Researchers pinpoint variables linked to adolescent depression outcomes

Researchers identified variables reported as significant in three or more randomized clinical trials with respect to adolescent depression outcomes, according to results of a scoping review published in JAMA Network Open.

These included age, sex/gender and baseline depression severity.

“An up-to-date, systematic and comprehensive examination of what is currently known about predictors, moderators and mediators derived from RCTs [randomized controlled trials] for the treatment of [depressive disorders in adolescents] can inform the extent to which clinicians can practice precision medicine and guide trialists on interventions targeting specific mechanisms of action,” Darren B. Courtney, MD, of the Centre for Addiction and Mental Health in the department of psychiatry at the University of Toronto, and colleagues wrote. “The aims of this scoping review,” they said, “were to (1) identify the predictors, moderators and mediators that have been studied to date in published RCTs of treatment for [depressive disorders in adolescents]; (2) map out the reported findings from their analyses to guide further hypothesis testing; and (3) describe the extent to which a priori hypotheses and adjustments for multiple comparisons are reported in published analyses.”

Courtney and colleagues searched four databases and included 81 articles that tested predictors, moderators or mediators linked to depression symptom outcomes in RCTs related to the treatments of adolescents aged 13 to 17 years. They defined predictors as variables linked to depression outcomes that were independent of treatment group and moderators as baseline variables linked to differential outcomes between treatment groups. They defined mediators using a formal mediation analysis.

Results showed variable domains considered significant in three or more RCTs included age, sex/gender, baseline depression severity, early response to treatment, sleep changes, parent-child conflict, overall psychopathology, suicidal ideation, hopelessness, functional impairment, therapy session attendance and trauma history. According to two publications that reported a priori hypotheses and adjustment for multiple comparison, depression severity and family conflict correlated with poorer outcomes.

“Researchers can use information from this review to guide next steps for study design, such as individual patient data meta-analyses, machine learning strategies and trials of interventions targeting specific variables thought to be associated with unfavorable depression symptom severity outcomes,” Courtney and colleagues wrote. “With high quality investigations of predictors, moderators and mediators associated with outcomes through robust research designs, there is immense potential to improve the lives of adolescents with depression.”