Interpersonal Psychotherapy for Depressed Adolescents (IPT-A)

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

About This Program

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

Target Population: Adolescents ages 12-18 years old suffering from nonpsychotic depression who can be treated on a once-a-week outpatient basis

For children/adolescents ages: 12 – 18

Brief Description

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. 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.

Program Goals:

The goal of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) are:

  • Improve relationships by:
    • Improving communication skills
    • Improving problem solving skills

Essential Components

The essential components of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) include:

  • 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 areas: 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/Adolescent Services

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) directly provides services to children/adolescents and addresses the following:

  • Interpersonal problems and depression symptoms.
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: There is recommended parental involvement to address psychoeducation about depression, interpersonal and communication skills, problem-solving and to practice these skills with their children.

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.

Implementation Information

Since Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

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Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Interpersonal Psychotherapy for Depressed Adolescents (IPT-A).

Formal Support for Implementation

There is no formal support available for implementation of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A).

Fidelity Measures

There are fidelity measures for Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) as listed below:

The fidelity measures are checklists of the main tasks for the sessions that a supervisor can check off if they are done based on supervision and/or review of audiotapes.

Implementation Guides or Manuals

There are no implementation guides or manuals for Interpersonal Psychotherapy for Depressed Adolescents (IPT-A).

Research on How to Implement the Program

Research has not been conducted on how to implement Interpersonal Psychotherapy for Depressed Adolescents (IPT-A).

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 pretest/posttest design
Number of Participants: Phase I: 5, Phase II: 14

Population:

  • Age — 12-18 years
  • Race/Ethnicity — Phase 1: Not specified, Phase II: 11 Hispanic and 3 African-American
  • Gender — Phase 1: Not specified, Phase II: 12 Females and 2 Males
  • 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 utilized include the Schedule for Affective Disorders and Schizophrenia for School-Age Children – Epidemiologic Version (K-SADS-E), Hamilton Rating Scale for Depression (HRSD), Global Assessment Scale for Children (C-GAS), Beck Depression Inventory (BDI), the Social Adjustment Inventory for Children and Adolescents (SAICA), and the Symptom Checklist (SCL-90). 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 postintervention 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

Population:

  • Age — Mean=17.5 years
  • Race/Ethnicity — 7 Latinas and 3 African-Americans
  • Gender — 100% Female
  • Status — Participants 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)
Note: This study uses a subset of the sample from Mufson et al. (1994). Approximately 1 year after completion of Interpersonal Therapy for Depressed Adolescents (IPT-A), 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 utilized include the Schedule for Affective Disorders and Schizophrenia for School-Age Children – Epidemiologic Version (K-SADS-E), the Life Events Questionnaire, the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HRSD), the Symptom Checklist (SCL-90), the Social Adjustment Scale – Self-Report (SAS-SR), and Children’s Global Assessment Scale (C-GAS). 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 postintervention 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: Clinical Monitoring Group: 24, IPT-A: 24

Population:

  • Age — 12-18 years
  • Race/Ethnicity — Clinical Monitoring Group: 62.5% Hispanic, IPT-A Group: 79.2% Hispanic (rest unspecified)
  • Gender — Clinical Monitoring Group: 70.8% Female and 29.2% Male, IPT-A Group: 75% Female and 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-A or clinical monitoring. Measures utilized include 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 postintervention 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 — 13-17 years
  • Race/Ethnicity — Not specified
  • Gender — 54% Female and 46% Male
  • Status — Participants 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) [now called Interpersonal Therapy for Depressed Adolescents (IPT-A)], or waitlist (WL). Measures utilized include the Children's Depression Inventory (CDI), the Piers-Harris Children’s Self-Concept Scale (PHCSCS), the Social Adjustment Scale for Children and Adolescents (SASCA), the Family Emotional Involvement and Criticism Scale (FEICS), and the Child Behavior Checklist (CBCL). 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 postintervention 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 — 12-18 years
  • Race/Ethnicity — 71% Hispanic
  • Gender — 84% Female and 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 utilized include the Hamilton Depression Rating Scale (HAMD), Beck Depression Inventory (BDI), the Children’s Global Assessment Scale (C-GAS), Clinical Global Impressions (CGI) Scale, and the Social Adjustment Scale – Self-Report (SAS-SR). 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 postintervention 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 — 12-18 years
  • Race/Ethnicity — 74.6% Latino, 14.3% African American, 1.6% Asian American, and 9.5% Other
  • Gender — 84.1% Female and 15.9% Male
  • Status — Participants 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. Measures utilized include Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Hamilton Rating Scale for Depression (HRSD), the Conflict Behavior Questionnaire (CBQ-20), and the Social Adjustment Scale – Self-Report (SAS-SR). 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 postintervention follow-up: None (aside from 1 month follow-up telephone interview).

Gunlicks-Stoessel, M., & Mufson, L. (2011). Early patterns of symptom change signal remission with interpersonal psychotherapy for depressed adolescents. Depression and Anxiety, 28, 525–531.

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

Population:

  • Age — 12-18 years
  • Race/Ethnicity — 75% Hispanic, 14% African American, 1% Asian, and 10% Other
  • Gender — 84% Female and 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: New York

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: The study used the sample from Mufson et al. (2004). This study examined whether reductions in depression symptoms at different time points over the course of therapy predict remission for depressed adolescents treated with Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) or treatment as usual (TAU) delivered in school-based health clinics. Adolescents were assessed at baseline and weeks 4, 8, 12, and 16 (or at early termination) with the Hamilton Rating Scale for Depression (HRSD). Analysis was used to identify the time point and degree of reduction in HRSD that best predicted remission at the end of the trial (week 16). Week 4 was the best time point for classifying adolescents as likely to remit or not likely to remit for both IPT-A and TAU. A 16.2% reduction in HRSD from baseline represented the best combined sensitivity and specificity in predicting week 16 remission status for adolescents treated with IPT-A. A 24.4% reduction in depressive symptoms represented the best combined sensitivity and specificity in predicting remission status for TAU. Limitations of the study include the small sample size and questionable generalizability of a sample primarily consisting of low-income Hispanic females.

Length of postintervention follow-up: None.

O’Shea, G., Spence, S. H., & Donovan, C. L. (2015). Group versus individual Interpersonal Psychotherapy for Depressed Adolescents. Behavioural and Cognitive Psychotherapy, 43(1), 1-19.

Type of Study: Randomized controlled trial
Number of Participants: 39

Population:

  • Age — 13-19 years
  • Race/Ethnicity — 38 Caucasian and 1 Aboriginal
  • Gender — 33 Females and 6 Males
  • Status — Participants were adolescents diagnosed with Major Depressive Disorder.

Location/Institution: Brisbane, Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluates a small examination of the long-term efficacy of group versus individual delivery of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A). Participants were randomly assigned to either group or individual IPT-A. Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School Aged Children – Epidemiological version, 5th edition (K-SADS-E), Beck Depression Inventory – II (BDI-II), The Children’s Global Assessment Scale (CGAS), Youth Self-Report-Revised (YSR), Child Behavior Check List (CBCL), and the Spence Children’s Anxiety Scale (SCAS-C). Results indicated significant improvement in depression, anxiety, youth-reported internalizing problems and global functioning from pretest to posttest treatment for those receiving IPT-A, with no significant differences in outcome between group and individual formats of delivery. Improvements were maintained at 12 month follow-up. Individual IPT-A showed significantly greater improvement than group IPT-A in parent-reporting internalizing problems for the completer but not the intent-to-treat analyses. Limitations include small sample size, lack of wait list control group, and lack of comparison of dosages across experimental conditions.

Length of postintervention follow-up: 12 months.

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: (646) 774-5791
Fax: (212) 543-6660

Date Research Evidence Last Reviewed by CEBC: June 2016

Date Program Content Last Reviewed by Program Staff: April 2016

Date Program Originally Loaded onto CEBC: August 2010