Annotated Abstracts of Journal Articles
2014, 3rd Quarter
Annotation by Audrey Walker, MD, FAPM
Szigethy E, Bujoreanu SI, Youk AO, et al
J Am Acad Child Adolesc Psychiatry 2014 Jul; 53(7):726-35
ANNOTATION (Audrey Walker)
The Finding: A high remission rate (66%) in depressive symptoms was found in both treatment groups. There was no statistically significant difference in remission rates between the two therapies. Both therapies demonstrated improvement in HRQoL and psychosocial function at the conclusion of the treatment period. IBD activity improved over time in both treatment groups.
Strengths and Weaknesses: This study did not include a control group of treatment-as-usual (TAU), so the question of whether the improvement seen could have been a function merely of the passage of time could not be answered. The authors note that this possibility of passage of time as explanatory of improvement is unlikely, as previous studies have demonstrated that CBT is superior to TAU in adolescents with depression.
Relevance: This is an important study in pediatric psychosomatic medicine as it is the first randomized, controlled study that demonstrates improvement in depression severity, global functioning, quality of life, and disease activity in pediatric patients with IBD. The finding that both interventions yield similar improvements lends weight to the possibility that modality-specific skills may be less important factors in causing improvement than “common factors” such as empathic attention, social support, construction of an illness narrative, and family intervention.
Objective: Pediatric inflammatory bowel disease (IBD) is associated with high rates of depression. This study compared the efficacy of cognitive behavioral therapy (CBT) to supportive nondirective therapy (SNDT) in treating youth with comorbid IBD and depression.
Method: Youth (51% female and 49% male; age 9-17 years, mean age 14.3 years) with depression and Crohn’s disease (n = 161) or ulcerative colitis (n = 56) were randomly assigned to a 3-month course of CBT or SNDT. The primary outcome was comparative reduction in depressive symptom severity; secondary outcomes were depression remission, increase in depression response, and improved health-related adjustment and IBD activity.
Results: A total of 178 participants (82%) completed the 3-month intervention. Both psychotherapies resulted in significant reductions in total Children’s Depression Rating Scale Revised score (37.3% for CBT and 31.9% for SNDT), but the difference between the 2 treatments was not significant (p = .16). There were large pre-post effect sizes for each treatment (d = 1.31 for CBT and d = 1.30 for SNDT). More than 65% of youth had a complete remission of depression at 3 months, with no difference between CBT and SNDT (67.8% and 63.2%, respectively). Compared to SNDT, CBT was associated with a greater reduction in IBD activity (p = .04) but no greater improvement on the Clinical Global Assessment Scale (p = .06) and health-related quality of life (IMPACT-III scale) (p = .07).
Conclusion: This is the first randomized controlled study to suggest improvements in depression severity, global functioning, quality of life, and disease activity in a physically ill pediatric cohort treated with psychotherapy.