An Exploratory Analysis of the Impact of Family Functioning on Treatment for Depression in Adolescents

Abstract

This article explores aspects of family environment and parent–child conflict that may predict or moderate response to acute treatments among depressed adolescents (N = 439) randomly assigned to fluoxetine, cognitive behavioral therapy, their combination, or placebo. Outcomes were Week 12 scores on measures of depression and global impairment. Of 20 candidate variables, one predictor emerged: Across treatments, adolescents with mothers who reported less parent–child conflict were more likely to benefit than their counterparts. When family functioning moderated outcome, adolescents who endorsed more negative environments were more likely to benefit from fluoxetine. Similarly, when moderating effects were seen on cognitive behavioral therapy conditions, they were in the direction of being less effective among teens reporting poorer family environments.

The Treatment for Adolescents with Depression Study (TADS) is coordinated by the Department of Psychiatry and Behavioral Sciences and the Duke Clinical Research Institute at Duke University Medical Center in collaboration with the National Institute of Mental Health (NIMH), Rockville, Maryland. The Coordinating Center principal collaborators are John March, Susan Silva, Stephen Petrycki, John Curry, Karen Wells, John Fairbank, Barbara Burns, Marisa Domino, and Steven McNulty. The NIMH principal collaborators are Benedetto Vitiello and Joanne Severe. Principal Investigators and Co-investigators from the clinical sites are as follows: Carolinas Medical Center: Charles Casat, Jeanette Kolker, Karyn Riedal, Marguerita Goldman; Case Western Reserve University: Norah Feeny, Robert Findling, Sheridan Stull, Felipe Amunategui; Children's Hospital of Philadelphia: Elizabeth Weller, Michele Robins, Ronald Weller, Naushad Jessani; Columbia University: Bruce Waslick, Michael Sweeney, Rachel Kandel, Dena Schoenholz; Johns Hopkins University: John Walkup, Golda Ginsburg, Elizabeth Kastelic, Hyung Koo; University of Nebraska: Christopher Kratochvil, Diane May, Randy LaGrone, Martin Harrington; New York University: Anne Marie Albano, Glenn Hirsch, Tracey Knibbs, Emlyn Capili; Northwestern University: Mark Reinecke, Bennett Leventhal, Catherine Nageotte, Gregory Rogers; University of Cincinnati: Sanjeev Pathak, Jennifer Wells, Sarah Arszman, Arman Danielyan Sanjeev; University of Oregon: Anne Simons, Paul Rohde, James Grimm, Lananh Nguyen; University of Texas Southwestern: Graham Emslie, Beth Kennard, Carroll Hughes, Maryse Ruberu; Wayne State University: David Rosenberg, Nili Benazon, Michael Butkus, Marla Bartoi. Greg Clarke (Kaiser Permanente) and David Brent (University of Pittsburgh) are consultants; James Rochon (Duke Clinical Research Institute) is statistical consultant.

TADS was supported by contract N01 MH80008 from the National Institute of Mental Health to Duke University Medical Center (John S. March, Principal Investigator).

Notes

Note: Sample baseline median for the measure was imputed in the event of missing values. COMB = combination; FLX = fluoxetine; CBT = cognitive behavioral therapy; PBO = placebo; FAM-A/FAM-P = Family Assessment Measure adolescent completed or parent completed; CBQ-A/CBQ-P = Conflict Behavior Questionnaire, adolescent completed or parent completed; ICA/ICP = Issues Checklist adolescent completed or parent completed; CDRS–R = Children's Depression Rating Scale–Revised; IE = independent evaluator; RADS = Reynolds Adolescent Depression Scale; CGAS = Children's Global Assessment Scale.

^a N = 107.

^b N = 109.

^c N = 111.

^d N = 112.

Note: CBQ-A/CBQ-P = Conflict Behavior Questionnaire, adolescent completed or parent completed; FAM-A/FAM-P = Family Assessment Measure adolescent completed or parent completed; ICA/ICP = Issues Checklist adolescent completed or parent completed.

Note: Results from general linear models. The p values for Type III Sum of Squares. Moderator = Candidate × Treatment interaction (p ≤ .05). Predictor = candidate main effect only (p ≤ .05). FAM-A = Family Assessment Measure adolescent completed; CDRS–R = Children's Depression Rating Scale–Revised; RADS = Reynolds Adolescent Depression Scale; CGAS = Children's Global Assessment Scale; ICP = Issues Checklist parent completed.

Note: General linear models (GLM) least squares means and standard deviations: GLM adjusted for the effects of site and the baseline values of the outcome measure (CDRS–R, RADS, or CGAS) score. CDRS–R = Children's Depression Rating Scale–Revised; IE = independent evaluator; FAM–A = Family Assessment Measure adolescent completed; COMB = combination treatment; FLX = fluoxetine; CBT = cognitive behavior therapy; PBO = placebo; RADS = Reynolds Adolescent Depression Scale; CGAS = Children's Global Assessment Scale.