potential moderators and mediators evaluated in this study.
Mentions: The aim of this study is to investigate the effectiveness and the cost-effectiveness of the individual CBT program the “D(o)epression course” in a sample of referred adolescents with a Depressive Disorder according to DSM-IV-TR [25] in a randomized controlled trial. We expect that CBT will be more effective than TAU (without CBT). Furthermore, cost-effectiveness of CBT and the cost of illness of clinical depression in adolescents will be established. Potential moderators (comorbidity, severity of depression, age, ethnicity, gender, suicidal thoughts and psychopathology in parents) and mediators (negative automatic thoughts, cognitive emotion regulation and attribution style) for the effectiveness of CBT will be studied. The role of non-specific treatment variables (therapeutic alliance, client expectancy, client satisfaction, treatment adherence) will be taken into account as well (see Figure 1).

Bottom Line: The targeted population is 140 clinically referred depressed adolescents aged 12 to 21 years old.Primary outcome measure is depression diagnosis based on a semi-structured interview namely the K-SADS-PL.Secondary outcome measures include depressive symptoms, severity and improvement of the depression, global functioning, quality of life, suicide risk, comorbidity, alcohol and drug use, parental depression and psychopathology, parenting and conflicts.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Child and Adolescent Studies, Utrecht University, PO Box 80,140, NL-3508 TC Utrecht, Netherlands. Y.Stikkelbroek@uu.nl.

ABSTRACT

Background: Depressive disorders occur in 2 to 5% of the adolescents and are associated with a high burden of disease, a high risk of recurrence and a heightened risk for development of other problems, like suicide attempts. The effectiveness of cognitive behaviour therapy (CBT), cost-effectiveness of this treatment and the costs of illness of clinical depression in adolescents are still unclear. Although several Randomized Controlled Trials (RCT) have been conducted to establish the efficacy of CBT, the effectiveness has not been established yet. Aim of this study is to conduct a RCT to test the effectiveness of CBT and to establish the cost-effectiveness of CBT under rigorous conditions within routine care provided by professionals already working in mental health institutions.

Method/design: CBT is investigated with a multi-site, RCT using block randomisation. The targeted population is 140 clinically referred depressed adolescents aged 12 to 21 years old. Adolescents are randomly assigned to the experimental (N = 70, CBT) or control condition (N = 70, TAU). Four assessments (pre, post, follow up at 6 and 12 months) and two mediator assessments during treatment are conducted. Primary outcome measure is depression diagnosis based on a semi-structured interview namely the K-SADS-PL. Secondary outcome measures include depressive symptoms, severity and improvement of the depression, global functioning, quality of life, suicide risk, comorbidity, alcohol and drug use, parental depression and psychopathology, parenting and conflicts. Costs and treatment characteristics will also be assessed. Furthermore, moderator and mediator analyses will be conducted.

Discussion: This trial will be the first to compare CBT with TAU under rigorous conditions within routine care and with a complex sample. Furthermore, cost-effectiveness of treatment and cost-of-illness of clinical depression are established which will provide new insights on depression as a disorder and its treatment.

Trial registration: Dutch Trial register number NTR2676. The study was financially supported by a grant from ZonMw, the Netherlands organization for health research and development, grant number 157004005.

Show MeSH
Related in: MedlinePlus