The context of depression in clinic-referred youth: Neglected areas in treatment

Objective: To review the empirical, methodological, and conceptual limitati ons of psychotherapy and pharmacotherapy for childhood and adolescent depre ssion and to present descriptive data on key characteristics of a depressed sample to illustrate gaps in treatment. Method: Interview-based assessment of psychiatric features and psychosocial functioning, family psychopatholo gy and marital adjustment, and child and parent stressful life events was p erformed in a sample of 43 depressed youngsters seeking outpatient treatmen t. Results: The empirical and conceptual review indicated that treatments b ased on downward extensions of adult procedures are limited in number and s uccess. Also, the treatments generally neglect the following characteristic s revealed in the descriptive data: depressed youngsters have high rates of recurrent depression and comorbid conditions, impaired academic and social functioning, exposure to high rates of parental psychopathology, parental assortative mating, severe marital dysfunction, and high rates of severe st ressors. Conclusions: Treatments need to be informed by and address the act ual characteristics of depressed youngsters and their environments, which a re highly dysfunctional.