The British Journal of Psychiatry (2009) 194: 334-341. doi: 10.1192/bjp.bp.108.052381
© 2009 The Royal College of Psychiatrists
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Treated depression in adolescents: predictors of outcome at 28 weeks

Paul Wilkinson, MRCPsych, MD

Developmental Psychiatry Section, University of Cambridge

Bernadka Dubicka, MRCPsych

Department of Child Psychiatry, University of Manchester, and the Junction Adolescent Unit, Scotforth, Lancaster

Raphael Kelvin, MRCPsych

Developmental Psychiatry Section, University of Cambridge

Chris Roberts, PhD

Biostatistics Group, School of Epidemiology & Health Sciences, University of Manchester

Ian Goodyer, FRCPsych, MD

Developmental Psychiatry Section, University of Cambridge, UK

Correspondence: Paul Wilkinson, Developmental Psychiatry Section, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge CB2 8AH, UK. Email: pow12{at}cam.ac.uk

Declaration of interest

None.

Funding

The ADAPT study was funded by the NHS Health Technology Assessment Programme, Central Manchester and Manchester Children’s University Hospitals NHS Trust and the Cambridge and Peterborough Mental Health Partnership Trust.

Background

There is great heterogeneity of clinical presentation and outcome in paediatric depression.

Aims

To identify which clinical and environmental risk factors at baseline and during treatment predicted major depression at 28-week follow-up in a sample of adolescents with depression.

Method

One hundred and ninety-two British adolescents with unipolar major depression were enrolled in a randomised controlled trial (the Adolescent Depression Antidepressants and Psychotherapy Trial, ADAPT). Participants were treated for 28 weeks with routine psychosocial care and selective serotonin reuptake inhibitors (SSRIs), with half also receiving cognitive–behavioural therapy (CBT). Full clinical and demographic assessment was carried out at baseline and 28 weeks.

Results

Depression at 28 weeks was predicted by the additive effects of severity, obsessive–compulsive disorder and suicidal ideation at entry together with presence of at least one disappointing life event over the follow-up period.

Conclusions

Clinicians should assess for severity, suicidality and comorbid obsessive–compulsive disorder at presentation and should monitor closely for subsequent life events during treatment.


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