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Improving Mood with Psychoanalytic and Cognitive Therapies (IMPACT)

  • Summary

    In the UK, 1 in 10 young people referred to Child and Adolescent Mental Health Services (CAMHS) receives a diagnosis of depression. There are strong links between adolescent depression and recurrent depressive episodes and suicidality in later life.

    This highlights the need to identify psychological treatments that have long-term benefits in reducing the risk of relapse in later life.

    In 2005, the NICE guidelines highlighted the need for a randomised controlled trial (RCT) to assess the efficacy of Cognitive Behavioural Therapy (CBT) and psychodynamic psychotherapy in the treatment of adolescent depression.

    The IMPACT trial was set up in response to NICE recommendations, and is the largest clinical trial of psychological therapies for adolescent depression ever to have taken place in Europe.

    Aims:

    • To assess the effectiveness of three therapeutic interventions in the treatment and relapse prevention of adolescent depression.

    • To estimate the overall health, social and educational costs of the interventions based on research findings, and build ground for future adolescent depression treatment recommendations.

    • To explore whether, or how, cortisol levels and genes might influence individual responses to treatment.

    Methodology

    The study is a pragmatic randomised controlled trial, which reflects how these services are provided, and used, in real NHS settings by the adolescent population.

    470 participants aged 11-17 years with moderate/severe depression have been recruited from CAMHS within NHS Trusts across three regions in the UK: North London, East Anglia and the North West.

    Participants are randomly allocated to one of the three interventions: Cognitive Behavioural Therapy (CBT), Short Term Psychoanalytic Psychotherapy (STPP) and Specialist Clinical Care (SCC). Outcome assessments take place with participants at 6, 12, 36, 52 and 86 weeks after starting treatment.

    Results

    Young people in all three arms of the study were found to have sustained reduced depressive symptoms at 86 week follow-up. The three treatments were found to be equally effective in maintaining reduced depressive symptoms, with an average of 49-52% reduction in depressive symptoms one year after the end of treatment. There were no significant differences in the total costs of the three treatment groups by the end of the study.

  • Project team

    Collaborators

    • University of Cambridge,
    • University of Manchester,
    • University College London

    Contact

    Sally.Parkinson@annafreud.org

  • Publications

    Goodyer, I. M., Tsancheva, S., Byford, S., Dubicka, B., Hill, J., Kelvin, R., et al. (2011). Improving mood with psychoanalytic and cognitive therapies (IMPACT): a pragmatic effectiveness superiority trial to investigate whether specialized psychological treatment reduces the risk for relapse in adolescents with moderate to severe unipolar depression: Study protocol for a randomized controlled trial. Trials, 12, 175.

    Goodyer, I., Reynolds, S., Barrett, B., Byford, S., Dubicka, B., Hill, J., Holland, F., Kelvin, R., Midgley, N., Roberts, C., Senior, R., Target, M., Widmer, B., Wilkinson, P., Fonagy, P. (2016). Effectiveness And Cost-Effectiveness Of Cognitive Behaviour Therapy And Short-Term Psychoanalytic Psychotherapy Compared With Brief Psychosocial Intervention In Maintaining Reduced Depressive Symptoms 12 months after end of treatment in Adolescents with Unipolar Major Depression (IMPACT): A Pragmatic Superiority Randomised Controlled Trial. Lancet Psychiatry

    Cousins, L., Whitaker, K., Widmer, B., Midgley, N. et al. (2016). Clinical characteristics associated with the prescribing of SSRI medication in adolescents with major unipolar depression. European Child and Adolescent Psychiatry.

    Cregeen, S., Hughes, C., Midgley, N.Rhode, M. & Rustin, M. (ed. by Catty, J.) (2017). Short-term Psychoanalytic Psychotherapy for Adolescents with Depression: A Treatment Manual. London: Karnac