Depression, Self-injurious Behavior
Conditions
Keywords
self-injurious behavior, depression, adolescents, psychotherapy
Brief summary
The purpose of this study is to examine the feasibility of using Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) to treat adolescents who are experiencing symptoms of depression and are engaging in non-suicidal self-injurious behaviors. The trial will include recruiting 10 particpants, administering 12-sessions of individual IPT-A, and determining how the IPT-A protocol needs to be amended to adequately address the self-injury in addition to depression.
Detailed description
Engagement in non-suicidal self-injury (NSSI), purposefully harming oneself without the conscious intent to die such as cutting or burning, is pervasive among adolescents. Lifetime prevalence estimates among community samples of high school students range from 13.0% to 23.2%. Despite the significance of this public health problem, there are no known interventions that successfully reduce the frequency of NSSI or prevent NSSI in adolescents. The goal of the current study is to develop an effective psychosocial intervention for NSSI among adolescents who are engaging in self-injury and have a depressive disorder. Specifically, we will amend Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), a psychotherapy that has demonstrated efficacy in treating depressed adolescents (Mufson et al., 1994, 1999, 2004), for use with adolescents with depression who are engaging in NSSI, with the ultimate goal of curing the depression and NSSI. Ten participants will be administered IPT-A and assessed several times throughout the course of the trial. It is expected that IPT-A will be a useful treatment for co-morbid depression and self-injury, although adaptations to the protocol will likely be needed to address the behavioral aspect of the self-injury. Data analyses will be descriptive in nature and involve examining the individual trajectories of depression and NSSI over time. The data obtained from the current study will lay the groundwork for an ultimate randomized controlled trial in which we plan to compare IPT-A versus nondirective supportive therapy in the treatment of co-morbid depression and NSSI.
Interventions
Open clinical trial of IPT-ASI for depressed and self-injuring adolescents, 12-18 years. Goal is to assess feasibility of using IPT-A protocol for teens with co-morbid depression and self-injury. All eligible participants receive 12 weeks of individual IPT-ASI with optional monthly booster sessions. IPT-ASI is a psychosocial intervention that focuses on the importance of interpersonal relationships in relation to psychological functioning. The first phase (4 weeks) includes a review of depression and self-injury symptoms, psycho-education about depression and self-injury, and a detailed assessment of the patient's important interpersonal relationships. The middle phase (weeks 5-9) involves interpersonal skill building, including communication skills, affect identification and expression, problem solving. The final phase ( weeks 10-12) involves review of skills, generalization of skills to other relationships, termination.
Sponsors
MINT: Mental Health Initiative
New York State Psychiatric Institute
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
12 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
1. 12 to 18 years of age 2. Diagnosis of MDD, Dysthymic Disorder, Depressive Disorder NOS, Adjustment Disorder with depressed Mood 3. Non-suicidal self-injurious behavior 4. CDRS \>= 36 5. C-GAS \<= 65 6. English speaking patient 7. One English speaking caregiver -
Exclusion criteria
1. Suicide attempt within past 6 months or actively suicidal 2. Severe incident of non-suicidal self-injury in past 3 months 3. Severe episode of MDD 4. Treatment resistant non-suicidal self-injury 5. Frequent non-suicidal self-injury 6. Mentally retarded 7. Current diagnosis of: PTSD, OCD, Schizophrenia, Bipolar Disorder, Psychosis, Substance Dependence, ADHD 8. Current substance use 9. Currently in active treatment for same condition 10. Currently taking antidepressant medication 11. Medical illness likely to interfere with treatment -
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| C-GAS | 1 month |
| Self-Injurious Thoughts and Behaviors Interview | 8 weeks |
| Self-injury Monitoring Card | 1 month |
| CGI | 1 week |
| CDRS | 1 week |
Secondary
| Measure | Time frame |
|---|---|
| Multidimensional Anxiety Scale for Children | recently |
| Beck Depression Inventory | 2 weeks |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Group 1 All participants recieved Interpersonal psychotherapy | 12 |
| Total | 12 |
Baseline characteristics
| Characteristic | Group 1 |
|---|---|
| Age, Categorical <=18 years | 12 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants |
| Age Continuous | 14.5 years STANDARD_DEVIATION 1.3 |
| Region of Enrollment United States | 12 participants |
| Sex: Female, Male Female | 9 Participants |
| Sex: Female, Male Male | 3 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 12 |
| serious Total, serious adverse events | 0 / 12 |
Outcome results
Primary
CDRS
Time frame: 1 week
Primary
C-GAS
Time frame: 1 month
Primary
CGI
Time frame: 1 week
Primary
Self-Injurious Thoughts and Behaviors Interview
Time frame: 8 weeks
Population: Data for all subjects who completed the study was examined - however because this was a small pilot study and only 5 subjects completed treatment, no statistical tests were completed.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Group 1 | Self-Injurious Thoughts and Behaviors Interview | 0.4 episodes of self-injury past month | Standard Deviation 0.9 |
Primary
Self-injury Monitoring Card
Time frame: 1 month
Secondary
Beck Depression Inventory
Time frame: 2 weeks
Secondary
Multidimensional Anxiety Scale for Children
Time frame: recently