Depressive symptoms and clinical status during the Treatment of Adolescent Suicide Attempters (TASA) Study.
OBJECTIVE
To examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide.


METHODS
Adolescents (N = 124), ages 12 to 18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating Scale-Revised (CDRS-R) score of 36 or higher, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission rates were computed with the last observation carried forward.


RESULTS
Most patients (n = 104 or 84%) chose treatment assignment, and overall, three fourths (n = 93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12 and to 27.0 (10.1) at week 24 (p < .0001), with a Clinical Global Impression -defined improvement rate of 58.0% at week 12 and 72.2% at week 24 and a remission (CDRS-R ≤ 28) rate of 32.5% at week 12 and 50.0% at week 24. The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline (r = 0.43, p < .0001) and declined in parallel.


CONCLUSIONS
When vigorously treated with a combination of medication and psychotherapy, adolescents with depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression.
Vitiello
Benedetto
B
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University. Electronic address: bvitiell@mail.nih.gov.
Brent
David A
DA
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Greenhill
Laurence L
LL
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Emslie
Graham
G
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Wells
Karen
K
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Walkup
John T
JT
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Stanley
Barbara
B
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Bukstein
Oscar
O
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Kennard
Betsy D
BD
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Compton
Scott
S
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Coffey
Barbara
B
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Cwik
Mary F
MF
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Posner
Kelly
K
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Wagner
Ann
A
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
March
John S
JS
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Riddle
Mark
M
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Goldstein
Tina
T
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Curry
John
J
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Capasso
Lisa
L
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Mayes
Taryn
T
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Shen
Sa
S
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Gugga
S Sonia
SS
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Turner
J Blake
JB
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Barnett
Shannon
S
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
Zelazny
Jamie
J
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein, and Ms. Zelazny are with the University of Pittsburgh Western Psychiatnc Institute and Clinic; Drs. Greenhill Stanley, Posner, Shen, and Turner, and Ms. Gugga and Ms. Capasso are with the Columbia University-New York State Psychiatric Institute; Drs. Emslie and Kennard, and Ms. Mayes are with the University of Texas Southwestern Medical Center in Dallas; Drs. Wells, Compton, Curry, and March are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; Drs. Walkup, Cwik, Barnett, and Riddle are with Johns Hopkins University.
D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D055502:Secondary Prevention; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology* / Q000706:statistics & numerical data
D000928:Antidepressive Agents