When compared with adolescents receiving routine treatment for depression
in school-based health clinics, those who received interpersonal psychotherapy
for depressed adolescents (IPT-A) experienced greater reduction in depression
symptoms and improved overall functioning.
This was the major finding of a study examining the effectiveness of IPT in
urban schools published in the June Archives of General
Researchers at the New York State Psychiatric Institute conducted the study
in five school-based health clinics in impoverished communities in New York
City. They gathered data on the mental health outcomes of 63 adolescents
referred for treatment to their school's health clinic.
The lead investigator was Laura Mufson, Ph.D., an associate professor of
clinical psychology in psychiatry at Columbia University College of Physicians
and Surgeons and director of the department of psychology at New York State
Psychiatric Institute. She adapted the therapy—which was developed in
the 1980s to target depressive symptoms in adults—for use in
IPT is a time-limited form of psychotherapy "based on the premise
that depression occurs in the context of interpersonal relationships,"
Mufson told Psychiatric News.
While problems in a person's relationships with others may not be the cause
of the depression, she noted, they can "exacerbate and prolong
IPT, she added, focuses on one or two problems within a patient's
interpersonal relationships and helps the patient develop better ways of
communicating and problem solving within that area of his or her life.
To be eligible for the study, adolescents had to meet DSM-IV
criteria for major depression, dysthymia, adjustment disorder with depressed
mood, or depressive disorder NOS. They also had to have a score of 10 or
higher on the Hamilton Depression Rating Scale (HAM-D) and 65 or lower on the
Children's Global Assessment Scale.
A child psychologist determined whether students met eligibility criteria
after independent evaluators, who were master's-level social workers, assessed
children using the Schedule for Affective Disorders and Schizophrenia for
School-Aged Children and conducted a clinical interview with the students.
The students were between the ages of 12 and 18, with an average age of 15
years; 84 percent were female, and 71 percent were Hispanic.
If at any time during the study, an adolescent's symptoms or functioning
appeared to be worsening—for example, if their HAM-D score was greater
than 25—he or she was referred for an evaluation by a child psychologist
or psychiatrist and offered an additional treatment such as medication.
Between spring 1999 and summer 2002, 34 students were randomly assigned to
receive 12 sessions of IPT-A over 16 weeks, and 29 were randomly assigned to
treatment as usual, which typically included supportive counseling on an
The mean number of sessions for the treatment-as-usual condition was about
eight sessions, according to the report. Eight adolescents received one to
three additional family/parent therapy sessions, and five students also
participated in group therapy.
Mufson measured depressive symptoms of students in both groups using the
HAM-D and Beck Depression Inventory (BDI), global functioning with the
Clinical Global Impressions scale and the Children's Global Assessment Scale,
and social functioning with the Social Adjustment Scale Self-Report.
At the end of the clinical trial, 17 students, or 50 percent, of those who
received IPT-A met the criterion for improvement of depression as measured by
the HAM-D as compared with 10 students, or 34 percent, of those who received
treatment as usual.
On the BDI, 25, or 74 percent, of those receiving IPT-A met recovery
criteria as compared with 15, or 52 percent, who received treatment as
Adolescents who received IPT also fared significantly better on measures of
global and social functioning than had those who received treatment as
Mufson said she would like to see the results of the study replicated in a
larger sample, and noted that IPT-A is the type of treatment clinicians can
learn and conduct easily within a number of school health clinic settings.
"We were able to train the clinicians from the schools that
participated in the study to conduct IPT-A with a brief training program and
supervision, and they were able to implement the study with good
fidelity," she said.
The study was funded by the Substance Abuse and Mental Health Services
Administration and the National Institute of Mental Health Child Psychiatry
Intervention Research Center.
An abstract of the article, "A Randomized Effectiveness Trial
of Interpersonal Psychotherapy for Depressed Adolescents," is posted