Intervention Summary

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A)

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) is a short-term, manual-driven outpatient treatment intervention that focuses on the current interpersonal problems of adolescents (aged 12-18 years) with mild to moderate depression severity. Adapted from the original IPT program developed for adults, IPT-A addresses the developmental and interpersonal needs of adolescents and their families. IPT-A attempts to improve the adolescents' communication and social problem-solving skills to increase their personal effectiveness and satisfaction with current relationships, ultimately resulting in the relief of depression symptoms. IPT-A links the onset and perpetuation of depression symptoms to problems or conflicts in interpersonal relationships while acknowledging the contributions of genetic, biological, and personality factors to increased vulnerability for depression episodes. IPT-A helps adolescents understand the effects of interpersonal events and situations on their mood, and each adolescent chooses the focus of treatment by identifying one of four interpersonal problem areas--grief, role disputes, role transitions, or interpersonal deficits--temporally associated with the onset or continuation of the current depression episode. IPT-A also addresses items commonly contributing to developmental problems (e.g., separation from parents, the exploration of authority in relationship to parents, development of dyadic relationships, death of a relative or friend, peer pressure, single-parent families). IPT-A is not intended for adolescents who are acutely suicidal or homicidal, psychotic, bipolar, or intellectually disabled or for those who are actively abusing substances.

IPT-A is delivered by a therapist in hospital-based, school-based, and community outpatient clinics over 12 weeks through weekly 35- to 50-minute treatment sessions. Parental involvement is strongly encouraged (but not mandatory) at three phases of IPT-A:

During the first IPT-A session. At least one parent helps confirm the diagnosis of depression and level of interpersonal functioning and receives education from the therapist on the nature, course, and treatment options available for depression.
During the middle phase of treatment (typically after the adolescent participates in four one-on-one sessions with the therapist). If the adolescent's identified problem area involves a parent, then the possibility of a parent-adolescent session is offered to the adolescent as an opportunity to practice problem-solving skills and new communication techniques with the parent in a safe and supportive therapeutic environment.
At the end of treatment. Ideally, the adolescent's overall progress, interpersonal skills and strategies learned, and warning signs of possible relapse are discussed at a final dyadic session. Changes in family interactions and functioning during treatment are highlighted with discussion around their maintenance after treatment. If the adolescent has not fully recovered from depression or has an additional mental disorder, then continued treatment options are discussed.

If necessary, treatment with IPT-A can be extended to 16 weeks through additional sessions. However, because the focus of IPT-A is on short-term treatment for current interpersonal problems associated with mild to moderate depression severity, continuation of treatment beyond 16 weeks is not recommended.

Descriptive Information

Areas of Interest	Mental health treatment
Outcomes	1: Depression symptoms 2: General level of mental health 3: Social functioning 4: Social problem-solving skills
Outcome Categories	Family/relationships Mental health Social functioning
Ages	13-17 (Adolescent)
Genders	Male Female
Races/Ethnicities	Asian Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	Outpatient School
Geographic Locations	Urban
Implementation History	IPT-A is regularly implemented in school-based and outpatient hospital clinics in New York City and Connecticut, and it has been implemented in three randomized clinical trials: two in New York and one in Puerto Rico. Outside of the United States, IPT-A has been implemented in Canada and the United Kingdom. IPT-A training workshops have been conducted in Canada, Finland, Japan, Norway, the United Kingdom, and the United States. More than 1,000 clinicians have attended these workshops, and approximately 10% of them have pursued additional case consultation to achieve a standardized level of adherence and competence for certification as an IPT-A therapist or supervisor.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: Yes
Adaptations	The program has been adapted for use with Puerto Rican adolescents with depression.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	IOM prevention categories are not applicable.

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Outcomes

Outcome 1: Depression symptoms
Description of Measures	Depression symptoms were measured using the following instruments in each study: The Hamilton Rating Scale for Depression (HAM-D). The HAM-D is a 24-item, structured, clinician-administered interview that rates depression symptoms and severity over the prior week. Scores range from 0 to 74, with higher scores indicating a greater number of symptoms and greater symptom severity. The Beck Depression Inventory (BDI). The BDI is a 21-item self-report of depression symptoms rated on a 4-point scale for severity over the prior week. Scores range from 0 to 63, with higher scores indicating greater symptom severity. In one study, an independent clinician-evaluator administered the HAM-D and the BDI at baseline and then at 4-week intervals up to week 12 or at early termination from the study; the HAM-D also was administered through a telephone follow-up at week 16. In another study, an independent clinician-evaluator administered the HAM-D and the BDI at baseline and then at 2-week intervals up to week 12 or at early termination from the study.
Key Findings	A 16-week clinical trial at five school-based health clinics randomly assigned mental health clinicians to deliver and adolescents (aged 12-18 years) to receive 12 sessions of IPT-A or usual care. Usual care varied across the school-based health clinics but typically consisted of individual, and sometimes group, psychotherapy and supportive counseling with up to three family/parent sessions. Study eligibility for adolescents required parental consent and a DSM-IV diagnosis of one of the following Axis I mood disorders: major depression, dysthymia, adjustment disorder with depressed mood, or depressive disorder not otherwise specified. Findings from this study included the following: At week 12 or at early study termination, adolescents receiving IPT-A had fewer and less severe depression symptoms (HAM-D) than those receiving usual care (p = .04). This group difference was associated with a medium effect size (Cohen's d = 0.50). Also at week 12 or at early study termination, older adolescents (aged 15-18 years) receiving IPT-A had fewer and less severe depression symptoms (HAM-D) than those receiving usual care (p = .006), after controlling for baseline scores. At week 12 or at early study termination, a higher percentage of IPT-A than usual care adolescents met the criterion for recovery (score of ≤9 on the BDI) from a major depression episode (74% vs. 52%; p = .048). Among the most severely depressed adolescents at baseline (score of ≥22 on the HAM-D), those receiving IPT-A had fewer and less severe depression symptoms at week 12 or at early study termination relative to those receiving usual care (p = .04). Although scores from the HAM-D decreased for both conditions, adolescents receiving IPT-A had a faster decrease in the number and severity of depression symptoms from baseline to week 12 (p = .004) and a larger decrease from baseline to weeks 8 (p = .003) and 12 (p < .001) relative to those receiving usual care. Although severity of depression symptoms (BDI) decreased for both conditions, from baseline to week 8, adolescents receiving IPT-A had a larger decrease in the severity of depression symptoms relative to those receiving usual care (p = .001). At the week 16 follow-up, adolescents receiving IPT-A had fewer and less severe depression symptoms (HAM-D) than those receiving usual care (p = .04). This group difference was associated with a medium effect size (Cohen's d = 0.51). In a 12-week clinical trial at a hospital-based clinic in an academic medical center, adolescents (aged 12-18 years) with a DSM-III-R diagnosis of major depressive disorder were randomly assigned to receive either weekly 45- to 50-minute sessions of IPT-A (with weekly telephone contact during the first 4 weeks of treatment) or monthly 30-minute sessions provided in a clinical monitoring control condition. Modeled after a "call-me-if-you-need-me" ethical wait-list control, the clinical monitoring condition consisted of supportive listening, a simple review of depression symptoms and school attendance, and an assessment of suicide risk; it also included an optional second session per month. Findings from this study included the following: At week 12, adolescents receiving IPT-A had fewer and less severe depression symptoms than those in the control group (HAM-D and BDI; p < .02 and p < .05, respectively), after controlling for baseline levels of depression. For adolescents who completed the study (66.7% of the sample), those receiving IPT-A had fewer and less severe depression symptoms than those in the control group at week 12 (HAM-D; p < .01), although the self-rated severity of depression symptoms (BDI) no longer differed between conditions. A larger percentage of IPT-A than control group adolescents met criteria for recovery from a major depression episode (score of ≤6 on the HAM-D) at week 12 (75% vs. 46%; p = .04).
Studies Measuring Outcome	Study 1, Study 2
Study Designs	Experimental
Quality of Research Rating	4.0 (0.0-4.0 scale)

Outcome 2: General level of mental health
Description of Measures	General level of mental health was measured using at least one of the following instruments in each study: The Children's Global Assessment Scale (C-GAS). The C-GAS is a clinician-rated global measure of social functioning designed to determine the functional level of a child or an adolescent with psychiatric disturbance during a specified time period. The score ranges from 1 (the most functionally impaired child/adolescent) to 100 (the healthiest child/adolescent). The severity of illness and global improvement items from the National Institute of Mental Health (NIMH)/Early Clinical Drug Evaluation Program (ECDEU) version of the Clinical Global Impressions (CGI). The NIMH/ECDEU version of the CGI is a 3-item, clinician-rated scale that measures illness severity, global improvement/change, and therapeutic response. In the studies reviewed, only illness severity and global improvement/change were measured. Ratings for the severity of illness item range from 1 (normal, not at all ill) to 7 (among the most extremely ill patients), and ratings for the global improvement item range from 1 (very much improved) to 7 (very much worse). In one study, an independent clinician-evaluator conducted in-person assessments with the C-GAS and the NIMH/ECDEU version of the CGI at baseline and then at 4-week intervals up to week 12 or at early termination from the study; an assessment also was conducted with the C-GAS through a telephone follow-up at week 16. In another study, the clinician conducted in-person assessments with the NIMH/ECDEU version of the CGI at baseline and then at 2-week intervals up to week 12 or at early termination from the study.
Key Findings	A 16-week clinical trial at five school-based health clinics randomly assigned mental health clinicians to deliver and adolescents (aged 12-18 years) to receive 12 sessions of IPT-A or usual care. Usual care varied across the school-based health clinics but typically consisted of individual, and sometimes group, psychotherapy and supportive counseling with up to three family/parent sessions. Study eligibility for adolescents required parental consent and a DSM-IV diagnosis of one of the following Axis I mood disorders: major depression, dysthymia, adjustment disorder with depressed mood, or depressive disorder not otherwise specified. Findings from this study included the following: At week 12 or at early study termination, C-GAS scores indicated that adolescents receiving IPT-A had greater improvement in social functioning levels than adolescents receiving usual care (p = .04). Also at week 12 or at early study termination, older adolescents (aged 15-18 years) receiving IPT-A had greater improvement in social functioning levels compared with those receiving usual care (p = .02), after controlling for baseline scores. At week 12 or at early study termination, scores from the ECDEU version of the CGI indicated that adolescents receiving IPT-A were less depressed (severity of illness item; p = .03) and had a greater overall improvement in their depression symptoms (global improvement item; p = .03) relative to adolescents receiving usual care. Small and medium effect sizes were associated with these group differences (Cohen's d = 0.48 and 0.59, respectively). In a 12-week clinical trial at a hospital-based clinic in an academic medical center, adolescents (aged 12-18 years) with a DSM-III-R diagnosis of major depressive disorder were randomly assigned to receive either weekly 45- to 50-minute sessions of IPT-A (with weekly telephone contact during the first 4 weeks of treatment) or monthly 30-minute sessions provided in a clinical monitoring control condition. Modeled after a "call-me-if-you-need-me" ethical wait-list control, the clinical monitoring condition consisted of supportive listening, a simple review of depression symptoms and school attendance, and an assessment of suicide risk; it also included an optional second session per month. At week 12, scores from the NIMH/ECDEU version of the CGI indicated that adolescents receiving IPT-A were less depressed (severity of illness item; p < .001) and had a greater overall improvement in their depression symptoms (global improvement item; p < .001) relative to adolescents in the control group.
Studies Measuring Outcome	Study 1, Study 2
Study Designs	Experimental
Quality of Research Rating	3.9 (0.0-4.0 scale)

Outcome 3: Social functioning
Description of Measures	Social functioning was measured using the adolescent version of the Social Adjustment Scale--Self-Report (SAS-SR), a 23-item instrument that assesses social functioning and adjustment in four domains: school, friends, family, and dating. Ratings for each item range from 1 to 5. A mean score is calculated for each domain, and a mean total score is calculated for the entire scale. Lower scores indicate better social functioning and adjustment. In one study, the adolescent version of the SAS-SR was administered by an independent clinician-evaluator at baseline and then at 4-week intervals up to week 12 or at early termination from the study. In another study, the adolescent version of the SAS-SR was administered by an independent clinician-evaluator at baseline and then at 2-week intervals up to week 12 or at early termination from the study.
Key Findings	A 16-week clinical trial at five school-based health clinics randomly assigned mental health clinicians to deliver and adolescents (aged 12-18 years) to receive 12 sessions of IPT-A or usual care. Usual care varied across the school-based health clinics but typically consisted of individual, and sometimes group, psychotherapy and supportive counseling with up to three family/parent sessions. Study eligibility for adolescents required parental consent and a DSM-IV diagnosis of one of the following Axis I mood disorders: major depression, dysthymia, adjustment disorder with depressed mood, or depressive disorder not otherwise specified. Findings from this study included the following: From baseline to week 12 or at early study termination, adolescents receiving IPT-A had an improvement in social functioning in dating relationships (adolescent version of the SAS-SR, dating domain; p = .03) and overall social functioning (adolescent version of the SAS-SR, total score; p = .01) relative to adolescents receiving usual care. These group differences were associated with small and medium effect sizes (Cohen's d = 0.43 and 0.55, respectively). From baseline to week 12, adolescents receiving IPT-A had an improvement in overall social functioning, and those receiving usual care had either worse or no change in overall social functioning (adolescent version of the SAS-SR, total score; p = .003). From baseline to weeks 8 (p = .03) and 12 (p < .001), improvement in overall social functioning (adolescent version of the SAS-SR, total score) by adolescents receiving IPT-A exceeded that by adolescents receiving usual care. In a 12-week clinical trial at a hospital-based clinic in an academic medical center, adolescents (aged 12-18 years) with a DSM-III-R diagnosis of major depressive disorder were randomly assigned to receive either weekly 45- to 50-minute sessions of IPT-A (with weekly telephone contact during the first 4 weeks of treatment) or monthly 30-minute sessions provided in a clinical monitoring control condition. Modeled after a "call-me-if-you-need-me" ethical wait-list control, the clinical monitoring condition consisted of supportive listening, a simple review of depression symptoms and school attendance, and an assessment of suicide risk; it also included an optional second session per month. At week 12, IPT-A adolescents had better overall social functioning (adolescent version of the SAS-SR, total score; p = .01), better social functioning with friends (adolescent version of the SAS-SR, friends domain; p = .02), and better social functioning in dating relationships (adolescent version of the SAS-SR, dating domain; p = .02) than adolescents in the control group.
Studies Measuring Outcome	Study 1, Study 2
Study Designs	Experimental
Quality of Research Rating	4.0 (0.0-4.0 scale)

Outcome 4: Social problem-solving skills
Description of Measures	Social problem-solving skills were measured using the Social Problem-Solving Inventory--Revised (SPSI-R), a 52-item self-report instrument composed of 5 dimensions: positive problem orientation, negative problem orientation, rational problem solving (including subscales of generating alternative options and solution implementation and verification), impulsive/careless problem-solving style, and avoidant coping style. Each item is a self-statement that reflects either a positive or a negative response to a hypothetical problem-solving situation and is rated on a 5-point scale from 0 (not at all true of me) to 4 (extremely true of me). Scores can be calculated for each dimension and for the entire instrument. Ratings for the negative-response items are reversed during scoring, and higher scores always indicate greater problem-solving skills. The SPSI-R was administered by an independent clinician-evaluator at baseline and then at 2-week intervals up to week 12 or at early termination from the study.
Key Findings	In a 12-week clinical trial at a hospital-based clinic in an academic medical center, adolescents (aged 12-18 years) with a DSM-III-R diagnosis of major depressive disorder were randomly assigned to receive either weekly 45- to 50-minute sessions of IPT-A (with weekly telephone contact during the first 4 weeks of treatment) or monthly 30-minute sessions of a clinical monitoring control condition. Modeled after a "call-me-if-you-need-me" ethical wait-list control, the clinical monitoring condition consisted of supportive listening, a simple review of depression symptoms and school attendance, and an assessment of suicide risk; it also included an optional second monthly session. From baseline to week 12: Relative to adolescents in the control group, those receiving IPT-A had greater improvement in positive problem orientation skills (p < .05) and rational problem-solving skills (p < .05). Relative to adolescents in the control group, those receiving IPT-A had greater improvement on the rational problem solving subscales of generating alternative options (p < .01) and solution implementation and verification (p < .01).
Studies Measuring Outcome	Study 2
Study Designs	Experimental
Quality of Research Rating	4.0 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	13-17 (Adolescent)	84.1% Female 15.9% Male	74.6% Hispanic or Latino 14.3% Black or African American 9.5% Race/ethnicity unspecified 1.6% Asian
Study 2	13-17 (Adolescent)	72.9% Female 27.1% Male	70.8% Hispanic or Latino 20.8% Black or African American 4.2% Race/ethnicity unspecified 4.2% White

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Depression symptoms	4.0	4.0	4.0	4.0	3.8	4.0	4.0
2: General level of mental health	3.9	3.9	4.0	4.0	3.8	4.0	3.9
3: Social functioning	4.0	4.0	4.0	4.0	3.8	4.0	4.0
4: Social problem-solving skills	4.0	4.0	4.0	4.0	3.8	4.0	4.0

Study Strengths

All but one of the measurement scales are well-established instruments that have been used extensively and have strong psychometric properties. Attention to intervention fidelity was excellent in both studies and included the use of an adherence checklist previously demonstrated to have strong psychometric properties in studies that used IPT with adults with depression. Attrition rates were low across treatment and follow-up, and completion rates were high for participants in the active treatment conditions. Both studies used randomized group assignments and an appropriate intent-to-treat approach to analysis.

Study Weaknesses

In one study, the NIMH/ECDEU version of the CGI was administered by the treating clinician rather than an independent clinician-evaluator, which may have weakened its psychometric strength. Only the more recent study noted a prior reliability study that established agreement across independent evaluators and school-based clinicians on all assessment and screening instruments. Age and gender were potential confounding variables because of the limitations of sample size.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Mufson, L. Interpersonal Psychotherapy for Depressed Adolescents [PowerPoint slides].

Mufson, L., Dorta, K. P., Moreau, D., & Weissman, M. M.. Interpersonal Psychotherapy for Depressed Adolescents (2nd ed.). New York: Guilford Press.

Other program materials:

Closeness Circle
Communication Analysis worksheet
IPT-A case vignettes
IPT-A consultation checklists
IPT training video [DVD]
IPT training video guide
Sample workshop schedules
Teen Tips

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
3.5	4.0	3.0	3.5

Dissemination Strengths

The intervention manual thoroughly describes each aspect of the intervention and presents many sample scripts and case examples for each treatment phase. Further, it provides guidance for therapeutic issues that may arise, such as general adolescent issues, use of medications, and crisis management. The developer is able to tailor the training for length and specific agency needs without sacrificing the basic goals of the training. Detailed training materials provide written and video case examples and many session scripts to assist with learning. Ongoing case consultation and individual supervision are available. The program Web site offers additional resources, as well as a feature that provides International Society for Interpersonal Psychotherapy (ISIPT) members with access to a wide range of information disseminated by ISIPT. Checklists help implementers maintain fidelity to session content and processes, and several monitoring tools are available to support quality assurance. Through the therapist training process, trainers review therapist audiotapes and provide written feedback. Clinicians can earn certification, which helps to ensure clinical quality.

Dissemination Weaknesses

Although the intervention manual is thorough, it does not provide succinct information on the phases of treatment or desired outcomes. Recommendations about evaluation instruments can be obtained from the program developer; however, protocols for measuring intervention outcomes are not readily available.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
IPT-A treatment manual	$33 each	Yes
Intervention training DVD	$30 each	No
1- to 2-day on-site implementation training	$2,000-$5,000 per site depending on the training length, trainer fees, and travel expenses	Yes
IPT-A workshop (provided sporadically at assorted professional meetings)	Varies depending on the fee schedule of the organization sponsoring the meeting, as well as the location and length of the workshop	No
Therapist certification	Varies depending on the number of participants and whether supervision is in an individual or group format (starting at $9,000 for two participants)	Yes
Supervisory certification for certified therapists	Varies depending on the number of participants and whether supervision is in an individual or group format (starting at $2,800 for one participant)	Yes
Occasional email consultation	Free	No
Phone-based or on-site consultation	About $150 per hour depending on the frequency and duration of the consultation, as well as the type of agency	No
Expert Adherence and Competency Rating Sheets	Free	Yes

Additional Information

All training-related costs are subject to change, depending on the type of agency, purpose of the training, available resources, community, and training circumstances (e.g., group or individual training). For certification, supervision can be conducted by phone or in person. Supervision and training can be conducted by the developer or a team of trained experts in various cities.