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Randomized Controlled Trial
. 2014 Jul;53(7):726-35.
doi: 10.1016/j.jaac.2014.04.014. Epub 2014 May 10.

Randomized efficacy trial of two psychotherapies for depression in youth with inflammatory bowel disease

Eva Szigethy  1 , Simona I Bujoreanu  2 , Ada O Youk  3 , John Weisz  4 , David Benhayon  3 , Diane Fairclough  5 , Peter Ducharme  2 , Joseph Gonzalez-Heydrich  2 , David Keljo  3 , Arvind Srinath  3 , Athos Bousvaros  2 , Margaret Kirshner  3 , Melissa Newara  3 , David Kupfer  3 , David R DeMaso  2
Affiliations
Randomized Controlled Trial

Randomized efficacy trial of two psychotherapies for depression in youth with inflammatory bowel disease

Eva Szigethy et al. J Am Acad Child Adolesc Psychiatry. 2014 Jul.

Abstract

Objective: Pediatric inflammatory bowel disease (IBD) is associated with high rates of depression. This study compared the efficacy of cognitive behavioral therapy (CBT) to supportive nondirective therapy (SNDT) in treating youth with comorbid IBD and depression.

Method: Youth (51% female and 49% male; age 9-17 years, mean age 14.3 years) with depression and Crohn's disease (n = 161) or ulcerative colitis (n = 56) were randomly assigned to a 3-month course of CBT or SNDT. The primary outcome was comparative reduction in depressive symptom severity; secondary outcomes were depression remission, increase in depression response, and improved health-related adjustment and IBD activity.

Results: A total of 178 participants (82%) completed the 3-month intervention. Both psychotherapies resulted in significant reductions in total Children's Depression Rating Scale Revised score (37.3% for CBT and 31.9% for SNDT), but the difference between the 2 treatments was not significant (p = .16). There were large pre-post effect sizes for each treatment (d = 1.31 for CBT and d = 1.30 for SNDT). More than 65% of youth had a complete remission of depression at 3 months, with no difference between CBT and SNDT (67.8% and 63.2%, respectively). Compared to SNDT, CBT was associated with a greater reduction in IBD activity (p = .04) but no greater improvement on the Clinical Global Assessment Scale (p = .06) and health-related quality of life (IMPACT-III scale) (p = .07).

Conclusion: This is the first randomized controlled study to suggest improvements in depression severity, global functioning, quality of life, and disease activity in a physically ill pediatric cohort treated with psychotherapy. Clinical trial registration information-Reducing Depressive Symptoms in Physically Ill Youth; http://clinical trials.gov; NCT00534911.

Keywords: depression; inflammatory bowel disease; physical illness; psychotherapy; quality of life.

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Figures

Figure 1
Figure 1
Recruitment of youth with inflammatory bowel disease (IBD) for randomized efficacy trial of cognitive behavioral therapy (CBT) and supportive non-directive therapy (SNDT) for depression. Note: CDI = Child Depression Inventory; KSADS = Kiddie-Schedule for Affective Disorders and Schizophrenia for Children.
See this image and copyright information in PMC

Comment in

  • Inflammatory depressive bowel diseases: the new era.
    Shemesh E, Gabbay V. Shemesh E, et al. J Am Acad Child Adolesc Psychiatry. 2014 Jul;53(7):720-2. doi: 10.1016/j.jaac.2014.03.010. J Am Acad Child Adolesc Psychiatry. 2014. PMID: 24954820 Free PMC article. No abstract available.

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