OBJECTIVE Depression is the most prominent mental health disorder among youth and has a profound impact with respect to morbidity and mortality if not addressed. The Treatment for Adolescent Depression Study (TADS) is one of the largest randomized controlled trials that compared the effectiveness of four treatments: cognitive-behavioral therapy (CBT); fluoxetine (FLX); combined cognitive-behavioral and fluoxetine treatment (COMB); and placebo (PBO). However, meaningful heterogeneous treatment courses are masked by these group mean comparisons of treatment impact. The present study sought to characterize the acute phase symptom trajectories of the depressed teens enrolled in TADS and to explore predictors of these trajectories, including TADS treatment condition. METHOD The TADS sample of 439 adolescent participants diagnosed with major depressive disorder was subjected to growth mixture modeling (GMM) to evaluate subgroups of adolescents with unique trajectories of depression symptom change. RESULTS Growth mixture modeling revealed three unique classes of adolescents: (1) a high-severity class with early significant improvement; (2) a high-severity class with limited symptom change; and (3) a moderate severity class with late significant improvement. Baseline predictors of class membership included treatment condition, sex, age, stage of change, depression severity, number of comorbid disorders, hopelessness, melancholia, suicidality, and cognitive distortions. CONCLUSION Results of this study may have implications for the selection of which treatment to use for which depressed adolescent. CLINICAL TRIAL REGISTRATION INFORMATION Treatment for Adolescents With Depression Study (TADS); https://clinicaltrials.gov/; NCT00006286.

中文翻译：

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青少年抑郁症治疗中症状变化的轨迹研究。


目的 抑郁症是青少年中最突出的精神健康疾病，如果不加以解决，将对发病率和死亡率产生深远影响。青少年抑郁症治疗研究 (TADS) 是最大的随机对照试验之一，比较了四种治疗方法的有效性：认知行为疗法 (CBT)；氟西汀（FLX）；认知行为和氟西汀联合治疗（COMB）；和安慰剂（PBO）。然而，有意义的异质治疗过程被这些组治疗影响的平均比较所掩盖。本研究旨在描述参加 TADS 的抑郁青少年的急性期症状轨迹，并探索这些轨迹的预测因素，包括 TADS 治疗状况。方法 对 439 名被诊断患有重度抑郁症的青少年参与者的 TADS 样本进行生长混合模型 (GMM)，以评估具有独特抑郁症状变化轨迹的青少年亚组。结果 生长混合模型揭示了青少年的三个独特类别：（1）早期显着改善的高严重性类别； (2) 症状变化有限的高严重级别； (3) 中等严重程度，后期有显着改善。班级成员的基线预测因素包括治疗条件、性别、年龄、变化阶段、抑郁严重程度、合并症数量、绝望、忧郁、自杀和认知扭曲。结论 这项研究的结果可能对选择针对抑郁青少年的治疗方法具有影响。临床试验注册信息 青少年抑郁症治疗研究 (TADS)； https://clinicaltrials.gov/； NCT00006286。