Depressive symptoms and clinical status during the Treatment of Adolescent Suicide Attempters (TASA) Study

Abstract

Objective: To examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide.

Method: Adolescents (N = 124), ages 12 to 18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating Scale-Revised (CDRS-R) score of 36 or higher, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission rates were computed with the last observation carried forward.

Results: Most patients (n = 104 or 84%) chose treatment assignment, and overall, three fourths (n = 93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12 and to 27.0 (10.1) at week 24 (p < .0001), with a Clinical Global Impression -defined improvement rate of 58.0% at week 12 and 72.2% at week 24 and a remission (CDRS-R ≤ 28) rate of 32.5% at week 12 and 50.0% at week 24. The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline (r = 0.43, p < .0001) and declined in parallel.

Conclusions: When vigorously treated with a combination of medication and psychotherapy, adolescents with depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression.

Figure 1. Child Depression Rating Scale-Revised Scores Over Time^a

CBT: cognitive-behavioral therapy (N=17). Med: algorithmic SSRI medication treatment (N=14). Comb: combination of CBT and Med (N=93). ^aAdjusted means based on mixed effects regression models of the independent evaluator ratings. Seventeen patients completed treatment after the end of the 6 months. Mixed-model regression model: time: F=91.0, p<0.0001; treatment group differences at baseline: F=4.3, p=0.001 (COMB>CBT, Med); treatment*time: F=0.93, p=0.40.