Predictors, Moderators, and Mediators Associated With Treatment Outcome in Randomized Clinical Trials Among
Darren B Courtney1,2, Priya Watson1,2, Karolin R Krause1
1Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
JAMA Network Open
|February 1, 2022
Summary
This review examined predictors, moderators, and mediators of adolescent depression treatment outcomes in randomized clinical trials (RCTs). Key factors like baseline severity and family conflict significantly impact treatment success, guiding future precision medicine approaches.
Area of Science:
- Adolescent psychiatry and psychology
- Precision medicine in mental health
- Clinical trial methodology
Background:
- Adolescent depression treatment requires personalized approaches.
- Understanding factors influencing treatment outcomes is crucial for precision medicine.
- Randomized clinical trials (RCTs) provide valuable data on treatment efficacy.
Purpose of the Study:
- To systematically review predictors, moderators, and mediators of treatment outcomes in adolescent depression RCTs.
- To identify variables associated with depression symptom reduction, response, and remission.
- To inform future research and clinical practice in adolescent depression treatment.
Main Methods:
- A comprehensive scoping review of RCTs was conducted.
- Databases searched included MEDLINE, Embase, APA PsycInfo, and CINAHL.
- Variables were extracted and analyzed for their association with depression outcomes in adolescents (ages 13-17).
Main Results:
- Eighty-one articles from 33 RCTs were analyzed.
- Significant variables included age, sex/gender, baseline depression severity, early treatment response, sleep, parent-child conflict, psychopathology, suicidal ideation, hopelessness, functional impairment, therapy attendance, and trauma history.
- Baseline depression severity and family conflict were associated with poorer outcomes when a priori hypotheses and multiple comparisons were considered.
Conclusions:
- This review highlights commonly researched and underresearched variables in adolescent depression treatment.
- Identifying predictors, moderators, and mediators can optimize treatment strategies.
- Further research in this area holds significant potential for improving care for adolescents with depression.
Related Concept Videos
01:23Antidepressant Drugs: MAOIs and Other Agents
408
Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
408
01:27Depressive Disorders: Etiology
178
Depressive disorders result from a complex interplay of biological, psychological, and sociocultural factors, each contributing uniquely to the development and persistence of the condition. Understanding these factors provides critical insight into the multifaceted nature of depression.
Biological Factors in Depression
Biological predispositions significantly influence the risk of developing depressive disorders. Genetic studies highlight the role of variations in the serotonin transporter...
Biological Factors in Depression
Biological predispositions significantly influence the risk of developing depressive disorders. Genetic studies highlight the role of variations in the serotonin transporter...
178
01:18Depression: Overview
409
Depression is a prevalent mental illness marked by persistent sadness and lack of interest in previously enjoyable activities. It can take several forms, including major depression, persistent depressive disorder, and bipolar I and II disorders. Symptoms range from emotional changes like chronic worry to physical changes like sleep disturbances and suicidal thoughts. From a neurobiological perspective, depression is believed to be triggered by abnormalities in the brain's prefrontal cortex,...
409
01:24Treatment Strategies for Psychological Disorders
319
Treatment approaches for psychological disorders fall into three main categories: psychological, biological, and sociocultural. Each approach targets different aspects of mental health, requiring varying levels of education and training.
Psychological therapies focus on modifying emotions, thoughts, and behaviors through talking, interpreting, listening, rewarding, challenging, and modeling. Clinical psychologists, counselors, and social workers commonly practice psychotherapy. Clinical...
Psychological therapies focus on modifying emotions, thoughts, and behaviors through talking, interpreting, listening, rewarding, challenging, and modeling. Clinical psychologists, counselors, and social workers commonly practice psychotherapy. Clinical...
319
01:25Antidepressant Drugs: Overview
859
Antidepressant drugs are a class of medications primarily used for treating various mood disorders, including major depression, anxiety disorders, and other related conditions. These medicines work by modulating the neurotransmitter balance within the brain, alleviating depressive symptoms. Antidepressants can be broadly categorized into several groups according to their mechanism of action and chemical structure: Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine...
859
01:29Theoretical Approaches to Psychological Disorder
370
The development of psychological disorders, which are characterized by deviant, maladaptive, and personally distressing behaviors, has been explored through several theoretical approaches.
Biological approach
The biological approach posits that internal, organic factors are the primary causes of such disorders. This perspective emphasizes brain structure and function, genetic predispositions, and neurotransmitter imbalances. For example, schizophrenia has been associated with both genetic...
Biological approach
The biological approach posits that internal, organic factors are the primary causes of such disorders. This perspective emphasizes brain structure and function, genetic predispositions, and neurotransmitter imbalances. For example, schizophrenia has been associated with both genetic...
370