Tuesday, April 18, 2023

Some Interpersonal Problems More Difficult to Treat in Teens With Depression, Small Study Finds

Teenagers with depression related to problems with “role transitions” (life changes that require a new role) may be less responsive to interpersonal psychotherapy than peers experiencing depression related to other interpersonal problems, a report in the American Journal of Psychotherapy suggests.

“[F]uture researchers and therapists might consider how IPT-A [interpersonal psychotherapy for adolescents] may need to be modified for individuals with the role transitions problem area to improve outcomes,” wrote Meredith Gunlick-Stoessel, Ph.D., of the University of Minnesota and colleagues. “For example, these adolescents may need additional IPT-A sessions or other types of coping strategies to augment IPT-A.”

IPT-A, adapted from interpersonal therapy for adults, aims to treat depression by addressing one of four problem areas: grief (difficulty coping with the death of a loved one); role disputes (disagreements between an adolescent and others about expectations of each other in a relationship); role transitions; and interpersonal deficits (social isolation and feelings of loneliness). The goal of IPT-A is to help adolescents learn the communication and interpersonal problem-solving skills needed to resolve the problem area most closely related to their depression.

The researchers looked at treatment outcomes for 40 adolescents (aged 12 to 17 years) who underwent 12 IPT-A sessions over 16 weeks. The youth were divided into four groups: 15 had problems with role disputes, 12 had problems with role transitions, 12 had problems with interpersonal deficits, and one had problems with grief. Because only one adolescent had a primary problem area of grief, that adolescent was not included in the analyses.

The adolescents were assessed for depression at baseline and at 16 weeks with a battery of tests, including the Beck Depression Inventory, the Beck Hopelessness Scale, and the Children’s Depression Rating Scale–Revised.

The results of the study suggested that the type of interpersonal problem area affected treatment outcomes. Adolescents in the role transitions group had more severe depression and social adjustment problems than those in the interpersonal deficits group and more severe social adjustment problems than those in the role disputes group.

Some other findings included the following:

  • Adolescents in the role disputes group were significantly younger than adolescents in the interpersonal deficits and role transitions groups.
  • Adolescents in the role disputes group also had significantly worse expectations for therapeutic alliance than did participants in the role transitions group.
  • Adolescents in the interpersonal deficits group had higher attachment avoidance (for example, they reported more discomfort with interpersonal closeness and intimacy and greater hesitancy to rely on others for emotional support) at baseline than adolescents in the role transitions group.

The authors noted that role transitions may be more complicated for teens to navigate compared with the other problem areas, requiring them to adjust their expectations of people in the new situation, negotiate disagreements about those expectations, learn new interpersonal skills, and come to terms with the loss of how things used to be.

“This preliminary study provided information about characteristics of adolescents with depression receiving IPT-A for different problem areas and about the impact of problem areas on outcomes after 16 weeks of IPT-A. If these results are replicated, close attention to the therapeutic relationship for adolescents experiencing role disputes, and to the potential need to augment treatment for adolescents experiencing a role transition, may be helpful,” they concluded.

For related information, see the Psychiatric News article “IPT: From Humble Origins as ‘High Contact Therapy’ to International Adoptions.”

(Image: iStock/spb2015

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