Sheree Toth, executive director of the University of Rochester's Mt. Hope Family Center and associate professor of psychology, has been awarded $3.6 million from the National Institute of Mental Health to identify effective interventions for disadvantaged teenaged girls struggling with the early signs of depression.
"Girls are twice as likely as boys to suffer from depression," explains Toth. "And female teens burdened by poverty, racial discrimination, or a history of abuse face even greater odds of developing the mood disorder. Yet there has been little research on therapies for these at-risk youths."
To answer that need, Toth and her research team will focus exclusively on girls from low-income, racially and ethnically diverse backgrounds both with and without histories of maltreatment.
"This research holds the promise of finding concrete ways to help our most vulnerable youths before their teen years are disrupted by the hopelessness, irritability, and even suicidal thoughts that can mark major depressive episodes," says Toth. Early intervention is critical, she adds, because the illness often triggers a cascade of other problems at home and in school.
"We know that therapeutic interventions work with more affluent populations," says Toth. She hopes this new research will help to make life-altering interventions more widely available in community settings.
The study will follow 350 13-to-15-year-old girls with depressive symptoms through a structured, three-and-a-half month treatment program called Interpersonal Psychotherapy for Adolescents. Each week a trained therapist will meet individually with each girl, helping her to identify troubled relationships in her life and to formulate positive strategies for navigating these difficult areas. The therapy is focused on the present, not the past, and meetings are made as friendly and accessible as possible, with therapists often talking with teens at home, providing rides to an office, or conducting sessions in the car.
The study focuses on the early teen years because this is a peak period for the emergence of depression. Adolescence is also a critical time for social development. "Kids are more involved with peers and conflict in this area can lead to depression," explains Toth. "Interventions aimed at improving interpersonal skills become particularly important. Healthy friendships can exert a powerful protective role in the lives of adolescents," she adds.
To evaluate the therapy, investigators will look for signs of both mental and physiological improvement throughout the program and at an 18-month follow-up.
"Depression is marked by negative thinking, blaming, and self-esteem issues," says Toth. "For example, a child who is depressed and fails a test might say to herself, 'I failed because I am really stupid,' whereas a child who is not depressed might conclude that she simply did not study enough. The thinking is less negative about the self," says Toth. The study will look for indicators that the girls are learning to see their world and themselves through a more positive lens.
Investigators also will monitor the girls' stress hormones. Research has shown that trauma and neglect disrupt normal hormonal responses to tension and conflict. The study seeks to determine whether therapy can help to restore normal neuroendocrine function.
Finally, Toth's team will explore how genetics influence participants' response to therapy. Earlier research has found that certain genes may predispose individuals to depression under high-stress conditions like abuse, while the presence of other genes may confer a protective function. Understanding how genes interact with an individual's life experiences may help identify children at higher risk for problems and may ultimately inform prevention efforts, says Toth.
Dante Cicchetti, a professor of child development and psychiatry at the University of Minnesota and one of the principal investigators on the project, will oversee the genetic analysis for the grant.