An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder.

OBJECTIVE: To evaluate effectiveness of the Adolescent Coping With Depression (CWD-A) course, a cognitive-behavioral group intervention for depressed adolescents with comorbid conduct disorder. METHOD: Between 1998 and 2001, 93 nonincarcerated adolescents (ages 13-17 years) meeting criteria for major depressive disorder and conduct disorder were recruited from a county juvenile justice department and randomly assigned to the CWD-A or a life skills/tutoring control condition. Participants were assessed post-treatment and at 6- and 12-month follow-up. Dichotomous outcomes were analyzed with logistic regression; dimensional measures were analyzed using random effects regression. RESULTS: Major depressive disorder recovery rates post-treatment were greater in CWD-A (39%) compared with life skills/tutoring control (19%) (odds ratio 2.66, 95% confidence interval = 1.03-6.85). CWD-A participants reported greater reductions in Beck Depression Inventory-II (r2 = 0.055, p =.033) and Hamilton Depression Rating Scale (r2 = 0.047, p =.039) scores and improved social functioning (r2 = 0.064, p =.019) post-treatment. Group differences in major depressive disorder recovery rates at 6- and 12-month follow-up were nonsignificant, as were differences in conduct disorder both post-treatment and during follow-up. CONCLUSIONS: This is the first randomized, controlled trial of a psychosocial intervention with adolescents with major depressive disorder and conduct disorder. Although the CWD-A appears to be an effective acute treatment for depression in adolescents with multiple disorders, findings emphasize the need to improve long-term outcomes for depressed adolescents with psychiatric comorbidity and imply that interventions for comorbid populations focus directly on each specific disorder.

Pilot evaluation of the Coping Course: a cognitive-behavioral intervention to enhance coping skills in incarcerated youth.

OBJECTIVE: To describe the development and initial evaluation of the Coping Course, a cognitive-behavioral group intervention designed to enhance general coping and problem-solving skills among incarcerated youth. METHOD: Between 2001 and 2002, 76 male adolescents incarcerated at a youth correctional facility were assessed by questionnaire and randomly assigned to either the Coping Course (n = 46) or usual care (n = 30). Participants repeated the questionnaire after completion of the intervention. A second correctional facility served as an additional source of control group data (n = 62). RESULTS: Significant condition x time effects were present for seven of the examined measures: Youth Self-Report externalizing scores, three measures from the Life Attitudes Scale, self-esteem, one measure of social adjustment, and cognitive-behavioral therapy knowledge. Age and race/ethnicity did not moderate effects. Comparing control group participants with youth at a separate correctional facility who did not receive the Coping Course indicated that change was uniquely associated with participation in the intervention. CONCLUSIONS: Our goal was to take an efficacious adolescent depression group intervention and modify it for use with youth in correctional facilities. Preliminary findings are promising and provide evidence for future research of cognitive-behavioral group treatments with incarcerated youth.