Depression in adolescents

167 Pages·2012·6.77 MB·English

Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm
Prof. Dr. Jörg M. Fegert (Department Head)

Depression in adolescents: Feasibility, efficacy, and neural
correlates of a brief group psychotherapeutic treatment, along with
insights on epidemiology, symptoms, and diagnostics

Thesis presented to the
Faculty of Engineering, Computer Science and Psychology
Ulm University
for the degree of Doctor of Philosophy

Joana Franziska Straub
Freiburg
2015
Acting dean: Prof. Dr. T. Seufert

1. Representative: Prof. Dr. M.G. Kölch

2. Representative: Prof. Dr. Dr. M. Holtmann

Day of disputation: 12th November 2015

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Acknowledgements

I would like to thank…
… Prof. Dr. Michael Kölch, who gave me the opportunity to explore different research
topics, fostered my scientific interests, and supervised and supported me during my
years as a PhD student.

… Prof. Dr. Birgit Abler, Dr. Paul Plener and Dr. Nina Spröber who spent a great amount
of time and effort to support, encourage, and improve my work. Thank you for this
intensive mentoring.

… Prof. Dr. Ferdinand Keller and Prof. Dr. Georg Grön, for their statistical and technical
support and for sharing helpful ideas on research questions.

… my colleagues Martina Bonenberger and Rebecca Groschwitz, for always lending me
an ear and for laughing together.

… my colleagues in the fMRI lab.

… the research assistants who helped me with data acquisition and literature searches.

… all patients and subjects who agreed to participate in the studies.

… Prof. Dr. Michael Kölch and Prof. Dr. Dr. Martin Holtmann for reviewing this
dissertation.

… my partner, my friends, and my whole family for their constant support during the
time I worked on this thesis.

Without you, this thesis would not have been possible. Thank you!
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Table of Contents

Abstract ...................................................................................................................................... X
German Summary/Zusammenfassung ..................................................................................... XII
1. General Introduction ........................................................................................................... 1
1.1. Epidemiology of depressive disorders in adolescents .................................................... 1
1.2. Classification of symptoms .............................................................................................. 3
1.3. Instruments for diagnosing depression in adolescents .................................................. 4
1.4. Aetiology.......................................................................................................................... 7
1.4.1. Psychological and social factors .................................................................................. 8
1.4.2. Biological factors .......................................................................................................... 9
1.4.2.1. Genetics, sex, neurotransmitters and structural brain differences......................... 9
1.4.2.2. Brain development and development of psychiatric disorders ............................ 10
1.4.2.3. Functional differences in brain imaging in adolescents with depression.............. 12
1.5. Pharmacological and psychotherapeutic treatment of depression in adolescents ..... 13
1.5.1. Guidelines for the treatment of depression in minors .............................................. 13
1.5.2. Efficacy of psychotherapeutic treatment .................................................................. 14
1.6. Treatment programs for depression ............................................................................. 14
1.6.1. Individual treatment programs available in English-speaking countries .................. 15
1.6.2. International group treatment programs .................................................................. 17
1.6.3. Treatment programs available in Germany .............................................................. 18
1.6.4. Duration of treatment ............................................................................................... 19
1.6.5. Development of a brief CBT-G called MICHI ............................................................. 20
1.7. Neural correlates of depression treatment .................................................................. 21
1.7.1. Neural correlates of pharmacological treatment ...................................................... 21
1.7.2. Neural correlates of psychotherapeutic treatment .................................................. 21
IV
1.7.3. Neural correlates of depression treatment in children and adolescents ................. 24
1.7.4. Paradigm for assessing neuronal correlates of depression treatment ..................... 24
2. Aims and research questions of the present work ........................................................... 25
3. Results ............................................................................................................................... 30
3.1. Changes in prevalence rates of ICD-10 F3 diagnoses in the inpatient setting .............. 30
3.2. Association between symptoms of depression plus mania and suicidal behavior ...... 30
3.3. Convergence of CDRS-R scores with a mild depressive episode according to ICD-10.. 31
3.4. Agreement between BDI-II and CDRS-R in assessing depression in minors ................. 32
3.5. Literature review on psychotherapeutic group treatment for depressed minors ....... 33
3.6. Pilot study on feasibility and acceptance of MICHI in adolescent inpatients ............... 34
3.7. Pilot study on feasibility and acceptance of MICHI in adolescent outpatients ............ 35
3.8. RCT for the assessment of efficacy of MICHI in depressed adolescent outpatients .... 36
3.9. Neural correlates of successful psychotherapy of depression in adolescents ............. 38
4. General discussion ............................................................................................................ 40
4.1 Limitations ..................................................................................................................... 49
4.2 Conclusions and perspectives ....................................................................................... 52
5 References ........................................................................................................................ 56
6 Original research articles .................................................................................................. 74
6.1 Treatment of mental diseases in children in German hospitals: analysis of frequencies
in the years 2003 to 2012. ........................................................................................................ 74
6.2 Suicidal behavior in German adolescents: prevalence and association with depressive
and manic symptoms ............................................................................................................... 81
6.3 Convergence of children's depression rating scale-revised scores and clinical diagnosis
in rating adolescent depressive symptomatology ................................................................... 89
6.4 Agreement between self-report and clinician’s assessment in depressed adolescents,
using the example of BDI-II and CDRS-R .................................................................................. 93
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6.5 Psychotherapeutic treatment of children and adolescents with depression. Review of
the literature on cognitive-behavioral and interpersonal group therapies ........................... 104
6.6 Innovations in Practice: MICHI, a brief cognitive-behavioural group therapy for
adolescents with depression - a pilot study of feasibility in an inpatient setting ................. 114
6.7 A brief cognitive-behavioural group therapy programme for the treatment of
depression in adolescent outpatients: a pilot study .............................................................. 119
6.8 MICHI – a brief, manualized cognitive behavioural group therapy for the treatment of
depression in adolescents: randomized controlled trial. ....................................................... 130
6.9 Neural correlates of successful psychotherapy of depression in adolescents ........... 141
7 Curriculum Vitae ............................................................................................................. 150
8 Scientific articles published in peer-reviewed journals .................................................. 151

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List of Tables
Table 1 Questionnaires and structured interviews for the assessment of depression in
adolescents ................................................................................................................................. 5
Table 2 Meta-analyses about the efficacy of psychotherapies of depressed children and
adolescents ............................................................................................................................... 15
Table 3 German-language therapy programs for the treatment of depressed minors ........... 19
Table 4 Studies investigating neural correlates of psychotherapeutic treatment of depression
by means of an active paradigm .............................................................................................. 22

List of Figures
Figure 1 Neurobiological model demonstrating that bottom-up processes develop faster
than top-down processes in adolescents (modified after Casey et al. 2008) .......................... 11
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Abbreviations
ACC anterior cingulate cortex
BAT behavioural activation therapy
BDI-II Beck Depression Inventory-Revision
CAR cortisol awakening response
CBT cognitive behavioural psychotherapy
CBT-G group cognitive behavioural therapy
CDRS-R Children’s Depression Rating Scale-Revised
CWD-A Coping With Depression course for Adolescents
DSM Diagnostic and Statistical Manual of Mental Disorders
fMRI functional Magnetic Resonance Imaging
ICD International Classification System of Diseases
IPT interpersonal psychotherapy
IPT-A interpersonal psychotherapy for depressed adolescents
MDD major depressive disorder
MICHI Manualized Intervention to Cope with depressive symptoms, Help strengthen
resources and Improve emotion regulation
PASCET Primary and Secondary Control Enhancement Training
PAT-I Depressed adolescent patients (PAT) assigned to the intervention group (I)
PAT-W Depressed adolescent patients (PAT) assigned to the wait-list control group (W)
RCT randomized controlled trial
sgACC subgenual anterior cingulate cortex
SSRI selective serotonin reuptake inhibitor
TAU psychiatric treatment as usual
vACC ventral anterior cingulate cortex
WHO World Health Organization
WL wait list

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