Therapist adherence to interpersonal vs. supportive therapy for social anxiety disorder.

We assessed therapist adherence to interpersonal therapy (IPT) and supportive therapy (ST) in a controlled trial for social anxiety disorder. Raters blindly scored n = 133 videotapes from 53 participants using the Collaborative Study Psychotherapy Rating Scale (CSPRS). Results reveal statistical differences across groups, but higher than expected overlap. Greater use of IPT in beginning sessions predicted better outcome in both therapies. Suboptimal adherence may be due to the crossed design in which the same therapists delivered both IPT and ST. Since switching between different approaches is a clinical reality for integrative psychotherapists, these findings may have important clinical implications.

Psychiatric disorders in youth with medically unexplained chest pain versus innocent heart murmur.

OBJECTIVE: To examine the prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric disorders in youth with chest pain compared with a control sample with innocent heart murmur. STUDY DESIGN: We assessed youth ages 8 to 17 years who were examined in cardiology settings for medically unexplained chest pain (n=100) or innocent heart murmur (n=80). We conducted semi-structured interviews and assessed medical history, quality of life, and disability. RESULTS: Youth with chest pain had a higher prevalence of psychiatric disorders compared with youth with murmur (74% versus 47%, χ(2)=13.3; P<.001). Anxiety disorders predominated, although major depression was also more common in the chest pain group (9% versus 0%; Fisher exact tests; P<.01). Onset of psychiatric disorders generally preceded chest pain. Patterns were similar for boys and girls and for children and adolescents. Chest pain was associated with poorer quality of life and with pain-related disability for youth with co-morbid psychiatric disorder. CONCLUSIONS: In childhood and adolescence, medically unexplained chest pain is associated with a high prevalence of psychiatric disorders. Systematic mental health screening may improve detection and enhance treatment of these patients.

A psychological intervention for pediatric chest pain: development and open trial.

OBJECTIVE: Noncardiac chest pain (NCCP) is a common and persistent problem for children and adolescents; typically there is no clear medical cause. To date, no psychological intervention has been studied for chest pain in a pediatric sample. METHODS: (a) We developed a brief psychological treatment for chest pain and associated worry in children and adolescents with NCCP. This program includes psychoeducation, breathing retraining, cognitive coping strategies, and 1 session of parent education and coaching regarding the impact of reinforcement on pain and coping behaviors. (b) We treated 9 youngsters with chronic NCCP, assessing pain, somatization, disability, anxiety and depressive symptoms, and coping. Assessments were conducted before, after, and 6 months following treatment. RESULTS: After treatment, there was a significant decrease in chest pain and somatization. Benefits were maintained at 6-month follow-up. There was no decrease in associated psychological symptoms. CONCLUSIONS: A brief psychological treatment for pediatric NCCP is feasible to administer and may help alleviate symptoms of pediatric NCCP. Further study in a randomized trial is needed.

Psychopathology and disability in children with unexplained chest pain presenting to the pediatric emergency department.

OBJECTIVE: Chest pain is a common presentation in the pediatric emergency department (PED). In the majority of cases, no clear medical cause is found. Among adults with noncardiac chest pain, psychopathology including panic disorder is common. We assessed the likelihood and type of psychopathology as well as the health status of children and adolescents with unexplained chest pain who presented to the PED. METHODS: We performed a semistructured diagnostic interview of children 8 to 17 years old who presented to an urban, tertiary-care PED with a primary complaint of chest pain for which no medical cause was found. We used Diagnostic Statistical Manual of Mental Disorders, Fourth Edition criteria to diagnose psychopathology. We also assessed pain severity, extent of other somatic complaints, quality of life, and functional disability using standard, validated instruments. RESULTS: We enrolled 32 children with a mean age of 12.8 (SD, 2.9) years (range, 8-17 years); 47% were female. Twenty-six (81%) were diagnosed with a Diagnostic Statistical Manual of Mental Disorders, Fourth Edition anxiety disorder; 9 (28%) had full-criteria panic disorder. Quality of life was compromised in multiple domains, and children reported a range of functional disabilities due to chest pain. Other somatic symptoms, including other pain complaints, were commonly reported in this sample. CONCLUSION: Unexplained chest pain in the PED is frequently associated with potentially treatable anxiety disorders. Emergency physicians should consider the possibility of anxiety disorders in patients with medically unexplained chest pain.

Interpersonal psychotherapy with pregnant adolescents: two pilot studies.

OBJECTIVE: To test the feasibility, acceptability and helpfulness of group Interpersonal Psychotherapy (IPT-PA) for depression in pregnant adolescents. METHOD: Two open clinical trials were conducted of IPT-PA delivered in group format in a New York City public school for pregnant girls. Study 1 tests IPT-PA for management of depressive symptoms by delivery during health class to pregnant girls with varying levels of depressive symptoms (N = 14; 10 Hispanic, 3 African-American and 1 bi-racial). Study 2 tests IPT-PA for treatment of depression by delivery after school for self-nominating pregnant girls with DSM-IVR diagnoses of depressive disorder or an adjustment disorder (N = 11; 8 African-American, 1 girl Hispanic and 2 bi-racial). Depressive symptoms were assessed using the Beck Depression Inventory and the Edinburgh Depression Scale (for its sensitivity to severe symptoms, the Hamilton Depression Scale was added in Study 2). Clinical diagnosis was assessed using the Schedule for Affective Disorders and Schizophrenia for Children (K-SADS). STUDY 1 RESULTS: At 12-week termination, level of depressive symptoms had decreased by 50%; 13/14 girls showed a decrease in level of symptoms. STUDY 2 RESULTS: At 12-week termination, level of depressive symptoms had decreased by 40%; 10/11 girls showed decrease in level of symptoms and in DSM-IVR clinical diagnosis; treatment gains were maintained at 20-week post-partum follow-up. CONCLUSION: IPT-PA appears feasible and helpful in managing and treating depression in pregnant girls.

A randomized trial of interpersonal therapy versus supportive therapy for social anxiety disorder.

Seventy patients seeking treatment for social anxiety disorder (SAD) were randomly assigned to 14 weekly individual sessions of interpersonal therapy (IPT) or supportive therapy (ST). We hypothesized that IPT, a psychotherapy with established efficacy for depression and other psychiatric disorders, would lead to greater improvement than ST. Patients in both groups experienced significant improvement from pretreatment to posttreatment. However, improvement with IPT was not superior to improvement with ST. Mean scores on the Liebowitz Social Anxiety Scale decreased from 67.7 to 46.9 in the IPT group and 64.5 to 49.8 in the ST group. There were also no differences in proportion of responders between IPT and ST. Only for a scale measuring concern about negative evaluation (Brief Fear of Negative Evaluation Scale) was IPT superior. Limitations of this initial controlled trial of IPT include a nonsequential recruitment strategy and overlap in the administration of the two therapies. It is recommended that future studies of IPT for SAD include a more carefully defined control therapy condition, different therapists administering each therapy, a larger sample, and a more rigorous strategy for long-term follow-up assessments.

An open pilot study of interpersonal psychotherapy for panic disorder (IPT-PD).

Interpersonal psychotherapy (IPT) is a time-limited psychotherapy initially developed to treat depression. It has yet to be studied systematically for treatment of panic disorder. We modified IPT for the treatment of panic disorder and tested this treatment in an open clinical trial with 12 patients seeking treatment of DSM-IV panic disorder. Patients were assessed before during and after treatment. At completion of treatment, nine patients (75%) were independently categorized as responders (i.e., rated as much improved or very much improved on the Clinical Global Impression-Change Scale). Substantial improvement was found for panic symptoms, associated anxiety and depressive symptoms, and physical and emotional well-being. Degree of change in this sample approximated that obtained in studies using established treatments such as cognitive behavioral therapy. Results, though preliminary, suggest that IPT may have efficacy as a primary treatment of panic disorder. Further study is warranted.

Noncardiac chest pain and psychopathology in children and adolescents.

OBJECTIVE: We sought to examine the prevalence of DSM-IV psychiatric disorders in children and adolescents with complaints of noncardiac chest pain (NCCP). METHOD: We assessed 27 youngsters (ages 8-17 years) referred to a pediatric cardiology practice with complaints of NCCP. Each child and a parent were interviewed using the Anxiety Disorders Interview Schedule for Children. RESULTS: Sixteen youngsters (59%) were diagnosed with a current DSM-IV disorder. Fifteen (56%) had a current anxiety disorder, nine of whom were diagnosed with panic disorder. One participant was diagnosed with a depressive disorder. CONCLUSION: Results of this preliminary study suggest that DSM-IV anxiety disorders may be common in youngsters with NCCP. No evidence was found for high prevalence of depression in this sample. Larger controlled studies are needed to determine the prevalence and impact of psychopathology in youngsters with NCCP.

Maternal depression and the intergenerational transmission of religion.

This study tests the hypothesis that maternal depression (major depressive disorder; MDD) decreases rates of the intergenerational transmission of religiosity from mother to offspring and attenuates the beneficial qualities of religiosity in offspring. Depression was assessed using semistructured clinical interviews; religiosity was assessed based upon the personal importance of religion, frequency of attendance at religious services, and religious denomination. Results suggest that (1) maternal depression attenuates the intergenerational transmission of religion; (2) in the presence of maternal depression, offspring were more likely to have MDD at 10-year follow-up when mother-offspring were concordant on religious importance; and (3) in the absence of maternal depression, offspring were less likely to have MDD at 10-year follow-up when mother-offspring were concordant on attendance. Thus, in the presence of maternal depression, transmission of religious attendance is no longer associated with decreased likelihood of offspring MDD, whereas transmission of religious importance is associated with increased likelihood of offspring depression.

Religiousness and sexual responsibility in adolescent girls.

OBJECTIVE: To investigate a potential association between religiousness and sexual responsibility in a nationally representative sample of adolescent girls. METHODS: Subjects were 3356 adolescent girls (mean age 15.97 years, SD = 1.77; 59.4% Euro-American, 23.3% African-American, 6.0% Hispanic, and 11.4% of other ethnic backgrounds) from the Wave I, In-Home section of the National Longitudinal Study of Adolescent Health (Add Health Study) who responded to items on four dimensions of religiousness (frequent attendance of religious events, personal conservatism, personal devotion, and religious denomination) and three dimensions of sexual responsibility (sexual activity, perception of risk in unprotected intercourse, and birth control use). Data were analyzed using a series of regression analyses with religiousness as the predictor and sexual responsibility as the outcome. RESULTS: Personal devotion was positively associated with fewer sexual partners outside a romantic relationship. Frequent attendance of religious events was positively associated with greater perception of risk of contracting human immunodeficiency virus (HIV) or pregnancy from unprotected intercourse, greater foresight of suffering from HIV or pregnancy, and a responsible and planned use of birth control. Personal conservatism was positively associated with unprotected sex. CONCLUSION: Sexual responsibility was positively associated with personal devotion and frequent attendance of religious events but inversely associated with personal conservatism.

Adult religiousness and history of childhood depression: eleven-year follow-up study.

This study investigates the association between childhood depression and the protective qualities of adult religiousness. Subjects were 146 (65 female and 81 male) adults with a history of childhood depression and 123 (61 female and 62 male) adults without a history of childhood depression interviewed as part of a long-term follow-up study (mean years of follow-up, 11.2; SD = 1.4). Depression in childhood and adulthood was assessed by blind and independent clinical interviews by using the Schedule for Affective Disorders for School Aged Children and the Schedule for Affective Disorders Life-time Version, respectively. Religiousness was assessed by report on the personal importance of religion, frequency of attendance of religious services, religious denomination, and child-adult concordance of report. Findings showed adult personal importance of religion to be associated with a decreased risk for depression in women without a history of childhood depression but an increased risk for depression in women with a history of childhood depression. Adult Catholicism as compared with Protestantism was associated with a decreased risk for depression in male childhood depressives, but this association was not found in men without childhood depression. The findings potentially suggest a reciprocal-influence process between childhood pathology and the development of religiousness.

Religiosity, depression, and physical maturation in adolescent girls.

OBJECTIVE: To assess the impact of physical maturation on the protective qualities of religiosity against depression in adolescent girls. METHOD: Subjects were 3,356 adolescent girls (mean age 16.0, SD = 1.8) interviewed in 1995 as part of the Wave I In-Home Version of the North Carolina Adolescent Health Study. Maturation was assessed on the basis of self-report of secondary sexual characteristics and age at onset of menstruation. Religiosity was assessed on the basis of personal devotion, personal conservatism, institutional conservatism, and participation in religious community. Logistic regression analyses were conducted with each variable of religiosity used to predict depression, controlling for age and ethnicity. RESULTS: Personal devotion and participation in religious community were associated with a 19% to 26% decreased likelihood of depression in non-highly mature girls and a relatively more robust 32% to 43% decreased likelihood of depression in highly mature girls. Personal conservatism and institutional conservatism were associated with a 17% to 24% decreased likelihood of depression among non-highly mature girls, but were not associated with depression in highly mature girls. CONCLUSION: Physical maturation may be associated with the protective qualities of religiosity against depression in adolescent girls.