Family-focused treatment for adolescents with bipolar disorder: results of a 2-year randomized trial

Abstract

Context: Family interventions have been found to hasten episode recovery and delay recurrences among adults with bipolar disorder.

Objective: To examine the benefits of family-focused treatment for adolescents (FFT-A) and pharmacotherapy in the 2-year course of adolescent bipolar disorder.

Design: Two-site outpatient randomized controlled trial with 2-year follow-up.

Patients: A referred sample of 58 adolescents (mean [SD] age, 14.5 [1.6] years) with bipolar I (n = 38), II (n = 6), or not otherwise specified disorder (n = 14) with a mood episode in the prior 3 months.

Interventions: Patients were randomly assigned to FFT-A and protocol pharmacotherapy (n = 30) or enhanced care (EC) and protocol pharmacotherapy (n = 28). The FFT-A consisted of 21 sessions in 9 months of psychoeducation, communication training, and problem-solving skills training. The EC consisted of 3 family sessions focused on relapse prevention.

Main outcome measures: Independent "blind" evaluators assessed patients every 3 to 6 months for 2 years. Outcomes included time to recovery from the index episode, time to recurrence, weeks in episode or remission, and mood symptom severity scores.

Results: Analyses were by intent to treat. Rates of 2-year study completion did not differ across the FFT-A (60.0%) and EC conditions (64.3%). Although there were no group differences in rates of recovery from the index episode, patients in FFT-A recovered from their baseline depressive symptoms faster than patients in EC (hazard ratio, 1.85; 95% confidence interval, 1.04-3.29; P = .04). The groups did not differ in time to recurrence of depression or mania, but patients in FFT-A spent fewer weeks in depressive episodes and had a more favorable trajectory of depression symptoms for 2 years.

Conclusions: Family-focused therapy is effective in combination with pharmacotherapy in stabilizing bipolar depressive symptoms among adolescents. To establish full recovery, FFT-A may need to be supplemented with systematic care interventions effective for mania symptoms.

Trial registration: ClinicalTrials.gov NCT00571402.

Figures

Figure 1. Consort Diagram

FFT-A indicates family-focused therapy for adolescents; EC, enhanced care.

Figure 2

Time to recovery from depressive symptoms at study intake (N = 58; sample mean, 12.4 weeks ± 17.1). After accounting for baseline depression severity, site, and gender, a Cox proportional hazards model indicated that patients in family-focused treatment for adolescents (FFT-A, n = 30) and medication recovered from their baseline depressive symptoms faster than patients in enhanced care (EC, n = 28) and medication (χ2 (1) = 4.36, P = .037; hazard ratio = 1.85, 95% CI, 1.04 – 3.29).

Figure 3

Longitudinal trajectory of Psychiatric Status Ratings (PSR) from the Adolescent Longitudinal Interval Follow-up Interview (N = 58). Family-focused treatment for adolescents (FFT-A) was associated with a more favorable trajectory of PSR depression scores than enhanced care (EC) (treatment by time interaction, linear effect, P = .002; quadratic effect, P = .03; difference in −2 log-likelihood = 14.0 (df = 2), P < .001).