Impact of comorbidity on a cognitive-behavioral group treatment for adolescent depression

Objective: Examine hypotheses concerning the negative impact of lifetime ps ychiatric comorbidity on participation in, and benefit from, a cognitive-be havioral group treatment for depression in adolescents (e.g., greater sever ity at intake, less recovery and more recurrence, less participation in tre atment). Method: Across two previous studies conducted between 1986 and 199 3, 151 depressed adolescents (aged 14-18) were randomly assigned to one of three treatment conditions (two active treatments and a waitlist control) a nd followed for 24 months posttreatment. Forty percent of participants had one or more lifetime comorbid diagnoses at intake. Results: Comorbid anxiet y disorders were associated with higher depression measure scores at intake and greater decrease in depression scores by posttreatment. Overall lifeti me comorbidity was unrelated to diagnostic recovery, but lifetime substance abuse/dependence was associated with slower time to recovery. Participants with attention-deficit and disruptive behavior disorders were more likely to experience depression recurrence posttreatment. Associations between com orbidity and participation or therapy process measures were nonsignificant. Conclusions: Although some outcomes were worse for some comorbid diagnoses , the reassuring overall conclusion is that the presence of psychiatric com orbidity is generally not a contraindication for the use of structured grou p cognitive-behavioral interventions for depressed adolescents.