Qualitative Evaluation of Therapeutic Alliance in Adolescent Psychiatry

Study Overview
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Brief Summary
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Context: Psychiatric disorders (anorexia nervosa, depression, anxiety based school refusal) are a major public health concern in adolescence. Their treatment is a challenge for the families, the health care system and society. The treatment is complex and non-standardized. In clinical practice, the relational dimension between the stakeholders is recognized by all. Nevertheless no study has ever crossed their perspectives about therapeutic alliance in adolescent psychiatry. Objective: to explore, within a qualitative approach, how a therapeutic alliance is established in three different clinical situations according to the adolescents, their parents and their physicians by crossing their perspectives. Methods: This is a national (France) multi-center qualitative study based on 180 semi-structured interviews. Participants (purposively selected until data saturation) came from three different sub-samples: (i) adolescents with anorexia nervosa (N =20) plus their parents (N=20) and their physicians (N=20), (ii) adolescents with depressions (N=20) plus their parents (N=20) and their physicians (N=20), and (iii) adolescents with anxiety-based school refusal (N=20) plus their parents (N=20) and their physicians (N=20). Data are collected through open ended semi structured interviews and independently analyzed with NVivo V.11 software by three researchers according to the principles of Interpretative Phenomenological Analysis.

Official Title
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Qualitative Evaluation of Therapeutic Alliance in Adolescent Psychiatry: Crossing Perspectives of Adolescents, Parents and Physicians

Conditions
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Anorexia Nervosa, Depression, School Phobia

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adolescents, boys and girls, aged 12 to 18 years, speaking fluent French, with (i) anorexia nervosa according to DSM 5 criteria (ii) depressive disorders (dysthymia, depressive episode) according to DSM 5 criteria (iii) anxiety-based school refusal according to four criteria: refusal to attend school (to operationalize this first criterion, adolescents were included if they had not attended school at all for at least one month before starting treatment); (2) presence of a DSM-5 anxiety disorder (except obsessive-compulsive or post-traumatic stress disorders) with emotional upset at the prospect of attending school; (3) absence of a DSM-5 conduct disorder; and (4) parental knowledge of the adolescent's whereabouts during the period of non-attendance. that led to treatment that had begun at least six months earlier and clinically determined to be well enough to participate in a research interview. receiving treatment for at least 6 months one parent at least agrees to participate Exclusion Criteria: acute symptoms and serious somatic and/or psychiatric co-morbidities

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Anorexia nervosa<br>adolescents with anorexia nervosa (N=20 ?), their parents (N=20), their physicians (N=20) | |
| Anxiety based school refusal<br>adolescents with anxiety based school refusal (N=20 ?), their parents (N=20), their physicians (N=20) | |
| Depression<br>adolescents with depression (N=20 ?), their parents (N=20), their physicians (N=20) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| to describe the facilitators of therapeutic alliance within adolescent psychiatry using a qualitative approach | qualitative methodology using verbal data analysis of semi-structured interviex | 2 years |