Dysfunctional attitudes scale perfectionism: a predictor and partial mediator of acute treatment outcome among clinically depressed adolescents

Abstract

The effect of perfectionism on acute treatment outcomes was explored in a randomized controlled trial of 439 clinically depressed adolescents (12-17 years of age) enrolled in the Treatment for Adolescents with Depression Study (TADS) who received cognitive behavior therapy (CBT), fluoxetine, a combination of CBT and FLX, or pill placebo. Measures included the Children's Depression Rating Scale-Revised, the Suicidal Ideation Questionnaire-Grades 7-9, and the perfectionism subscale from the Dysfunctional Attitudes Scale (DAS). Predictor results indicate that adolescents with higher versus lower DAS perfectionism scores at baseline, regardless of treatment, continued to demonstrate elevated depression scores across the acute treatment period. In the case of suicidality, DAS perfectionism impeded improvement. Treatment outcomes were partially mediated by the change in DAS perfectionism across the 12-week period.

FIGURE 1

Change in Dysfunctional Attitudes Scale Perfectionism subscale scores (DAS) over 12 weeks of treatment. Note: Base = baseline; COMB = CBT and fluoxetine; FLX = fluoxetine; CBT = cognitive behavior therapy; PBO = pill placebo; Wk = week.

FIGURE 2

Children’s Depression Rating Scale–Revised (CDRS–R) total scores adjusted for Dysfunctional Attitudes Scale perfectionism change scores. Note: Base = baseline; COMB = CBT and fluoxetine; FLX = fluoxetine; CBT = cognitive behavior therapy; PBO = pill placebo; Wk = week.

FIGURE 3

The Suicidal Ideation Questionnaire Grades 7–9 total score (SIQ-Jr) adjusted for Dysfunctional Attitudes Scale perfectionism change scores. Note: Base = baseline; COMB = CBT and fluoxetine; FLX = fluoxetine; CBT = cognitive behavior therapy; PBO = pill placebo; Wk = week.