Does Interpersonal Psychotherapy improve clinical care for adolescents with depression attending a rural child and adolescent mental health service? A feasibility study

Adolescent depression is a costly problem for our communities, families and young people. Currently, when detected, treatment provided for depression within Australian Child and Adolescent Mental Health Services (CAMHS) is of unknown content and effectiveness. The objectives of the clinical research are: 1. to investigate the impact on clinical care of implementing Interpersonal Psychotherapy for Adolescents (IPT-A) for the treatment of adolescent depression within a rural CAMHS compared with Treatment as Usual (TAU). 2. to evaluate the issues associated with implementing a clinical trial in CAMHS (i.e. feasibility, acceptability, sustainability). Half the participating clinicians will receive IPT-A training and supervision, with the remaining clinicians providing their usual care (i.e. Treatment as Usual). Treatment as Usual (TAU) for adolescent depression in CAMHS is anticipated to vary in content and frequency according to who is providing it. One outcome of the project will be the clarification of what TAU comprises within the rural CAMHS. Eligible and consenting therapists will be randomized to either stream (within each site) where possible. Implementation issues will be investigated qualitatively using focus groups with clinicians and interviews with clients, carers and clinicians. The research will be conducted within the Latrobe Regional Hospital (LRH) CAMHS in Gippsland. All clinicians, employed full- or part-time within the LRH CAMHS, will be invited to participate. The trial aims to include a minimum of 60 adolescent clients of LRH CAMHS, aged 12 to 18 years, recruited over two years. Adolescents will be eligible to participate if they have significant depressive symptoms (exceeding Reynold’s Adolescent Depression Scale clinical cutoff) or a DSM-IV diagnosis of a depressive disorder (i.e. Major Depressive Disorder (MDD), Dysthymic Disorder, Depressive Disorder Not Otherwise Specified (NOS), or Adjustment Disorder with Depressed Mood) and a Children’s Global Assessment Scale (CGAS) of 65 or lower. All eligible clients will need parental consent and the agreement of the CAMHS consultant psychiatrist, regarding diagnosis and client suitability, to participate. Monitoring and outcome assessment will use the usual CAMHS outcome measures as well as some additional reliable and valid measures applied in similar research. They will include adolescent self-report, parent-report and clinician ratings. Treatment groups will be compared for demographic characteristics, diagnosis, measures of clinical improvement and treatment acceptability. Themes from focus group and interview data will be detected in qualitative analysis of transcripts using the constant comparative cyclic analysis method. The project is expected to increase understanding of the issues and outcomes associated with implementing and evaluating an evidence-based intervention for adolescent depression in a rural child and adolescent mental health service.