Reducing Depressive Symptoms in Physically Ill Youth

• Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS; Parent and Child) [ Time Frame: MOb, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Children's Depression Inventory (CDI; Parent and Child forms) [ Time Frame: MOb, M1, M2, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Children's Depression Rating Scale-Revised (CDRS) [ Time Frame: M0b, M3, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Clinical Global Impression Scale- Improvement (CGI-I) [ Time Frame: MOb, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Children's Global Assessment Scale (CGAS) [ Time Frame: MOb, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Impact-III Questionnaire [ Time Frame: MOb, M1, M2, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Medical Adherence Measure (MAM) [ Time Frame: MOb, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Brief Illness Perception Questionnaire (BIPQ) [ Time Frame: MOb, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Pediatric Crohn's Disease Activity Index (PCDAI; for Crohn's disease) [ Time Frame: MOa, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Pittsburgh Sleep Quality Index (PSQI) [ Time Frame: MOb, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Abdominal Pain Index (API; child and parent forms) [ Time Frame: MOb, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Laboratory Measurement for markers of cytokine-induced inflammation [ Time Frame: MOa, M3, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• IBD Course will be assessed using a validated classification system of acute, chronic and chronic intermittent course (Greene et al., 1994) [ Time Frame: MOb, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  

• Perceived Control Scale [ Time Frame: MOb, M1, M2, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Coping Strategies Inventory [ Time Frame: MOb, M1, M2, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Therapist Alliance Scale for Adolescents (TASA; therapist, and patient forms) [ Time Frame: M3 ] [ Designated as safety issue: No ]
  
• Screen for Child Anxiety Related Emotional Disorders (SCARED, parent and child versions) [ Time Frame: MOb, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Child and Adolescent Services Assessment (CASA) [ Time Frame: M3, M6, M9, M15 ] [ Designated as safety issue: No ]
  
• General Information Form (GIF) [ Time Frame: M0a ] [ Designated as safety issue: No ]
  
• Medical history information [ Time Frame: MOb, M3, M6, M9, M15, M18 ] [ Designated as safety issue: No ]
  
• Treatment Credibility Scale [ Time Frame: M3 ] [ Designated as safety issue: No ]
  
• Therapy Procedure Checklist [ Time Frame: M3 ] [ Designated as safety issue: No ]
  

Children and adolescents with inflammatory bowel disease (IBD) have high rates of depressive symptoms and more trouble with daily functioning than those without physical illness. Furthermore, the medications used to treat IBR, such as steroids, may induce depression. The proposed study will investigate if cognitive behavioral therapy (CBT) is better than supportive therapy (SNDT) in reducing emotional distress and improving functioning in youth ages 9-17 with Crohn's disease and depression. This study will also be the first to assess the effect of CBT on IBD-related factors such as disease severity, medication adherence, and physical-health related quality of life.

Participants will be carefully evaluated for depression and those who have clinically significant depression will be randomly assigned to either CBT designed for youth with IBD or supportive therapy sessions. Youth in the CBT group will learn new ways of thinking and acting to reduce symptoms of depression focused on the reconstruction of negative or hopeless physical illness narratives. Parents in the CBT group will participate in three family sessions designed to improve family understanding and communication about the physical illness and about risks for developing depression. Children in the supportive therapy condition will receive social support and information about IBD and depression similar to what they would likely receive from social workers in their pediatric medical clinic. Because emotional difficulties such as the experience of depressive symptoms have been linked with the severity and course of IBD symptoms, this information may enable parents to better help their child cope with his/her physical illness. In addition, participants in both groups may experience reduced depression and improved quality of life.

It is predicted that those in the CBT group will benefit by learning effective strategies for coping with IBD and depression, enhancing their social skills, and improving family communication skills while those in the supportive therapy group will benefit by receiving social support and useful information. The proposed study will help determine which psychosocial approach is of greater benefit for depressed youth with IBD and provide a model for integrating behavioral treatment to decrease both emotional and IBD-related suffering into the comprehensive medical care for IBD in the pediatric population.

Hypotheses

• Individuals who receive CBT will have significantly decreased severity of symptoms of depression, improved functioning more generally, improved medication adherence, illness perception and health-related quality of life compared to the SNDT group
• The CBT group will have significantly decreased negative cognitive processing and improved coping strategies compared to the SNDT group
• (Exploratory) Changes in depressive severity will be mediated by changes in cognitive processes and coping strategies on the CBT group
• (Exploratory) Corticosteroid treatment, older age, lower SES, degree of psychiatric comorbidity, and male gender will be moderators of the effect of the intervention on depressive symptoms