Volume 48, Issue 10 , Pages 997-1004, October 2009
Depressive Symptoms and Clinical Status During the Treatment of Adolescent Suicide Attempters (TASA) Study
Abstract
Objective
To examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide.
Method
Adolescents (N = 124), ages 12 to 18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating Scale-Revised (CDRS-R) score of 36 or higher, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission rates were computed with the last observation carried forward.
Results
Most patients (n = 104 or 84%) chose treatment assignment, and overall, three fourths (n = 93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12 and to 27.0 (10.1) at week 24 (p < .0001), with a Clinical Global Impression -defined improvement rate of 58.0% at week 12 and 72.2% at week 24 and a remission (CDRS-R ≤28) rate of 32.5% at week 12 and 50.0% at week 24. The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline (r= 0.43, p < .0001) and declined in parallel.
Conclusions
When vigorously treated with a combination of medication and psychotherapy, adolescents with depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression.
Key Words: adolescents , suicide , depression , treatment
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This article was reviewed under and accepted by Ad Hoc Editor Garry Walter, M.D., Ph.D.Funded by the National Institute of Mental Health through cooperative agreement grants MH66750 (PI: K.W., Duke University Medical Center), MH66769 (PI;J. W, Johns Hopkins University), MH66762 (PI: I. G, New York State Psychiatric Institute), MH66775 (PI: D.B., University of Pittsburgh), and MH66778 (PI: G.B., University of Texas Southwestern Medical Center). Data management was funded by an NIMH contract to KAI Research, Rockville, MD.The opinions and assertions contained in this article are the private views of the authors and are not to be construed as official or as reflecting the views of the National Institute of Mental Health, the National Institutes of Health, or the Department of Health and Human Services.This article is the subject of an editorial by Dr. Garry Walter in this issue.The authors thank Brian Knizner (project coordinator), Marcie McCullough (data entry), Travis Schermer (interviewer), Angela Aloxe (interviewer), Kim Poling (therapy supervhor, therapist), Nancy Tormey (therapist), Brian McKain (pharma-cotherapht and therapist), Sue Wesner (pharmacotherapht), Allen Chrhman (psychiatrist, pharmacotherapy supervisor), Rameshari Tumuluru (psychiatrist), John Campo (psychiatrist), Joanne Severe (operations), and the NIMH Data and Safety Monitoring Board.Clinical trial registration information–Treatment of Adolescent Suicide Attempters (TASA). URL: http://clinicaltrials.gov. Unique identifier: NCT00080158.
PII: S0890-8567(09)60164-7
doi:10.1097/CHI.0b013e3181b5db66
© 2009 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Volume 48, Issue 10 , Pages 997-1004, October 2009