Integrated Treatment for Comorbid Depression and Obesity in Adolescents
| Status: | Completed |
|---|---|
| Conditions: | Depression, Obesity Weight Loss |
| Therapuetic Areas: | Endocrinology, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 12 - 18 |
| Updated: | 5/27/2013 |
| Start Date: | December 2009 |
| End Date: | December 2012 |
| Contact: | Anthony Spirito, PhD |
| Email: | anthony_spirito@brown.edu |
| Phone: | 401-863-6623 |
Lifetime prevalence of major depression is estimated at 28% by age 18 (Lewinsohn et al.,
1999), with higher cumulative rates in females (35%) than males (19%). Approximately 17% of
children and adolescents in the United States are obese as defined by a BMI above the 95th
percentile, with more than 30% falling between the 85th and 95th percentiles (Ogden et al.,
2008). Overweight children and adolescents are at increased risk for type 2 diabetes
(Pinhas-Hamiel et al., 1996) and overwhelming risk for adult obesity (Guo et al., 1994).
There is a substantial percentage of adolescents who are both overweight and depressed with
estimates from clinical samples averaging 25%. Treatment of teens with comorbid medical and
psychiatric conditions such as overweight/obesity and depression has received little to no
attention in the psychosocial treatment research literature. Due to the large number of
adolescents who are both depressed and overweight, developing a behavioral treatment that
addresses both problems simultaneously has important public health significance. The purpose
of this proposal is to combine treatments for depression and overweight to address these
co-occurring conditions in one intervention. The long-term objectives of this research are
to develop efficient and effective treatments for co-occurring physical and emotional
disorders. The research program will be divided into 3 major phases: a development phase
(Stage 1a), a pilot study phase (Stage 1b), and a revision phase. During the development
phase (Stage 1a), a treatment for overweight teens and CBT treatment for depressed teens
will be adapted into one integrated protocol that addresses depression using CBT techniques,
an exercise component, and advice regarding healthy eating. As part of this phase, we will
adapt existing intervention manuals and therapist training materials, and gain some initial
clinical experience with the intervention via an open trial with 6 teens. During the
randomized pilot study phase (Stage 1b), the integrated intervention will be compared to a
control group receiving CBT treatment for depression alone (N=40 in total). During the pilot
phase, the feasibility and acceptability of administering the program will be assessed. In
addition, we will compare change in depressed mood at end of treatment and 6 month follow-up
periods across the two groups. During the revision phase, the intervention manual will be
further developed and refined, based on experiences and observations made during the
development and pilot study phases.
Inclusion Criteria:
Adolescents must: 1) be between the ages of 12 and 18 years (18 year olds must still be in
high school and living at home); 2) be at or above the 85th percentile with reference to
age and gender-specific Body Mass Index (BMI); 3) have at least one parent available to
participate in the treatment protocol; 4) speak English; 5) agree to study participation
and random assignment; and 6) be available for follow-up. In order to meet the depressed
mood criterion, adolescents must have a primary diagnosis of major depressive disorder
(single or recurrent), based on the KSADS-PL with a CGI-Severity ≥ 3 for depression and
CDRS ≥ 36. Participants must be healthy, as established by their primary care physician,
in order to participate in the exercise program -
Exclusion Criteria:
Adolescents will be excluded if: 1) they are currently receiving psychotherapy or
participating in another weight loss program (only can have been in a weight loss program
in the past); 2) they have a medical condition that would interfere with the prescribed
dietary plan or participation in physical activity; 3) they are developmentally delayed
such that the intervention materials will not be appropriate; 4) they are actively
suicidal at intake; 5) they have not been on a stable dose of a psychostimulant for 6
months to ensure that a recently prescribed psychostimulant is not contributing to weight
loss; 6) teens on an SSRI will not be allowed to participate due to potential effects of
medication on weight loss; 7) they have a substance abuse or dependence diagnosis; or 8)
they have failed a medication or psychotherapy trial for depression in the past.
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Brown University Located in historic Providence, Rhode Island and founded in 1764, Brown University is...
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