A Stepped Care Model of Adolescent Depression Treatment in Primary Care
Condition: Major Depressive Disorder; Dysthymia
MeSH terms: Depression; Depressive Disorder; Depressive Disorder, Major; Dysthymic Disorder
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      It is challenging for depressed adolescents and their families to access specialized mental
      health services. A viable option is delivering treatment in the primary care clinic (PCC)
      setting; however, few effective models are currently available. The overall aim of this study
      is to assess in the pediatric PCC, the preliminary acceptability and feasibility of a novel
      collaborative stepped care model of treatment for depressed adolescents.
    

Detailed description: 
      Interpersonal Psychotherapy for adolescents (IPT-A) is a guideline based treatment with
      established efficacy focusing on reducing depression symptoms and current interpersonal
      problems associated with depression. This stepped care model (SCIPT-A) first delivers a low
      intensity 6 session plus two parent session adaptation of IPT-A, a treatment designed for
      mild to moderate adolescent depression with impairment. The second phase in the model is for
      adolescents with persistent depressive symptoms who will receive 8 more sessions of IPT-A in
      combination with the addition of an antidepressant. The social worker clinicians (SW)
      currently employed in the PCC will be trained to deliver the Brief Interpersonal
      Psychotherapy for adolescents (BIPT-A)and in the second phase, the pediatrician will provide
      the medication treatment in collaboration with the SW clinician continuing to provide IPT-A.
      Fifty adolescents identified by their primary care pediatrician and meeting criteria for
      DSM-IV major depression, dysthymic disorder, or depression, not otherwise specified will be
      randomized to receive either treatment as usual (TAU) or the SCIPT-A model of stepped
      collaborative depression care in the PCC for 16 weeks. TAU consists of pediatrician referral
      of depressed adolescents to either a psychologist, social worker or child psychiatrist within
      the clinic or to another mental health agency in the community. All adolescents will be
      administered clinical interviews and self-report questionnaires during the 16 week protocol
      to assess treatment acceptability, feasibility, safety and preliminary change in symptoms.
      The project will provide information concerning the feasibility and acceptability of this
      treatment model for adolescent depression delivered by pediatricians and social work
      clinicians in pediatric primary care practice.
    

Intervention name(s): Stepped Care IPT-A (SCIPT-A); Treatment as Usual
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Interpersonal Psychotherapy for adolescents (IPT-A) is a guideline based treatment with established efficacy focusing on reducing depression symptoms and current interpersonal problems associated with depression.; Standard treatment in the community
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: MDD; Dysthymia; Depressive Disorder Not Otherwise Specified (DDNOS)