Title: Examining the Role of Parent-Adolescent Interactions in the Treatment of Adolescents with Depression
Funder: Department of Health and Social Care

Abstract: Depression is one of the most common mental health problems in adolescents, with almost a quarter of all young people experiencing at least one episode of depression before they are 19 years old. Depression significantly impacts on educational achievement and social functioning, and it raises the risk for other mental health and general health problems, later unemployment and suicide. Cognitive Behaviour Therapy (CBT) is associated with good outcomes in some patients, but up to half of treated depressed adolescents show a poor response or do not engage in treatment. There is growing interest in the factors that may moderate or enhance the effects of available treatments, particularly the possible role of the family environment. Problems in parent-adolescent interactions that are associated with adolescent depression, such as conflict and lack of parental positivity towards their child, may work in direct opposition to the core objectives of CBT and reduce the efficacy of treatment. However, family interaction factors have not been systematically examined in relation to treatment response. Many parents want to be involved in supporting their child's recovery and including parents in treatment could increase treatment efficacy, but this has not been evaluated and it is unclear whether parental involement in treatment is indicated. The overall aim of this research proposal is to identify potential parent-adolescent behaviours that moderate treatment outcomes for depressed adolescents, to develop and adapt psychological treatment, and to conduct a feasibility study of an adapted new treatment. This constitutes the groundwork for a subsequent trial to evaluate the adapted treatment approach, and, potentially, to improve outcomes for depressed adolescents and reduce NHS costs.Specific aims of proposed study; 1) To explore whether parent-adolescent conflict and positive interactions are associated with the response of depressed adolescents to standard psychological treatment. 2) To develop the format and evaluate the acceptability and feasibility of a novel intervention adjunct to standard treatment for depressed adolescents. First, observational studies will be conducted with depressed adolescents. Interactions between adolescents and their parents will be assessed before standard treatment. Interactions will be measured using laboratory-based observations, as well as analysis of speech samples and standard questionnaires. Parent-adolescent interactions, which are correlated with better treatment outcomes will be identified and effect sizes examined. Second, a new intervention will be developed and the format and acceptability of the intervention with parents and depressed adolescents will be evaluated. The development of the intervention will be informed by a number of sources: the outcomes of the observational studies; a systematic review of depression interventions which involve parents; service user involvement; and the findings of a current qualitative study with parents of depressed adolescents. The format, acceptability and feasibility of the intervention will be examined using qualitative methods. Depression is a serious condition in adolescence with far reaching consequences. It is, therefore, of utmost importance that available treatments and the factors that limit their effectiveness are studied more rigorously. The proposed research includes a preliminary investigation of the family environment and interaction patterns that may be associated with poorer responses to treatment, and the development and preliminary evaluation of a targeted new intervention for adolecents with depression. The research has the potential to highlight modifications to existing interventions that are both evidence-based and readily accepted by families. The research provides the groundwork for a definitive trial with the ulitmate aim of benefiting NHS services through improved screening and more efficient and targeted treatment delivery for depressed adolescents.

Lay abstract: Depression in adolescents is common and serious, and has negative influences on many aspects of adolescent life, such as school achievment and relationships with others. There are available treatments such as talking therapies but not all adolescents benefit from these treatments and almost half of those who receive treatment don't get better. There is a need to improve existing treatments and develop new ones. It's been shown that the family plays an important part in adolescent depression. For example, adolescents who are depressed seem to experience more arguments with their parents compared with adolescents who are not depressed. Parents of depressed adolescents also seem to show less postive behaviours towards their child such as less praise. It is possible that these parent and adolescent behaviours may get in the way of treatments working well but this has not been studied yet. Available treatments need to consider the role of the family more to see if treatment can be improved. Many parents say that they want to know more about how to support their adolescent child in their recovery from depression. Therapists also often think it is a good idea to include parents in treatment plans. There are no guidelines from studies about how to do this, whether it is a good idea to include parents or even whether it will improve the treatment.This study proposes firstly to examine whether particular aspects of how parents and adolescents behave and relate to each other, has an effect on how well adolescents do in treatment. The parent and adolescent behaviours will be studied by looking closely at what parents say about their child and how parents and adolescents behave towards one another during specific tasks. It is possible that certain behaviours (e.g. many arguments, little praise) may influence how well treatment works for the adolescents. The second part of the study will look at developing a new treatment for adolescents with depression that will consider how parents can support their child towards recovery. The development of the treatment will be carried out together with adolescents and parents to make sure it is something that families would find acceptable and useful. The results of the first part of the study will influence whether the new treatment has some focus on how parents and adolescents behave towards each other. If we find that parent-adolescent behaviours influence how usual treatment works then some help for these behaviours will be part of the new treatment. The new treatment will then be tested with a small group of patients and their experiences of the treatment will be examined in detail. The research has the potential to find out about how the adolescents' family may influence their recovery from depression and to improve existing treatments for depressed adolescents. Eventually, this could be useful not only to families experiencing these problems but also to the NHS in how quickly and efficiently it provides the right services.

Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL;7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH