During the 12-month period, a total of 129 willing adolescent depression who met the inclusion criteria were enrolled and underwent baseline measurements (T0). 47 participants did not come for treatment (including recovery, hospitalization, etc.), and the remaining 82 participants underwent long-term follow-up. Among patients receiving long-term psychotherapy intervention, 37 were enrolled in the SFBT group and 45 in the AC group.
Of the 37 participants enrolled in the SFBT group, 28 participants (9 boys and 19 girls) continued until the 10th intervention, and received complete three post-test data of T3, T6, and T10. Of the 45 participants recruited in the AC group, 25 participants continued until the 10th intervention (5 boys and 20 girls), and received complete three post-test data of T3, T6, and T10 In the end. As shown in Fig. 1.
Demographic and clinical characteristics
The demographic characteristics of subjects in each group are presented in Table 1. The SFBT group included 9 males and 19 females (mean age = 15.11 years; SD = 1.42). The AC group included 5 males and 20 females (mean age = 14.80 years; SD = 1.41). Both groups showed no difference in age, gender or education (P > 0.05). No statistically significant differences among treatment groups were found with respect to medicine treatment. As shown in Table 1.
Clinical data and VFT task performance of participants before and after therapy
Clinical data
The PHQ-9 was employed to assess the severity of depression in the SFBT group and AC group. A 2 (group: SFBT group, AC group) * 4 (time point: T0、T3、T6、T10) two-way mixed ANOVA was conducted to examine the effect of SFBT on participants. The results showed that the main effect of time point was significant [ F(3,49) = 9.865, P<0.001,η2 = 0.377], meaning that PHQ-9 scores decreased after therapy in all participants ( see Table 2). The main effect of Group was not significant [ F(1, 51) = 2.293, P = 0.136]. The interaction between Group and Time point was significant [ F(3, 49) = 2.969, P = 0.056, η2 = 0.142]. Simple effect analysis revealed that the PHQ-9 scores in both two groups were significantly reduced at T3, T6, T10 assessment compared with the T0 point ( P < 0.05). According to the simple effect analysis of treatment time, the results showed that the PHQ-9 scores of the two groups were not significant at T0, T3 and T10, while the PHQ-9 scores of the SFBT group were significantly lower than those in the AC group (p = 0.006) in the T6 time point ( P < 0.05).
The GAD-7 was employed to assess the severity of anxiety in the SFBT group and AC group. The results showed that the main effect of time point was significant [ F(3,49) = 11.148, P<0.001,η2 = 0.406], meaning that GAD-7 scores decreased after therapy in all participants (see Table 2). The main effect of Group was not significant [F(1, 51) = 2.618, P = 0.112]. The interaction between Group and Time point was not significant [ F(3, 49) = 0.589, P = 0.625].
Additional post hoc analyses found that the GAD-7 scores of T3, T6 and T10 were significantly lower than that of T0 ( P < 0.05). The GAD-7 scores of T10 showed a marginal significant lower than the score at T3 ( P = 0.061), and was significantly lower than the scores at T6 ( P = 0.002). While the scores of the rest of the time points were not significant between each other ( P>0.1). As shown in Table 2.
Table 2
Clinical data of SFBT group and controls (mean ± SD).
Condition
|
Time point
|
SFBT(n = 28)
|
AC(n = 25)
|
PHQ−9
|
T0
|
18.32 ± 5.40
|
17.80 ± 5.15
|
T3
|
15.43 ± 5.71b
|
17.12 ± 6.33
|
T6
|
13.29 ± 5.51ce
|
17.80 ± 6.03
|
T10
|
12.11 ± 6.25c
|
14.32 ± 7.16b
|
GAD−7
|
T0
|
13.54 ± 4.42
|
14.52 ± 5.14
|
T3
|
11.14 ± 5.05c
|
12.76 ± 5.44c
|
T6
|
11.04 ± 4.75b
|
13.88 ± 4.52b
|
T10
|
9.54 ± 5.33c
|
11.28 ± 6.07c
|
SFBT:Solution-focused brief therapy; AC: Psychodynamic therapy; PHQ-9: the Patient Health Questionnaire ; GAD-7: Generalized Anxiety Disorder-7.
Values are mean ± SD; with repeated-measures analysis of variance. 0.05 < aP < 0.1, bP<0.05, cP<0.001 relative to baseline;0.05 < dP < 0.1, eP<0.05, fP<0.001 between groups.
VFT task performance
During the VFT task, the numbers of words generated by the SFBT and AC groups are summarized in Table 3. A 2 (Group: SFBT group, AC group) * 4 (Time point: T0、T3、T6、T10) two-way mixed ANOVA was conducted to examine the performance of subjects on the VFT task. The results showed that the main effect of Group was significant [ F(1,51) = 8.752, P = 0.005, η2 = 0.146], meaning that the performances on the VFT task in the SFBT group were higher than those in the AC group. The main effect of Time point was not significant [ F(3,49) = 0.143, P = 0.934]. The interaction between Group and Time point was significant [ F(3,49) = 4.473, P = 0.005, η2 = 0.081]. There was no significant difference in the performances on the VFT task at T0 ( P = 0.980), while the SFBT group were significantly higher than those in the AC group in the time of T3, T6 and T10 ( P < 0.05). As shown in Fig. 3.
The integral value of oxy-Hb in the frontal lobe
A 2 (Group: SFBT group, AC group) * 4 (Time point: T0、T3、T6、T10) two-way mixed ANOVA was conducted to examine the integral value of Oxy-Hb in the frontal lobe of subjects on the VFT task. The results showed that the main effect of Time point was significant [ F(1,51) = 12.559, P = 0.001,η2 = 0.198] and the interaction between Group and Time point was significant [ F(3, 49) = 1.960, P < 0.001, η2 = 0.494]. Simple effect analysis revealed that the the integral value of Oxy-Hb at T10 was significant higher than that at T0, T3, T6 ( P < 0.05) in SFBT group. While there was no significant difference in the integral value of Oxy-Hb in AC group at the time point of T0, T3, T6 and T10 ( P>0.1). As shown in Table 3.
Figure 2 demonstrates the integral value of Oxy-Hb in the frontal lobe of the SFBT group and AC group during the task of VFT. It can be seen that there was no significant difference in the integral value of Oxy-Hb between the SFBT group and the AC group at baseline. But the integral value of Oxy-Hb in the SFBT group was marginal significantly lower than that in AC group( P = 0.060), and significantly higher at the time point of T6 and T10 than that in AC group ( P < 0.001).
Table 3
VFT task performance and the mean integral value of oxy-Hb of the frontal lobe area during VFT (mean ± SD).
Condition
|
Time point
|
SFBT(n = 28)
|
AC(n = 25)
|
VFT
|
T0
|
9.46 ± 3.64
|
9.44 ± 3.40
|
T3
|
11.18 ± 3.85be
|
8.48 ± 4.85
|
T6
|
11.21 ± 4.38be
|
8.08 ± 3.40
|
T10
|
11.68 ± 4.75be
|
7.64 ± 3.07b
|
Integral value
|
T0
|
39.23 ± 69.16
|
14.91 ± 61.20
|
T3
|
-23.96 ± 70.59cd
|
15.52 ± 78.81
|
T6
|
86.05 ± 67.82bf
|
9.37 ± 55.45
|
T10
|
153.53 ± 77.99cf
|
22.80 ± 58.25
|
Values are mean ± SD; with repeated-measures analysis of variance. 0.05 < aP < 0.1, bP<0.05, cP<0.001 relative to baseline;0.05 < dP < 0.1, eP<0.05, fP<0.001 between groups.
NIRS data analysis
A 2 (Group: SFBT group, AC group) * 4 (Time point: T0、T3、T6、T10) two-way mixed ANOVA was applied to examine the mean [Oxy-Hb] changes in participants.
The main effect of time point
The results showed that the main effect of Time point was significant in channel 17 [ F(3,49) = 3.687, P = 0.013, η2 = 0.067]. Additional post hoc analyses found that the mean active Oxy-Hb values at T10 was significantly higher than that at T3( P = 0.004), and was marginal significantly higher than that at T0 and T6 ( P = 0.056, P = 0.062). As shown in Table 4.
Table 4
The mean Oxy-hemoglobin (oxy-Hb) changes in the five channels across the groups.(mean ± SD).
|
SFBT(n = 28)
|
AC(n = 25)
|
CH1 oxy-Hb
|
|
|
T0
|
-0.066893 ± 0.421249
|
-0.146590 ± 0.553377
|
T3
|
-0.092196 ± 0.611896d
|
-0.258232 ± 0.289063
|
T6
|
-0.070937 ± 0.363762d
|
-0.157184 ± 0.412706
|
T10
|
-0.084603 ± 0.379781d
|
-0.258250 ± 0.382398
|
CH3 oxy-Hb
|
|
|
T0
|
-0.040874 ± 0.310211
|
−0.109224 ± 0.583864
|
T3
|
0.177522 ± 0.601971e
|
-0.161760 ± 0.343596
|
T6
|
0.038321 ± 0.533234e
|
-0.081278 ± 0.554993
|
T10
|
-0.035575 ± 0.403430e
|
-0.324650 ± 0.470708
|
CH11 oxy-Hb
|
|
|
T0
|
-0.096095 ± 0.437341
|
-0.180457 ± 0.310932
|
T3
|
0.049087 ± 0.604841e
|
-0.154253 ± 0.364345
|
T6
|
-0.054372 ± 0.595310e
|
-0.084196 ± 0.417738
|
T10
|
0.104943 ± 0.473885e
|
-0.306312 ± 0.468670
|
CH12 oxy-Hb
|
|
|
T0
|
-0.235744 ± 0.919030
|
-0.092010 ± 0.203480
|
T3
|
-0.076049 ± 0.390389
|
-0.205110 ± 0.258400
|
T6
|
-0.172352 ± 0.482569
|
-0.047436 ± 0.470329
|
T10
|
0.005516 ± 0.434714e
|
-0.244675 ± 0.400495
|
CH17 oxy-Hb
|
|
|
T0
|
-0.034038 ± 0.248337
|
-0.212178 ± 0.633903
|
T3
|
-0.169161 ± 0.394913
|
-0.256328 ± 0.497363
|
T6
|
-0.091867 ± 0.364183
|
-0.088492 ± 0.399559
|
T10
|
0.038872 ± 0.365417a
|
0.141596 ± 0.776911a
|
Values are mean ± SD; with repeated-measures analysis of variance. 0.05 < aP < 0.1, bP<0.05, cP<0.001 relative to baseline;0.05 < dP < 0.1, eP<0.05, fP<0.001 between groups.
The main effect of group
The results showed that the main effect of Group was significant in channel 3 [ F(1,51) = 8.116, P = 0.006, η2 = 0.137], channel 11 [ F (1,51) = 6.849, P = 0.012, η2 = 0.118], indicating that the mean active Oxy-Hb values in the SFBT group were higher than those in the AC group. Channel 1 showed a marginal significant change [ F(1,51) = 3.705, P = 0.060, η2 = 0.068].
The interaction between group and time point
The interaction between Group and Time point showed that Channel 12 showed a marginal significant change [F(3,49) = 2.459, P = 0.074, η2 = 0.131]. The mean active Oxy-Hb values in participants are shown in Fig. 3.
Simple effect analyses revealed that the mean active Oxy-Hb value in channel 12 in SFBT group was significantly increased at the T10 assessment compared with the T6 time point ( P = 0.082). While the mean active Oxy-Hb value in channel 12 in the AC group was significant decreased at the T10 assessment compared with the T6 time point ( P = 0.069). According to the simple effect analysis of treatment time, the results demonstrated that the mean active Oxy-Hb value in the SFBT group was significantly higher than that in the AC group at the T10 time point ( P = 0.035), but no significant change was found at the T0, T3, T6 time point between the groups ( P>0.1).