Abstract:
:This is a longitudinal randomized control trial on the impact of adding a parent psychoeducation intervention (TEPSI) as part of cognitive-behavioral therapy (CBT) for adolescents with Major Depressive Disorder (MDD) in a Puerto Rican sample. We tested the efficacy of adding 8 group sessions of TEPSI to 12 sessions of individual CBT on reducing depressive symptoms, MDD diagnosis, and improving family functioning. Participants (n = 121) were randomized to individual CBT with or without TEPSI. No main group effects were found for most patient domains including depression symptoms, as well as presence of adolescent's MDD diagnosis at posttreatment. Results did show a main effect of CBT over time for depression symptoms, suicide ideation, family criticism, and the presence of MDD diagnosis decreasing from pre- to postintervention. A year post treatment, almost 70% of adolescents in both conditions (CBT and CBT + TEPSI) remained in remission. A main effect was obtained for treatment in the adolescent's perception of familism and family emotional involvement. The primary hypothesis that family psychoeducation would optimize CBT for depression in adolescents was not supported. Both conditions yielded similar clinical end points. The culturally adapted CBT was found effective with Latino/a adolescents showing clinically significant improvements from pretreatment to posttreatment and remained stable at a 1-year follow-up. Regarding family outcomes, adolescents in CBT + TEPSI remained stable from pretreatment to posttreatment on family emotional involvement, while adolescents in CBT-alone showed an increase. The implication of these findings is discussed. :Este es un ensayo clínico longitudinal aleatorizado y controlado sobre el efecto de agregar una intervención psicoeducativa para los padres (TEPSI, en inglés) como parte de la terapia cognitivo-conductual (TCC) para adolescentes con trastorno depresivo mayor (TDM) en una muestra puertorriqueña. Evaluamos la eficacia de agregar 8 sesiones grupales de TEPSI a 12 sesiones de TCC individual en la reducción de síntomas depresivos, en el diagnóstico de TDM y en la mejora del funcionamiento familiar. Los participantes (n = 121) fueron distribuidos al azar a la TCC individual con o sin TEPSI. No se encontraron efectos grupales principales en la mayoría de las áreas de los pacientes, como en los síntomas de depresión ni en la presencia de un diagnóstico de TDM en los adolescentes después del tratamiento. Los resultados sí demostraron un efecto principal de la TCC con el tiempo para los síntomas de depresión, las ideas suicidas, la crítica familiar y la presencia de un diagnóstico de TDM que disminuye desde antes hasta después de la intervención. Un año después del final del tratamiento, casi el 70 % de los adolescentes en ambas condiciones (TCC y TCC + TEPSI) se mantuvo en remisión. Se obtuvo un efecto principal del tratamiento en la percepción de los adolescentes del familismo y la implicación emocional familiar. No se respaldó la hipótesis principal de que la psicoeducación familiar optimizaría la TCC para la depresión en los adolescentes. Ambas condiciones dieron variables clínicas similares. Se descubrió que la TCC culturalmente adaptada fue eficaz con los adolescentes latinos, ya que demostró mejoras clínicas considerables desde antes del tratamiento hasta después del tratamiento y permaneció estable un año después al momento del seguimiento. Con respecto a los resultados familiares, los adolescentes de la TCC + TEPSI se mantuvieron estables desde antes del tratamiento hasta después del tratamiento en la implicación emocional familiar, mientras que los adolescentes de la TCC sola demostraron un aumento. Se debaten las implicancias de estos resultados. :本研究是一项长期性的随机对照实验,考察对象是接受认知行为疗法(CBT)的波多黎各样本中重度抑郁症青少年患者,研究对他们实施干预的内容上增加家长心理教育干预(TEPSI)后的影响。我们在针对个人的12次CBT期间增加了8次家长教育学习会TEPSI,内容都是关于减轻抑郁症状,重度抑郁的诊断和如何提高家庭的效能,然后考察这些新增的干预是否有影响力。受试者人数为121人,随机安排他们接受增加了TEPSI干预的个人CBT,和没有TEPSI的个人CBT。抑郁病人的大多数病情状况包括抑郁症状和青少年在实施治疗后诊断出MDD重度症状方面,研究并未发现主要的群组效果。有一项主要的效果表现在实施CBT一段时间后,就抑郁症状,自杀意图,家庭批评行为,诊断出重度抑郁MDD等方面而言,对比干预前到干预后期,有下降趋势。干预治疗后的一年里,几乎70%的青少年无论在哪种干预策略下(只有CBT和 CBT+TEPSI)病情都有缓解。研究还得出一个主要效果是关于治疗期间青少年对家庭结构功能和家庭情感投入的认知有何影响作用。家庭心理教育会对治疗青少年抑郁的CBT起到优化作用这个主要假设并没有得到有力证据支持。两种干预策略下的临床效果其实是类似的。针对拉丁裔青少年所作的文化调适后的CBT被证实是有成效的,对比治疗前到治疗后能看到临床上的效果有重大提升,继续跟踪一年的观察研究结果也比较稳定。比较从治疗前到治疗后家庭方面的结果能看到接受了CBT+TEPSI的青少年患者中在家庭情感投入上一直保持稳定, 只接受CBT的青少年中表明有增加。这些结果的意义文中有讨论。.
journal_name
Fam Processjournal_title
Family processauthors
Bernal G,Rivera-Medina CL,Cumba-Avilés E,Reyes-Rodríguez ML,Sáez-Santiago E,Duarté-Vélez Y,Nazario L,Rodríguez-Quintana N,Rosselló Jdoi
10.1111/famp.12455subject
Has Abstractpub_date
2019-12-01 00:00:00pages
832-854issue
4eissn
0014-7370issn
1545-5300journal_volume
58pub_type
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