title: Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression.
abstract: OBJECTIVE
  To assess the predictors of treatment outcome across treatments, as well as those associated with differential treatment response.
  
  
  METHODS
  One hundred seven adolescent outpatients, aged 13 to 18 years, with DSM-III-R major depression were randomly assigned to one of three manual-based, brief (12 to 16 sessions) psychosocial treatments: cognitive-behavioral therapy (CBT), systemic-behavioral family therapy, or nondirective supportive therapy. Those with good and poor outcomes were compared.
  
  
  RESULTS
  Continued depression was predicted by clinical referral (versus via advertisement) and was in part mediated by hopelessness. Other predictors of depression were comorbid anxiety disorder and higher levels of cognitive distortion and hopelessness at intake. Achievement of clinical remission was predicted by a higher level of self-reported depression. Poorer functional status was predicted by a higher level of initial interviewer-rated depression. Comorbid anxiety and maternal depressive symptoms predicted differential treatment efficacy. CBT's performance continued to be robust with respect to nondirective supportive therapy, even in the presence of the above-noted adverse predictors.
  
  
  CONCLUSIONS
  Predictors of poor outcome may give clues as to how to boost treatment response. Subjects who come to treatment for clinical trials via advertisement (versus clinical referral) may show more favorable treatment responses. CBT is likely to be a robust intervention even in more complex and difficult-to-treat patients.
authors.affiliation: Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Brent
authors.forename: D J
authors.initials: DJ
authors.lastname: Kolko
authors.forename: B
authors.initials: B
authors.lastname: Birmaher
authors.forename: M
authors.initials: M
authors.lastname: Baugher
authors.forename: J
authors.initials: J
authors.lastname: Bridge
authors.forename: C
authors.initials: C
authors.lastname: Roth
authors.forename: D
authors.initials: D
authors.lastname: Holder
mesh_terms: D000293:Adolescent; D000296:Adolescent Psychiatry / Q000379:methods*; D015928:Cognitive Behavioral Therapy / Q000592:standards; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D005196:Family Therapy / Q000592:standards; D006801:Humans; D009629:Person-Centered Psychotherapy / Q000592:standards; D011379:Prognosis; D011614:Psychotherapy, Brief / Q000592:standards*; D013223:Statistics as Topic