Background Although there is good evidence to support the effectiveness of cognitive behavioral therapy (CBT) for the outpatient treatment of adolescent major depressive disorder (MDD), evidence-based manuals for the inpatient setting are lacking. This pilot study sought to (i) adapt an existing CBT manual (treatment of adolescent depression; TADS) to an inpatient setting (TADS-in), (ii) test its effectiveness at symptom reduction and remission of MDD in a pre-post design, and (iii) assess the strengths and limitations of the manual via a focus-group with clinicians. Methods Twenty nine adolescents aged 12-17 years with a primary ICD-10 diagnosis of MDD being treated as inpatients at a psychiatric clinic were included. Embedded in the regular inpatient treatment course (8 weeks), patients received 12 sessions of the TADS-in manual. Quantitative assessment of symptom reduction and remission of MDD was conducted using a non-controlled pre-post design. The quantitative results were supplemented by a focus group with participating psychotherapists. Results Of the 29 patients included in the study at the beginning, 19 (65.5%) remained in the study at week 8. Symptoms of depression were statistically significantly lower at the end of treatment than at baseline according to self- (d = 1.38; mean change = 19.88; 95% CI = 12.48-27.28) and other reports (d = 0.64, mean change = 0.35; 95% CI = 0.08-0.62). Clinicians ratings of improvement (CGI-I) suggested that at the end of treatment, 15.8% were very much improved, 68.4% much improved, and 15.8% were minimally improved. According to diagnostic interviews with patients conducted at the end of treatment, 73.3% were in remission. The qualitative analysis showed that on the whole, the TADS-in manual is suitable for the inpatient setting. However, clinicians believed the effectiveness of TADS-in was limited by patient comorbidity and the fact that the inpatients were unable to practice incorporating techniques learnt into everyday life. Conclusions This study is the first to adapt the TADS manual to the inpatient setting. The sample of depressed adolescents showed reduced symptomology following treatment, although these findings require replicating in a randomized controlled trial before effects can be attributed to the TADS-in manual specifically. This pilot study informs further development of the manual as well as representing an important first step in the evaluation of the inpatient treatment of adolescent depression.The study was retrospectively registered (DRKS00017308) and received no external funding.

中文翻译：

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基于 CBT 的青少年抑郁症住院治疗手册的改编和评估：一项试点研究。

背景 尽管有充分的证据支持认知行为疗法 (CBT) 对青少年重度抑郁症 (MDD) 门诊治疗的有效性，但缺乏针对住院环境的循证手册。该试点研究旨在 (i) 将现有的 CBT 手册（青少年抑郁症的治疗；TADS）适应住院环境 (TADS-in)，(ii) 在事后设计中测试其在 MDD 症状减轻和缓解方面的有效性，以及 (iii) 通过与临床医生的焦点小组评估手册的优势和局限性。方法 包括 29 名 12-17 岁的青少年，其主要 ICD-10 诊断为 MDD，在精神病诊所接受住院治疗。在常规住院治疗过程中（8 周），患者接受了 12 次 TADS-in 手册。使用非对照的前后设计对 MDD 的症状减轻和缓解进行定量评估。定量结果得到了心理治疗师参与的焦点小组的补充。结果 在开始时纳入研究的 29 名患者中，19 名（65.5%）在第 8 周仍留在研究中。根据自我（d = 1.38；平均变化 = 19.88；95% CI = 12.48-27.28）和其他报告（d = 0.64，平均变化 = 0.35；95% CI = 0.08-0.62）。临床医生的改善评级 (CGI-I) 表明，在治疗结束时，15.8% 的改善很大，68.4% 的改善很大，15.8% 的改善很小。根据在治疗结束时对患者进行的诊断性访谈，73.3% 的患者处于缓解状态。定性分析表明，总体而言，TADS-in 手册适用于住院环境。然而，临床医生认为 TADS-in 的有效性受到患者合并症和住院患者无法练习将所学技术融入日常生活这一事实的限制。结论 本研究首次将 TADS 手册应用于住院环境。抑郁青少年的样本在治疗后表现出减少的症状，尽管这些发现需要在随机对照试验中重复，然后才能将效果具体归因于 TADS-in 手册。该试点研究为手册的进一步发展提供了信息，并代表了评估青少年抑郁症住院治疗的重要第一步。