Mediators of Interpersonal Psychotherapy for Depressed Adolescents On Outcomes in Latinos: The Role of Peer and Family Interpersonal Functioning

Peer and family interpersonal functioning were examined as mediators of the impact of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A; Mufson, Dorta, Moreau, & Weissman, 2004) on depression and suicidal ideation among Latino youth. Only youth self-identifying as Latino (n = 50) were included in the analyses. The majority were female (86%) with a mean age of 14.58 (SD = 1.91). The current sample was drawn from the intent to treat sample of a clinical trial examining the effectiveness of IPT-A as compared with treatment as usual (TAU; Mufson, Dorta, Wickramaratne et al., 2004). Youth were randomly assigned to receive IPT-A or TAU delivered by school-based mental health clinicians. Assessments, completed at baseline and at Weeks 4, 8, and 12 (or at early termination), included self-report measures of depression and interpersonal functioning as well as clinician-Administered measures of depression. Multilevel modeling indicated that IPT-A led to greater improvement in interpersonal functioning with family and peers. Improved family and peer interpersonal functioning emerged as significant partial mediators of the relationship between IPT-A and depression. Only improved family interpersonal functioning emerged as a significant partial mediator of the relationship between IPT-A and suicidal ideation. However, this indirect effect was small, suggesting that most of the benefit of IPT-A for suicidal ideation appears to proceed through a pathway other than family interpersonal functioning. These results suggest that the impact of IPT-A on depressive symptoms is partially mediated by family and peer interpersonal functioning and contributes to our understanding of the mechanisms of IPT-A

Innovations in Practice: The Relationship Between Sleep Disturbances, Depression, and Interpersonal Functioning in Treatment for Adolescent Depression

Background: Sleep disturbance is frequently comorbid with depression and sleep complaints are the most common residual symptoms after treatment among adolescents with depression. The present analyses investigated the effect of sleep disturbance in depressed adolescents treated with interpersonal psychotherapy for adolescents (IPT-A) versus treatment as usual (TAU) in school-based mental health clinics. Method: Sixty-three adolescents participated in a randomized clinical trial of IPT-A versus TAU for adolescent depression. Participants were diagnosed with a DSM-IV depressive disorder and assessed for symptoms of depression, interpersonal functioning, and sleep disturbance. Measures were assessed at baseline, session 4 and 8 of treatment, and session 12 for postacute treatment follow-up. Hierarchical linear modeling was used to model change in depression, interpersonal functioning, and sleep disturbance. Results: Ongoing sleep disturbance was significantly associated with worse depression scores as rated by clinician (γ = 1.04, SE =.22, p \u3c.001) and self-report (γ = 1.63, SE =.29, p \u3c.001), as well as worse interpersonal functioning across the course of treatment (γ = 0.09, SE =.02, p \u3c.001). Treatment condition did not predict change in sleep disturbance (γ = −0.13, SE =.14, p = ns). Conclusions: For all patients in the study, sleep disturbance was a predictor of depression and interpersonal functioning for depressed adolescents. Sleep disturbance predicted more depression and interpersonal stress across treatments and led to a slower improvement in depression and interpersonal functioning. These data suggest that sleep disturbance should be a target for future treatment development research among depressed adolescents

Clinician Experience and Attitudes Toward Safety Planning with Adolescents At Risk for Suicide

This study examined clinician experiences and attitudes toward safety planning in a large urban pediatric psychiatry department serving primarily Latino youth. A total of 46 clinicians completed a survey assessing their experience with and attitudes toward safety planning with adolescents at-risk for suicide. The majority of clinicians were female (78%), non-Latino White (54%), and aged 30–39 (52%). Clinicians’ attitudes were largely positive (M = 3.69 SD = 0.47, Range = 2.42–4.42). However, many clinicians (n = 24) were not convinced that safety planning reduces the imminent risk of suicidal behavior in patients. This study provides more depth to our understanding of the way in which safety planning is perceived by clinicians

Sleep Deprivation and Stressors: Evidence for Elevated Negative Affect in Response to Mild Stressors When Sleep Deprived

Stress often co-occurs with inadequate sleep duration, and both are believed to impact mood and emotion. It is not yet known whether inadequate sleep simply increases the intensity of subsequent stress responses or interacts with stressors in more complicated ways. To address this issue, we investigated the effects of one night of total sleep deprivation on subjective stress and mood in response to low-stress and high-stress cognitive testing conditions in healthy adult volunteers in two separate experiments (total N ϭ 53). Sleep was manipulated in a controlled, laboratory setting and stressor intensity was manipulated by changing difficulty of cognitive tasks, time pressure, and feedback about performance. Sleep-deprived participants reported greater subjective stress, anxiety, and anger than rested controls following exposure to the low-stressor condition, but not in response to the high-stressor condition, which elevated negative mood and stress about equally for both sleep conditions. These results suggest that sleep deprivation lowers the psychological threshold for the perception of stress from cognitive demands but does not selectively increase the magnitude of negative affect in response to high-stress performance demands

Physical activity and sleep: Day-to-day associations among individuals with and without bipolar disorder

OBJECTIVE: To evaluate the relative role of psychopathology in the relationship between physical activity and sleep, the present study investigated the day-to-day relationship between physical activity and sleep in individuals without a psychiatric disorder and individuals with bipolar disorder using a longitudinal, naturalistic design. METHOD: Participants in two groups—a healthy group with no psychiatric illness (N=36) and an inter-episode bipolar disorder group (N=32)— were studied over a two-month period. Physical health was assessed by the SF-36. Daily subjective and objective measures of physical activity and sleep were collected. A total of 6,670 physical activity measurements and 6,548 sleep measurements were logged. RESULTS: The bipolar disorder group exhibited poorer physical health on the SF-36 and more sleep disturbance relative to the healthy group. No group differences were found in physical activity, nor in models examining the relationship between physical activity and sleep. Hierarchical linear models indicated that for every standard deviation increase in sleep disturbance (i.e., increased total wake time), there was a three percent decrease in subsequent day physical activity, in both the healthy and bipolar groups. Increased physical activity was associated with improved sleep for participants who reported greater average sleep disturbance. CONCLUSIONS: The results for all participants in the study suggest that reduced physical activity and sleep difficulties may be mutually maintaining processes, particularly for individuals who suffer from poor sleep. Findings also raise the potential importance of targeting physical activity and sleep concurrently in interventions aimed at improving physical and mental health