title: Effect of 2 psychotherapies on depression and disease activity in pediatric Crohn's disease.
abstract: BACKGROUND
  Crohn's disease (CD) is associated with depression. It is unclear if psychosocial interventions offer benefit for depressive symptoms during active CD. In this secondary analysis of a larger study of treating depression in pediatric inflammatory bowel disease, we assessed whether cognitive behavioral therapy (CBT) would differentiate from supportive nondirective therapy in treating depression and disease activity in youth with CD. We also explored whether somatic depressive symptoms showed a different pattern of response in the overall sample and the subset with active inflammatory bowel disease.
  
  
  METHODS
  Youth with depression and CD (n = 161) were randomized to 3 months of CBT (teaching coping skills) or supportive nondirective therapy (supportive listening). Depressive severity was measured using the Children's Depression Rating Scale-Revised (CDRS-R) with the somatic depressive subtype consisting of those CDRS-R items, which significantly correlated with CD activity. Disease activity was measured by the Pediatric Crohn's disease Activity Index. Given the potential confound of higher dose steroids, subanalyses excluded subjects on >20 mg/d prednisone equivalent (n = 34).
  
  
  RESULTS
  Total CDRS-R scores in the overall sample significantly decreased over time after both treatments (P < 0.0001). Treatment with CBT was associated with a significantly greater improvement in the Pediatric Crohn's disease Activity Index (P = 0.05) and somatic depressive subtype (P = 0.03) in those with active inflammatory bowel disease (n = 95) compared with supportive nondirective therapy. After excluding those on steroids (n = 34), there was a significant improvement in total CDRS-R (P = 0.03) and in Pediatric Crohn's disease Activity Index (P = 0.03) after CBT.
  
  
  CONCLUSIONS
  Psychotherapy may be a useful adjunct to treat depression in the context of CD-related inflammation in youth who are not concurrently on higher dose steroids.
authors.affiliation: *Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; †Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania; ‡Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; §Department of Psychology, Harvard University, Cambridge, Massachusetts; ‖Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado; ¶Department of Pediatric Gastroenterology, Children's Hospital of Pittsburgh UPMC, Pittsburgh, Pennsylvania; and **Department of Pediatric Gastroenterology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Eva
authors.initials: E
authors.lastname: Szigethy
authors.forename: Ada O
authors.initials: AO
authors.lastname: Youk
authors.forename: Joseph
authors.initials: J
authors.lastname: Gonzalez-Heydrich
authors.forename: Simona I
authors.initials: SI
authors.lastname: Bujoreanu
authors.forename: John
authors.initials: J
authors.lastname: Weisz
authors.forename: Diane
authors.initials: D
authors.lastname: Fairclough
authors.forename: Peter
authors.initials: P
authors.lastname: Ducharme
authors.forename: Neil
authors.initials: N
authors.lastname: Jones
authors.forename: Francis
authors.initials: F
authors.lastname: Lotrich
authors.forename: David
authors.initials: D
authors.lastname: Keljo
authors.forename: Arvind
authors.initials: A
authors.lastname: Srinath
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: David
authors.initials: D
authors.lastname: Kupfer
authors.forename: David R
authors.initials: DR
authors.lastname: DeMaso
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002648:Child; D015928:Cognitive Behavioral Therapy; D003424:Crohn Disease / Q000188:drug therapy / Q000523:psychology*; D003866:Depressive Disorder / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D012720:Severity of Illness Index; D012944:Social Support
chemical_list: D000305:Adrenal Cortex Hormones
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