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Interpersonal Psychotherapy for Depressed Adolescents (IPT-A)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare Relevance Level:
Medium

See descriptions of 3 levels

Brief Description

The information in this program outline is provided by the program representative and edited by the CEBC staff. The Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) program has been rated by the CEBC in the area of: Depression Treatment (Child & Adolescent).

  • Types of Maltreatment: Does not target any specific kind of maltreatment
  • Target Population: Adolescents ages 12-18 years old suffering from non-psychotic depression who can be treated on a once a week outpatient basis.

Interpersonal Psychotherapy (IPT) is a time-limited, manualized psychosocial treatment for depression in adolescents and adults. IPT for adults has been rated by the CEBC in the area of Depression Treatment (Adult). IPT identifies how interpersonal issues are related to the onset or maintenance of depressive symptoms while recognizing the contributions of genetic, biological, and personality factors to vulnerability for depression. The goal of treatment is to improve depressed patients’ communication and problem solving skills to help them improve their relationships. Patients work to understand the effects of interpersonal events on their mood and to improve their communication and problem-solving skills in order to increase their effectiveness and satisfaction in current relationships.

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) is defined in a treatment manual that was adapted to address the developmental needs of adolescents and their families. IPT-A is an outpatient treatment designed for adolescents with mild to moderate depression severity. It is not indicated for adolescents who are acutely suicidal or homicidal, psychotic, bipolar, or mentally retarded, or for adolescents who are actively abusing substances.

Essential Components

Initial Phase:

  • Psychoeducation about depression
  • Assignment of the limited sick role
  • Creation of the closeness circle
  • Conduct an interpersonal inventory
  • Problem Area Formulation: 1 of 4: grief, role transitions, role disputes, interpersonal deficits

Middle Phase: Work on Interpersonal Problem Area –

  • Clarification and expression of emotions
  • Communication analysis
  • Decision analysis for problem-solving
  • Teach communication skills
  • Role playing
  • Assign interpersonal experiments to do in between sessions

Termination:

  • Review of warning symptoms of depression
  • Review of interpersonal strategies
  • Generalization of strategies to future situations
  • Discuss feelings about ending treatment
  • Assess need for further treatment

Child Component

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) was designed with a child component that addresses the following presenting problems and symptoms:

  • Interpersonal problems and depression symptoms.

Age range: 12 – 18

Developmental Delays:

This program was not developed for children with developmental delays, and has not been tested for children with developmental delays.

Parent / Caregiver Component

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

  • There is recommended parental involvement to address psychoeducation about depression, interpersonal and communication skills, problem-solving and to practice these skills with their children.

Group Format

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) was not designed to be conducted in a group setting, and has not been tested for use in a group setting.

Delivery Settings

This program is typically conducted in a(n):

  • Outpatient Clinic
  • School

Homework

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) includes a homework component:

There is no prescribed homework, but during treatment teens are asked to practice different interpersonal skills and interactions.

Languages

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

Therapy offices and clinicians.

Minimum Provider Qualifications

Master's or doctoral degree in clinical or counseling psychology, or master's in social work.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Upon request, experts willing to provide informal consultation and supervision, but trainings are not set up as a regular offering.

Number of days/hours:

Varies.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Mufson, L., & Moreau, D. (1994). Modification of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A): Phase I and II studies. Journal of the American Academy of Child & Adolescent Psychiatry, 33(5), 695-705.

Type of Study: Within-group pre-/post-test design
Number of Participants: Phase I: 5; Phase II: 14

Population:

  • Age range — 12-18 years
  • Race/Ethnicity — Phase II: 11 Hispanic, 3 African-American
  • Gender — Phase II: 2 males, 12 females
  • Status — Participants (for both phases) were referred for treatment for depression to the Children’s Anxiety and Depression Clinic at Columbia Presbyterian Medical Center or the Research Clinic at New York State Psychiatric Institute.

Location / Institution: New York

Summary: (To include comparison groups, outcomes, measures, notable limitations)
These studies tested the efficacy of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A). In phase I, therapeutic methods were explored and refined in a small sample of depressed adolescents (n=5); these participants did not receive any assessment measures. In phase II, 14 depressed adolescents participated in a 12-week open clinical trial of IPT-A. Measures included the Schedule for Affective Disorders and Schizophrenia for School-Age Children – Epidemiologic Version (K-SADS-E), which assesses diagnoses at evaluation and termination; Hamilton Rating Scale for Depression (HRSD), in order to measure changes in depressive symptomatology over the course of treatment; Global Assessment Scale for Children (C-GAS), which assesses global functioning; Beck Depression Inventory (BDI), which assesses treatment outcome for depressive symptoms; the Social Adjustment Inventory for Children and Adolescents (SAICA), which evaluates social functioning; and the Symptom Checklist (SCL-90), in order to assess changes in psychological and physical symptoms of distress over the course of treatment. The results of phase II showed a significant decrease in participants’ depressive symptoms and symptoms of psychological and physical distress, as well as a significant improvement in functioning over the course of treatment. None of the subjects met criteria for depression at termination (week 12). Limitations of these studies include the small sample size, lack of follow-up data, and lack of control group.

Length of post-intervention follow-up: None.

Mufson, L., & Fairbanks, J. (1996). Interpersonal Psychotherapy for Depressed Adolescents: A one-year naturalistic follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 35(9), 1145-1155.

Type of Study: Within-group naturalistic follow-up
Number of Participants: 10 (out of original 14 in open clinical trial, Mufson et al., 1994)

Population:

  • Age range — Mean age at follow-up: 17.5 years
  • Race/Ethnicity — 7 Latinas, 3 African-Americans
  • Gender — 100% female
  • Status — Participants included 10 of the 14 adolescents who had participated in the 12-week open clinical trial of IPT-A (Mufson et al., 1994)

Location / Institution: New York

Summary: (To include comparison groups, outcomes, measures, notable limitations)
In an open clinical trial, 14 participants had completed 3 months of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) (Mufson et al., 1994). Approximately 1 year after completion of treatment, the original 14 subjects who had participated were sent a letter asking permission to contact them regarding participation in the follow-up study; ten of the 14 original participants completed the follow-up evaluation. Measures included the Schedule for Affective Disorders and Schizophrenia for School-Age Children – Epidemiologic Version (K-SADS-E), which is a semi-structured diagnostic interview that has been demonstrated in previous studies to diagnose depression in adolescents; the Life Events Questionnaire, which assesses life events in the categories of conflict, loss, violence, abuse, suicide, and parental disorder; the Beck Depression Inventory (BDI), a self-report instrument to assess depressive symptoms; the Hamilton Rating Scale for Depression (HRSD), which also assesses depressive symptoms; the Symptom Checklist (SCL-90), which is another self-report inventory to measure psychopathology; the Social Adjustment Scale – Self-Report (SAS-SR), which measures social functioning; and Children’s Global Assessment Scale (C-GAS), which measures global functioning. Only 1 of the 10 subjects who participated in the follow-up study reported having a current diagnosis of depression. The results of the follow-up suggest that the improvements that occurred during the course of the 12-week clinical trial were maintained for the year immediately following completion of treatment. Limitations of the study include the small sample, the questionable generalizability of a 100% female sample, lack of a control group, and the lack of control over the type and amount of treatment adolescents may or may not have received after completing the open trial.

Length of post-intervention follow-up: 12 months.

Mufson, L., Weissman, M., Moreau, D., & Garfinkel, R. (1999). Efficacy of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 56(6), 573-579.

Type of Study: Randomized controlled trial
Number of Participants: 48

Population:

  • Age range — 12-18 years
  • Race/Ethnicity — Clinical Monitoring Group: 62.5% Hispanic, IPT-A Group: 79.2% Hispanic (rest unspecified)
  • Gender — Clinical Monitoring Group (n=24): 70.8% female, 29.2% male; IPT-A Group (n=24): 75% female, 25% male
  • Status — Participants were recruited from the Child Anxiety and Depression Clinic at Babies Hospital Columbia Presbyterian Medical Center, New York, NY, and the clinical Research Center, New York State Psychiatric Institute, New York, between 1993 and 1996. Most patients were self-referred or referred by parents or mental health professionals from school-based clinics. All participants met the criteria for Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) major depressive disorder.

Location / Institution: New York

Summary: (To include comparison groups, outcomes, measures, notable limitations)
In a 12-week clinical trial of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), clinic-referred adolescents were randomly assigned to either weekly IPT-Aor clinical monitoring. Measures to diagnose and assess depression symptoms, global and social functioning, and problem-solving skills included the Diagnostic Interview Schedule for Children Version 2.3 (DISC 2.3), Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS-E), Hamilton Rating Scale for Depression (HRSD), Beck Depression Inventory (BDI), and Children’s Global Assessment Scale (C-GAS). Patients who received IPT-A reported a notably greater decrease in depressive symptoms and greater improvement in overall social functioning, functioning with friends, and specific problem-solving skills. Limitations of the study include the small sample size, predominantly Latino and low socioeconomic status sample, and the lack of follow-up data.

Length of post-intervention follow-up: None.

Rossello, J., & Bernal, G. (1999). The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. Journal of Consulting & Clinical Psychology, 67(5), 734-744.

Type of Study: Randomized controlled trial
Number of Participants: 71

Population:

  • Age range — 13-17 years
  • Race/Ethnicity — Not Specified
  • Gender — 54% female, 46% male
  • Status — All adolescents in the study were referred to the clinic by local schools after members of the research team visited schools in the area and presented the project to principals and social workers.

Location / Institution: Centro Universitario de Servicios y Estudios Psicologicos (University Center for Psychological Services and Research) at University of Puerto Rico.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were randomly assigned to 1 of 3 conditions: cognitive-behavioral therapy (CBT), Interpersonal Psychotherapy (IPT), or wait list (WL). In order to assess a wide range of depressive symptoms, the Child Depression Inventory (CDI) was used. Additional measures included the Piers-Harris Children’s Self-Concept Scale (PHCSCS), the Social Adjustment Scale for Children and Adolescents (SASCA), which measures the social adjustment by taking into account interpersonal and school functioning, the Family Emotional Involvement and Criticism Scale (FEICS), as well as the Child Behavior Checklist (CBCL), which assesses social abilities and behavior problems in children and adolescents. Results showed that both IPT and CBT significantly reduced depressive symptoms and increased self-esteem when compared with the WL condition. At posttreatment, it was found that 82% of those in IPT and 59% of those in CBT showed a clinically significant change. Limitations of the study include the small sample size and the primary use of self-report measures.

Length of post-intervention follow-up: 3 months.

Mufson, L., Dorta K. P., Wickramaratne, P., Nomura, Y., Olfson, M., & Weissman, M. M. (2004). A randomized effectiveness trial of Interpersonal Psychotherapy for Depressed Adolescents. Archives of General Psychiatry, 61(6), 577-584.

Type of Study: Randomized controlled trial
Number of Participants: 63

Population:

  • Age range — 12-18 years
  • Race/Ethnicity — 71% Hispanic
  • Gender — 84% female, 16% male
  • Status — Participants were referred to mental health clinicians in 1 of 5 school-based health clinics (3 middle schools and 2 high schools) within schools located in urban, impoverished areas of New York City.

Location / Institution: Five school-based mental health clinics in New York City

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study assessed the effectiveness of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) compared with treatment as usual (TAU) in school-based mental health clinics. Participants were randomly assigned to receive IPT-A (n=34) or TAU (n=29) from school-based health clinic clinicians. Measures used to assess depression symptoms included the Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI); the Children’s Global Assessment Scale (C-GAS), and Clinical Global Impressions (CGI) scale measured global functioning; and the Social Adjustment Scale – Self-Report (SAS-SR) assessed social functioning. Adolescents treated with IPT-A compared with TAU showed greater symptom reduction and improvement in overall functioning. Compared with the TAU group, the IPT-A group showed significantly fewer clinician-reported depression symptoms on the HAMD and BDI, significantly better functioning on the C-GAS, significantly better overall social functioning on the SAS-SR, and significantly greater clinical improvement and significantly greater decrease in clinical severity on the CGI scale. Limitations of the study include the small sample size & questionable generalizability of the predominantly female & Hispanic sample.

Length of post-intervention follow-up: 1 month or less.

Gunlicks-Stoessel, M., Mufson, L., Jekal, A., & Turner, J. (2010). The impact of perceived interpersonal functioning on treatment for adolescent depression: IPT-A versus treatment as usual in school-based health clinics. Journal of Consulting & Clinical Psychology, 78(2), 260-667.

Type of Study: Randomized controlled trial
Number of Participants: 63

Population:

  • Age range — 12-18 years
  • Race/Ethnicity — 74.6% Latino, 14.3% African American, 1.6% Asian American, 9.5% other
  • Gender — 84.1% female, 15.9% male
  • Status — Adolescents were referred for mental health treatment in five school-based health clinics in New York City, and each had a diagnosis of major depression, dysthymia, depressive disorder not otherwise specified, or adjustment disorder with depressed mood.

Location / Institution: Columbia University College of Physicians and Surgeons; New York State Psychiatric Institute

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were randomly assigned to receive Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) or treatment as usual (TAU) delivered by school-based mental health clinicians. In order to assess current, past, and lifetime diagnostic status of psychopathology for children and adolescents on the basis of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic criteria, the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) was administered. Other measures to assess perceived interpersonal functioning included the Hamilton Rating Scale for Depression (HRSD), which is a semi-structured interview developed to assess the severity of depression symptoms, the Conflict Behavior Questionnaire (CBQ-20), which is a self-report measure to assess parent-child communication and conflict style, and the Social Adjustment Scale – Self-Report (SAS-SR), which assesses social functioning in the following categories: friends, school, family, and dating. As hypothesized, adolescents treated with IPT-A showed greater and more rapid reductions in depression symptoms, as compared with participants treated with TAU. Results showed that the benefits of IPT-A over TAU were particularly strong for the adolescents who reported high baseline levels of conflict with their mothers and social dysfunction with friends. Limitations of the study include the small sample size and questionable generalizability of a sample primarily consisting of low-income Hispanic females, as well as the lack of follow-up data.

Length of post-intervention follow-up: None (aside from 1 month follow-up telephone interview).

References

Brunstein-Klomek, A., & Mufson, L. (2006). Interpersonal Psychotherapy for Depressed Adolescents. Child and Adolescent Psychiatric Clinics of North America, 15, 959-975.

Mufson, L. (2010). Interpersonal psychotherapy for depressed adolescents (IPT-A): Extending the reach from academic to community settings. Child & Adolescent Mental Health, 15(2), 66-72.

Mufson, L., Pollack Dorta, K., Moreau, D., & Weissman, M. M. (2004). Interpersonal Psychotherapy for Depressed Adolescents (2nd ed.). Guilford Publications, Inc.: New York.

Contact Information

Name: Laura Mufson, PhD
Agency/Affiliation: Columbia University College of Physicians and Surgeons
Email:
Phone: (212) 543-5561
Fax: (212) 543-6660

Date Reviewed: August 2010