Adolescent depression is highly prevalent and has substantial morbidity,
including suicide attempts, school dropout, and substance abuse, but many
depressed adolescents are untreated. The school-based health clinic offers
the potential for accessible and efficient treatment, although it is unknown
whether school-based clinicians can be trained to implement evidence-based
psychotherapies for depression in routine care.
To assess the effectiveness of interpersonal psychotherapy modified
for depressed adolescents (IPT-A) compared with treatment as usual (TAU) in
school-based mental health clinics.
A 16-week randomized clinical trial was conducted from April 1, 1999,
through July 31, 2002.
Five school-based mental health clinics in New York City, NY.
Sixty-three adolescents referred for a mental health intake visit who
met eligibility criteria. Eligible patients had a mean Hamilton Depression
Rating Scale score of 18.6 (SD, 5.5) and a mean Children's Global Assessment
Scale score of 52.6 (SD, 5.5) and met DSM-IV criteria
for major depressive disorder, dysthymia, depression disorder not otherwise
specified, or adjustment disorder with depressed mood. Mean age was 15.1 years
(SD, 1.9 years). The sample was predominantly female (n = 53 [84%]), Hispanic
(n = 45 [71%]), and of low socioeconomic status.
Patients were randomly assigned to receive IPT-A (n = 34) or TAU (n
= 29) from school-based health clinic clinicians.
Main Outcome Measures
The Hamilton Depression Rating Scale, Beck Depression Inventory, Children's
Global Assessment Scale, Clinical Global Impressions scale, and the Social
Adolescents treated with IPT-A compared with TAU showed greater symptom
reduction and improvement in overall functioning. Analysis of covariance showed
that compared with the TAU group, the IPT-A group showed significantly fewer
clinician-reported depression symptoms on the Hamilton Depression Rating Scale
(P = .04), significantly better functioning on the
Children's Global Assessment Scale (P = .04), significantly
better overall social functioning on the Social Adjustment Scale–Self-Report
(P = .01), significantly greater clinical improvement
(P = .03), and significantly greater decrease in
clinical severity (P = .03) on the Clinical Global
Interpersonal psychotherapy delivered in school-based health clinics
is an effective therapy for adolescent depression. This effort is a significant
step toward closing the gap between treatment conducted in the laboratory
and community clinic.