Clinical trial NCT03288649: Qualitative Evaluation of Therapeutic Alliance in Adolescent Psychiatry
Official title: Qualitative Evaluation of Therapeutic Alliance in Adolescent Psychiatry: Crossing Perspectives of Adolescents, Parents and Physicians
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Anorexia Nervosa
Depression
School Phobia
Lead sponsor: Centre Hospitalier Victor Dupouy
Sponsor class: OTHER
First posted: 2017-09-20
Enrollment: 129
Sex: ALL
Minimum age (years): 12
Maximum age (years): 18
Standard ages: CHILD
ADULT
Observational model: OTHER
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: adolescents with psychiatric disorders

Brief summary: 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.


Eligibility criteria: 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:

  1. 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

Primary outcomes:
measure: to describe the facilitators of therapeutic alliance within adolescent psychiatry using a qualitative approach
timeFrame: 2 years
Secondary outcomes:
Other outcomes:
Locations:
city: Argenteuil
country: France
facility: CHVictorDupouy
city: Rouen
country: France
facility: CHU Rouen
Study officials:
affiliation: Paris diderot University
name: Anne Revah-Levy, MD PhD
role: PRINCIPAL_INVESTIGATOR
References: