Concurrent treatment for adolescent and parent depressed mood and suicidality: feasibility, acceptability, and preliminary findings

Abstract

Objective: The purpose of this study was to conduct a treatment development study to examine the feasibility, acceptability, and preliminary efficacy of treating depressed, suicidal adolescents and their depressed parent concurrently in a cognitive behavioral therapy (CBT) protocol (Parent-Adolescent-CBT [PA-CBT]).

Methods: A randomized, controlled, repeated measures design was used to test the hypothesis that PA-CBT would lead to greater reductions in suicidality and depression compared with Adolescent Only CBT (AO-CBT). Participants included 24 adolescent and parent dyads in which the adolescent met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for current major depressive episode (MDE) and the parent met DSM-IV criteria for current or past MDE.

Results: The concurrent protocol was found to be feasible to implement with most depressed adolescents and parents. Adolescent ratings of program satisfaction were somewhat lower in PA-CBT, suggesting that some teens view treatment negatively when they are required to participate with a parent. The concurrent treatment protocol was more effective in reducing depressed mood in the parent-adolescent dyad at the end of maintenance treatment (24 weeks) than treating an adolescent alone for depression; the largest effect was on parental depressed mood. This difference between dyads was no longer significant, however, at the 48 week follow-up. Adolescent and parent suicidal ideation improved equally in both groups during active and maintenance treatment, and remained low at follow-up in both groups.

Conclusions: The PA-CBT protocol is feasible to conduct and acceptable to most but not all adolescents. The strongest effect was on parental depressed mood. A larger study that has sufficient power to test efficacy and moderators of treatment outcome is necessary to better understand which adolescents would benefit most from concurrent treatment with a parent.

FIG. 1.

Adolescent and parent outcomes on the Beck Suicide Scale (BSS) by treatment condition at baseline, mid-treatment, end of treatment, and 6 month posttreatment follow-up. BSS scores significantly decreased over the course of treatment, but there were no differences between treatment conditions. AO-CBT, adolescent only cognitive behavioral therapy condition; PA-CBT, parent and adolescent concurrent cognitive behavioral therapy condition.

FIG. 2.

Adolescent and parent outcomes on the Beck Depression Inventory (BDI) by treatment condition at baseline, midtreatment, end of treatment, and 6 month posttreatment follow-up. PA-CBT dyads had significantly greater reductions in BDI total scores over time than did AO-CBT participants. AO-CBT, adolescent only cognitive behavioral therapy condition; PA-CBT, parent and adolescent concurrent cognitive behavioral therapy condition.