Depression During Adolescence: An Examination of Treatment Outcomes Through an Intersectional Lens

Major Depressive Disorder is a common mental health disorder, with studies suggesting its potential to lead to academic and social-emotional impairment in youth (Alegria, Vallas, & Pumariega, 2011). Although psychological treatments for this disorder have been studied for decades, prior to recent years little was known about the generalizability of treatment effectiveness to non-European samples (Bernal, Bonila, & Bellido, 1995; Bernal & Scharron-Del-Rio, 2001). Data suggest that racial/ethnic minority youth experience more severe depression when diagnosed with the disorder and are less likely to access mental health services. Behavior Activation (BA) is a treatment approach found to be effective for severe depressive symptoms, but there is a dearth in the literature showing its effectiveness with youth and racial/ethnic minorities (Dimijidan et al., 2006). Additionally, prior examinations of treatment effectiveness have largely focused on reductions in symptom severity and have excluded other aspects, such as quality of life (Krause, Bear, Edbrooke-Childs, & Wolpert, 2019). The current study examined the relationship between ethnicity, gender, and treatment outcomes for 409 adolescents (ages 13-21) who had undergone BA treatment at behavioral health clinics throughout the U.S. Treatment outcomes included depressive symptomology and quality of life following treatment. Additionally, the study examined the potential moderation of gender on the relationship between ethnicity and treatment outcomes. Preliminary analyses revealed that for the overall sample, levels of depressive symptomology and quality of life significantly improved after BA treatment. Multiple regression analyses testing for interactions were conducted to determine if the demographic variables of interest (i.e., ethnicity, race, and/or gender) predicted quality of life or depressive symptomology following treatment. Results suggested there were no significant differences between ethnic, racial, or gender groups for quality of life or depressive symptomology following treatment. However, when testing for interaction effects, African American/Black females had significantly higher depressive symptoms post-treatment. The sample included a small number of Black females, therefore, these results should be generalized with caution. This study adds to the literature that BA is an effective treatment for adolescents, specifically those in intensive treatment settings (i.e., residential, partial hospitalization, intensive outpatient). Future research should include more ethnically/racially and gender diverse samples of adolescents and consider a qualitative approach in understanding patient’s perspectives on and satisfaction with BA as a treatment

Examining Patient Satisfaction and Treatment Effectiveness for Hispanic Adolescents Receiving Intensive Mental Health Services for Depression

Behavioral Activation (BA) is a treatment approach that has demonstrated promising outcomes for the adolescent population (Martin & Oliver, 2019). However, more studies are needed to examine its effectiveness with Hispanic adolescents. The prevalence and severity of depressive symptoms tend to be higher among Hispanic adolescents in comparison to their non-Hispanic White peers (Pratt & Brody, 2014). In addition, depressive symptoms are associated with poor social, academic, and later health outcomes (Naicker et al., 2013; Owens, Stevenson, Hadwin, 2012). Given the lack of prior investigations on the effectiveness of BA for Hispanic adolescents, this study aimed to fill a gap in the current literature by examining how Hispanic adolescents responded to BA treatment, as evidenced by changes in depressive symptoms and health-related quality of life. Hispanic adolescents in the study sought care at behavioral health clinics throughout the United States and were seen at multiple levels of care within intensive mental health care settings (i.e., intensive outpatient, partial hospitalization, and residential levels of care). In addition, providers underwent a 5-part allyship and belongingness training and targeted discussions to increase their knowledge of concepts such as privilege, bias, microaggressions. Therefore, the current study also assessed patient ratings of their satisfaction with care overall and as it related to provider sensitivity to their cultural identities. Lastly, this study aimed to examine the relationship between treatment outcomes and satisfaction with care overall, and the relationship between treatment outcomes and satisfaction with level of providers’ cultural sensitivity. The study found BA treatment significantly improved health-related quality of life and depressive symptoms for Hispanic adolescents. In addition, the study found that Hispanic adolescents ranged from “more satisfied than dissatisfied” to “very satisfied” with their care overall and as being sensitive to their cultural identity. When the relationship between treatment outcomes and satisfaction with care overall was examined, researchers found satisfaction with care overall was not correlated with changes in depressive symptom severity or health-related quality of life. When the relationship between treatment outcomes and satisfaction with care as it relates to provider’s level of cultural sensitivity was examined, researchers found satisfaction with care as it relates to provider’s level of cultural sensitivity was negatively correlated with changes in health-related quality of life. It should be noted that clinic procedures included patients debriefing with a staff member if they had ratings on the Patient Satisfaction Survey below a 3. This procedure may have resulted in higher ratings on the Patient Satisfaction Survey for patients who did not want to engage in this debriefing. Future research should examine effectiveness in community health settings, utilize a standardized measure of satisfaction, and explore factors like acculturation to examine how they affect treatment outcomes or satisfaction with care

Depression During Adolescence: An Examination of Treatment Outcomes Through an Intersectional Lens

Major Depressive Disorder is a common mental health disorder, with studies suggesting its potential to lead to academic and social-emotional impairment in youth (Alegria, Vallas, & Pumariega, 2011). Although psychological treatments for this disorder have been studied for decades, prior to recent years little was known about the generalizability of treatment effectiveness to non-European samples (Bernal, Bonila, & Bellido, 1995; Bernal & Scharron-Del-Rio, 2001). Data suggest that racial/ethnic minority youth experience more severe depression when diagnosed with the disorder and are less likely to access mental health services. Behavior Activation (BA) is a treatment approach found to be effective for severe depressive symptoms, but there is a dearth in the literature showing its effectiveness with youth and racial/ethnic minorities (Dimijidan et al., 2006). Additionally, prior examinations of treatment effectiveness have largely focused on reductions in symptom severity and have excluded other aspects, such as quality of life (Krause, Bear, Edbrooke-Childs, & Wolpert, 2019). The current study examined the relationship between ethnicity, gender, and treatment outcomes for 409 adolescents (ages 13-21) who had undergone BA treatment at behavioral health clinics throughout the U.S. Treatment outcomes included depressive symptomology and quality of life following treatment. Additionally, the study examined the potential moderation of gender on the relationship between ethnicity and treatment outcomes. Preliminary analyses revealed that for the overall sample, levels of depressive symptomology and quality of life significantly improved after BA treatment. Multiple regression analyses testing for interactions were conducted to determine if the demographic variables of interest (i.e., ethnicity, race, and/or gender) predicted quality of life or depressive symptomology following treatment. Results suggested there were no significant differences between ethnic, racial, or gender groups for quality of life or depressive symptomology following treatment. However, when testing for interaction effects, African American/Black females had significantly higher depressive symptoms post-treatment. The sample included a small number of Black females, therefore, these results should be generalized with caution. This study adds to the literature that BA is an effective treatment for adolescents, specifically those in intensive treatment settings (i.e., residential, partial hospitalization, intensive outpatient). Future research should include more ethnically/racially and gender diverse samples of adolescents and consider a qualitative approach in understanding patient’s perspectives on and satisfaction with BA as a treatment

Comparing diagnostic criteria for posttraumatic stress disorder in a diverse sample of trauma-exposed youth

Divergent conceptualization of posttraumatic stress disorder (PTSD) within the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) and International Statistical Classification of Diseases and Related Health Problems (11th ed..; ICD-11) significantly confounds both research and practice. Using a diverse sample of trauma-exposed youth (N = 1,542, age range: 8-20 years), we compared these two diagnostic approaches along with an expanded version of the ICD-11 PTSD criteria that included three additional reexperiencing symptoms (ICD-11+). Within the sample, PTSD was more prevalent using the DSM-5 criteria (25.7%) compared to the ICD-11 criteria (16.0%), with moderate agreement between these diagnostic systems, κ = .57. The inclusion of additional reexperiencing symptoms (i.e., ICD-11+) reduced this discrepancy in prevalence (24.7%) and increased concordance with DSM-5 criteria, κ = .73. All three PTSD classification systems exhibited similar comorbidity rates with major depressive episode (MDE) or generalized anxiety disorder (GAD; 78.0%-83.6%). Most youths who met the DSM-5 PTSD criteria also met the criteria for ICD-11 PTSD, MDE, or GAD (88.4%), and this proportion increased when applying the ICD-11+ criteria (95.5%). Symptom-level analyses identified reexperiencing/intrusions and negative alterations in cognition and mood symptoms as primary sources of discrepancy between the DSM-5 and ICD-11 PTSD diagnostic systems. Overall, these results challenge assertions that nonspecific distress and diagnostically overlapping symptoms within DSM-5 PTSD inflate comorbidity with depressive and anxiety disorders. Further, they support the argument that the DSM-5 PTSD criteria can be refined and simplified without reducing the overall prevalence of psychiatric diagnoses in youth