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
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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.
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Key Findings
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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).
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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4.0
(0.0-4.0 scale)
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Outcome 2: General level of mental health |
Description of Measures
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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.
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Key Findings
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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.
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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3.9
(0.0-4.0 scale)
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Outcome 3: Social functioning |
Description of Measures
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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.
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Key Findings
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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.
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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4.0
(0.0-4.0 scale)
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Outcome 4: Social problem-solving skills |
Description of Measures
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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.
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Key Findings
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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).
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Studies Measuring Outcome
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Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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4.0
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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13-17 (Adolescent)
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84.1% Female 15.9% Male
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74.6% Hispanic or Latino 14.3% Black or African American 9.5% Race/ethnicity unspecified 1.6% Asian
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Study 2
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13-17 (Adolescent)
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72.9% Female 27.1% Male
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70.8% Hispanic or Latino 20.8% Black or African American 4.2% Race/ethnicity unspecified 4.2% White
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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:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Depression symptoms
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4.0
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4.0
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4.0
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4.0
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3.8
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4.0
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4.0
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2: General level of mental health
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3.9
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3.9
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4.0
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4.0
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3.8
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4.0
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3.9
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3: Social functioning
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4.0
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4.0
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4.0
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4.0
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3.8
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4.0
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4.0
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4: Social problem-solving skills
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4.0
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4.0
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4.0
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4.0
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3.8
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4.0
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4.0
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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.
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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
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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3.5
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4.0
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3.0
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3.5
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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.
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