The bi-directional relationship between parent-child conflict and treatment outcome in treatment-resistant adolescent depression

Abstract

Objective: To examine the bidirectional relationship between parent-child discord and treatment outcome for adolescent treatment-resistant depression.

Method: Depressed youth who had not responded to an adequate course of a selective serotonin reuptake inhibitor (SSRI) were randomized to either a switch to another SSRI or venlafaxine, with or without the addition of cognitive behavior therapy (CBT) in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study. The Conflict Behavior Questionnaire was used to assess adolescent (CBQ-A) and parent-reported (CBQ-P) parent-child discord. The impact of remission on parent-child conflict, and the differential impact of medication and CBT on the CBQ-A and CBQ-P, were assessed using generalized linear models.

Results: Although there were no differential treatment effects on parent or adolescent-report of conflict, remission was associated with improvement in the CBQ-P. In general, intake family conflict did not predict remission, except in the sub-group of participants whose parents reported clinically significant parent-child conflict at intake, for whom high levels of parent-reported conflict predicted a lower likelihood of remission. Conflict also did not moderate treatment response.

Conclusions: Remission of depression may be sufficient to reduce parent-reported parent-child conflict. However, higher parent-reported conflict, in the clinically significant range, predicts a lower likelihood of remission from depression. Clinical trial registration information-Treatment of SSRI-Resistant Depression in Adolescents (TORDIA); https://ichgcp.net/clinical-trials-registry/NCT00018902" title="See in ClinicalTrials.gov">NCT00018902.

Copyright © 2013 American Academy of Child & Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

FIGURE 1

Impact of remission on family conflict. Note: Error bars: 95% confidence interval. CBQ-A Conflict Behavior Questionnaire–Adolescent; CBQ-P=Conflict Behavior Questionnaire–Parent.

FIGURE 2

Impact of medication and cognitive behavioral therapy (CBT) on family conflict. Note: Error bars: 95% confidence interval. CBQ-A=Conflict Behavior Questionnaire–Adolescent; CBQ-P=Conflict Behavior Questionnaire–Parent; SSRI=selective serotonin reuptake inhibitor.