Social problem-solving among adolescents treated for depression

Abstract

Studies suggest that deficits in social problem-solving may be associated with increased risk of depression and suicidality in children and adolescents. It is unclear, however, which specific dimensions of social problem-solving are related to depression and suicidality among youth. Moreover, rational problem-solving strategies and problem-solving motivation may moderate or predict change in depression and suicidality among children and adolescents receiving treatment. The effect of social problem-solving on acute treatment outcomes were explored in a randomized controlled trial of 439 clinically depressed adolescents enrolled in the Treatment for Adolescents with Depression Study (TADS). Measures included the Children's Depression Rating Scale-Revised (CDRS-R), the Suicidal Ideation Questionnaire--Grades 7-9 (SIQ-Jr), and the Social Problem-Solving Inventory-Revised (SPSI-R). A random coefficients regression model was conducted to examine main and interaction effects of treatment and SPSI-R subscale scores on outcomes during the 12-week acute treatment stage. Negative problem orientation, positive problem orientation, and avoidant problem-solving style were non-specific predictors of depression severity. In terms of suicidality, avoidant problem-solving style and impulsiveness/carelessness style were predictors, whereas negative problem orientation and positive problem orientation were moderators of treatment outcome. Implications of these findings, limitations, and directions for future research are discussed.

Figure 1

Mean SIQ scores at week 12 Note. SIQ scores are adjusted for the fixed (treatment, time, treatment-by-time, site) and random effects (patient, patient-by-time) included in the random coefficients regression model. High NPO was defined as a negative problem orientation scale score greater than or equal to 20 on the Social Problem-Solving Inventory – Revised.

Figure 2

Mean SIQ scores at week 12 Note. SIQ scores are adjusted for the fixed (treatment, time, treatment-by-time, site) and random effects (patient, patient-by-time) included in the random coefficients regression model. High PPO was defined as a positive problem orientation scale score greater than or equal to 8 on the Social Problem-Solving Inventory – Revised.