Social problem solving among depressed adolescents is enhanced by structured psychotherapies.
OBJECTIVE
Changes in adolescent interpersonal behavior before and after an acute course of psychotherapy were investigated as outcomes and mediators of remission status in a previously described treatment study of depressed adolescents. Maternal depressive symptoms were examined as moderators of the association between psychotherapy condition and changes in adolescents' interpersonal behavior.


METHODS
Adolescents (n = 63, mean age = 15.6 years, 77.8% female, 84.1% White) engaged in videotaped interactions with their mothers before randomization to cognitive behavior therapy (CBT), systemic behavior family therapy (SBFT), or nondirective supportive therapy (NST) and after 12-16 weeks of treatment. Adolescent involvement, problem solving, and dyadic conflict were examined.


RESULTS
Improvements in adolescent problem solving were significantly associated with CBT and SBFT. Maternal depressive symptoms moderated the effect of CBT, but not SBFT, on adolescents' problem solving; adolescents experienced increases in problem solving only when their mothers had low or moderate levels of depressive symptoms. Improvements in adolescents' problem solving were associated with higher rates of remission across treatment conditions, but there were no significant indirect effects of SBFT on remission status through problem solving. Exploratory analyses revealed a significant indirect effect of CBT on remission status through changes in adolescent problem solving, but only when maternal depressive symptoms at study entry were low.


CONCLUSIONS
Findings provide preliminary support for problem solving as an active treatment component of structured psychotherapies for depressed adolescents and suggest one pathway by which maternal depression may disrupt treatment efficacy for depressed adolescents treated with CBT.
Western Psychiatric Institute and Clinic, University of Pittsburgh.
Laura J
LJ
Dietz
Western Psychiatric Institute and Clinic, University of Pittsburgh.
Michael P
MP
Marshal
Western Psychiatric Institute and Clinic, University of Pittsburgh.
Chad M
CM
Burton
Research Institute at Nationwide Children's Hospital.
Jeffrey A
JA
Bridge
Western Psychiatric Institute and Clinic, University of Pittsburgh.
Boris
B
Birmaher
Western Psychiatric Institute and Clinic, University of Pittsburgh.
David
D
Kolko
Family Practice Center.
Jamira N
JN
Duffy
Western Psychiatric Institute and Clinic, University of Pittsburgh.
David A
DA
Brent
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D003865:Major Depressive Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009034:Mother-Child Relations; D011340:Problem Solving; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome