Assessment of youth psychopathology is frequently multi-informant, as each informant is presumed to provide unique information. However, clinicians frequently face a difficult task of integrating varying reports between informants as discrepancies in reports are common, particularly for less observable symptoms. Informant discrepancies have been linked to poorer treatment engagement and may contribute to the high rates of attrition in community-based services. The current study examined informant agreement on depressive symptoms among youths, parents, and clinicians to: 1) characterize patterns of agreement; 2) examine demographic and clinical predictors of agreement; and 3) examine the relationship between agreement and treatment engagement. It was hypothesized that levels of informant discrepancy would be high, predicted by sociodemographic and clinical factors, and predictive of poorer treatment engagement.

The sample consisted of 326 youths (ages 13-18) with clinically elevated depressive symptoms (as reported by the youth, parent, or clinician) seeking services from an outpatient mental health clinic serving an ethnically diverse, low-income population. The analyses examined parent-youth-clinician (triadic) agreement, in addition to three sub-samples of dyads (i.e., parent-youth, parent-clinician, and youth-clinician). The study aims were examined using regression models (linear, logistic, and negative binomial) nested within clinician.

Rates of dyadic agreement that the youth had clinically significant depressive symptoms ranged from 30.1% to 37.8%, while triadic agreement was 16.7%. Informant agreement was predicted by variables such as higher youth anxiety, higher perceived stress, and demographic factors (older age, female gender, and ethnic/racial minority status). A greater number of attended sessions was predicted primarily by agreement and clinical variables (lower youth anxiety). Greater consistency in treatment attendance was primarily predicted by agreement and demographic factors (being of non-minority status, not a recipient of public assistance). Clinician-defined dropout was not predicted by any of the variables of interest.

Among adolescent youths with elevated depressive symptoms, agreement among informants is low. Informant agreement affects both how many sessions youths attend and consistency of attendance, particularly in the youth-clinician analyses. Increasing agreement on youth depressive symptoms at the initiation of treatment may have a positive effect on critical treatment processes, and in turn, treatment outcomes.

Anxious and depressive disorders share common etiology and respond to similar treatments (Garber & Weersing, 2010). Transdiagnostic protocols may aid in treatment efficiency and reduce the burden of dissemination. Little is known regarding whether therapists are able to implement these treatments equally well across the range of clinical profiles they are intended to target and whether participants are equally engaged.

Youth (ages 8-16) with diagnoses of an anxious or depressive disorder were randomized to either brief behavioral treatment (BBT; N = 95) or usual care. Therapists rated adherence and participant engagement. Audio recordings of treatment sessions were also coded for adherence. Aim 1: Youth psychopathology severity, parental psychopathology, and family conflict were examined as predictors of adherence. Higher levels of psychopathology and conflict were hypothesized to predict lower levels of adherence. Aim 2: Psychopathology and conflict were examined as predictors of engagement. Higher levels of psychopathology and conflict were hypothesized to predict lower levels of engagement. Aim 3: Engagement was examined as a predictor of adherence. Higher levels of engagement were hypothesized to predict better adherence both within and across subsequent sessions.

Aim 1: As hypothesized, anxiety severity and comorbid depression predicted lower levels of therapist-reported adherence. In contrast with hypotheses, parental psychopathology and family conflict did not predict adherence. As hypothesized, in analyses of observer-reported adherence, higher levels of youth psychopathology, parental psychopathology, and family conflict predicted less coverage of core components of treatment and more time structuring session. Aim 2: As hypothesized, higher levels of youth psychopathology, parental psychopathology, and family conflict predicted lower levels of engagement. In-session engagement was predicted by youth psychopathology whereas homework completion and parental involvement were predicted by parental psychopathology and family conflict. Aim 3: As hypothesized, higher levels of engagement were associated with higher levels of adherence within session, but not between phase of treatment.

Results supported youth symptom severity and comorbidity as predictors of in-session processes (e.g., adherence) and parental psychopathology and family conflict as predictors of between-session processes (e.g., homework completion). Results from the current study are relevant in identifying families who may be at risk of receiving suboptimal treatment.

Depression is a prevalent and disabling disorder. Parental depression predicts onset and treatment resistance in offspring, and adolescent onset has been associated with severe and chronic course. Thus, much work has been done to prevent depression, particularly in adolescent offspring of depressed parents. Few prevention trials have evaluated disorder course. Understanding long-term patterns and predictors of prevention

response in at-risk adolescents may inform new intervention development. As such, the current study aimed to empirically derive longitudinal patterns of response to prevention and test predictors of response. Adolescents (N = 316) at personal and familial risk for depression were enrolled in a multi-site randomized controlled trial testing a nine-month group-based cognitive-behavioral prevention program (CBP). The Depression Symptom Rating Scale (DSR) was used to establish patterns of prevention response across 6 years of study participation. Candidate predictors included intervention assignment, current parental depression at baseline, adolescent risk (i.e., a history of depressive episode, subsyndromal depressive symptoms, both), adolescent functioning, anxiety symptoms, and hopelessness. Repeated Measures Latent Class Analysis (RMLCA) was used to identify patterns of response across follow-up. Predictors of class membership were then analyzed using Multinomial Logistic Regression. All analyses employed an intent-to-treat design, used an alpha level of .05, and were run using Mplus8. RMLCA model fit indices (i.e., AIC = 3211.24, BIC = 3476.76, BLMRT: p < .001; entropy = 87%) supported a four-class solution: well/late onset (n = 213; 68.5%), recurrent/brief episodes (n = 38; 12.2%), recurrent/persistent episodes (n = 19; 6.1%), early discontinuation (i.e., n = 41; 13.2%). Multinomial logistic regression revealed that increased odds of categorization in the well/late onset class vs. the recurrent/persistent class were related to being randomized to CBP and having better functioning and less hopelessness at baseline. Interestingly, adolescents at highest risk for depression were also more likely categorized in the well/late onset class compared to the recurrent/persistent class. The four distinct trajectories of prevention response identified have implications for booster session timing and prevention program content. Results also support the feasibility of using RMLCA and multinomial logistic regression in future work, progressing the understanding long-term depression prevention effects in at-risk adolescents.

Anxiety and depression in youth are prevalent, yet few affected youths receive an adequate dose of mental health treatment (MHT). Parents’ perceptions of barriers to treatment participation may be critical, as parents serve as gatekeepers to services. Providing MHT in high-access settings like pediatric primary care may reduce barriers and increase access to adequate care.

Parents’ perceptions of barriers were examined in an RCT (n = 185) investigating the effectiveness of primary-care-embedded Brief Behavioral Therapy (BBT) for anxious and/or depressed youths (ages 8-16) versus assisted referral to care (ARC) in traditional outpatient settings. Aims included identifying family characteristics associated with anticipated barriers (A-BTP; Aim 1) at baseline and experienced barriers (E-BTP; Aim 2) measured at Week 16 after treatment engagement and testing if E-BTP mediated the effects of treatment assignment on receipt of an adequate dose (≥ 8 sessions; Aim 3). It was hypothesized that psychopathology and marginalization would be associated with higher barriers, BBT assignment and lower E-BTP associated with adequate dose, and that associations between A-BTP and E-BTP would be weaker in BBT.

As hypothesized, higher A-BTP was associated with higher parent anxiety and depression at baseline; however, lower youth depression was also associated with higher A-BTP. Higher A-BTP, youth Latinx identity, poorer youth functioning, higher parent anxiety, and older parent age at baseline were associated with higher E-BTP. Associations between A-BTP and E-BTP were weaker in BBT versus ARC (interaction β = -0.27, p = .020). Assignment to BBT (OR = 22.42, p = .039, 95% CI = 9.06-55.50) was associated with adequate dose. However, contrary to hypotheses, treatment assignment was not related to E-BTP, and models including E-BTP, treatment, and dose were unstable and could not be estimated.

In this sample of anxious/depressed youths, parents’ perceptions of barriers were associated with psychopathology and Latinx identity. Anticipated (A-BTP) and experienced barriers (E-BTP) were associated, and assignment to primary care-based BBT was more likely to result in an adequate dose. Families with Latinx youth, elevated parent psychopathology, and poorer youth functioning are more likely to perceive barriers to treatment and may need additional support to facilitate treatment participation.