| Rates of depression rise in adolescence, and depressive disorders have been associated with comorbid disorders and detrimental outcomes. Randomized controlled trials have demonstrated efficacy for CBT in the treatment of adolescent depression. However, a substantial portion of adolescents in these trials, and in typical clinical practice, do not respond to treatment or terminate therapy prematurely. This study utilized a clinically-representative sample and an efficacious treatment to elucidate early markers of poor treatment response and attrition in school-based CBT for adolescent depression. Indicators of poor response and attrition included client characteristics, contextual characteristics, participation variables, and perceived barriers to treatment. Conduct disorder symptoms and life stressors predicted poor treatment response. High levels of family conflict and no-shows were associated with attrition. Adolescents' perceptions of barriers to treatment were associated with symptom change and number of sessions completed. These markers may help clinicians identify teens who are at-risk for not gaining full benefit from therapy or dropping-out early. In addition, these findings may inform modifications of existing protocols and guidelines as treatments are being transported to "real world" settings for use with adolescents with complex life situations and collateral problems. |
