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This is a longitudinal randomized control trial on the impact of adding a parent psychoeducation intervention (TEPSI) as part of cognitive-behavioral therapy (CBT) for adolescents with Major Depressive Disorder (MDD) in a Puerto Rican sample. We tested the efficacy of adding 8 group sessions of TEPSI to 12 sessions of individual CBT on reducing depressive symptoms, MDD diagnosis, and improving family functioning. Participants (n = 121) were randomized to individual CBT with or without TEPSI. No main group effects were found for most patient domains including depression symptoms, as well as presence of adolescent's MDD diagnosis at posttreatment. Results did show a main effect of CBT over time for depression symptoms, suicide ideation, family criticism, and the presence of MDD diagnosis decreasing from pre- to postintervention. A year post treatment, almost 70% of adolescents in both conditions (CBT and CBT + TEPSI) remained in remission. A main effect was obtained for treatment in the adolescent's perception of familism and family emotional involvement. The primary hypothesis that family psychoeducation would optimize CBT for depression in adolescents was not supported. Both conditions yielded similar clinical end points. The culturally adapted CBT was found effective with Latino/a adolescents showing clinically significant improvements from pretreatment to posttreatment and remained stable at a 1-year follow-up. Regarding family outcomes, adolescents in CBT + TEPSI remained stable from pretreatment to posttreatment on family emotional involvement, while adolescents in CBT-alone showed an increase. The implication of these findings is discussed.

Este es un ensayo clínico longitudinal aleatorizado y controlado sobre el efecto de agregar una intervención psicoeducativa para los padres (TEPSI, en inglés) como parte de la terapia cognitivo-conductual (TCC) para adolescentes con trastorno depresivo mayor (TDM) en una muestra puertorriqueña. Evaluamos la eficacia de agregar 8 sesiones grupales de TEPSI a 12 sesiones de TCC individual en la reducción de síntomas depresivos, en el diagnóstico de TDM y en la mejora del funcionamiento familiar. Los participantes (n = 121) fueron distribuidos al azar a la TCC individual con o sin TEPSI. No se encontraron efectos grupales principales en la mayoría de las áreas de los pacientes, como en los síntomas de depresión ni en la presencia de un diagnóstico de TDM en los adolescentes después del tratamiento. Los resultados sí demostraron un efecto principal de la TCC con el tiempo para los síntomas de depresión, las ideas suicidas, la crítica familiar y la presencia de un diagnóstico de TDM que disminuye desde antes hasta después de la intervención. Un año después del final del tratamiento, casi el 70 % de los adolescentes en ambas condiciones (TCC y TCC + TEPSI) se mantuvo en remisión. Se obtuvo un efecto principal del tratamiento en la percepción de los adolescentes del familismo y la implicación emocional familiar. No se respaldó la hipótesis principal de que la psicoeducación familiar optimizaría la TCC para la depresión en los adolescentes. Ambas condiciones dieron variables clínicas similares. Se descubrió que la TCC culturalmente adaptada fue eficaz con los adolescentes latinos, ya que demostró mejoras clínicas considerables desde antes del tratamiento hasta después del tratamiento y permaneció estable un año después al momento del seguimiento. Con respecto a los resultados familiares, los adolescentes de la TCC + TEPSI se mantuvieron estables desde antes del tratamiento hasta después del tratamiento en la implicación emocional familiar, mientras que los adolescentes de la TCC sola demostraron un aumento. Se debaten las implicancias de estos resultados.

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OBJECTIVES: The available literature on ethnic identity among Puerto Ricans has focused on those living in the United States, with little to no attention placed on examining ethnic identity and psychological constructs among youth living in Puerto Rico. Using a colonial mentality framework, the current study examined the associations between ethnic identity, cultural stress, and self-concept among adolescent boys and girls living in Puerto Rico. METHOD: The current cross-sectional study surveyed participants (N = 187) recruited from several junior high schools in the metropolitan area in Puerto Rico. RESULTS: Relations between ethnic identity, cultural stress, and self-concept differed by gender. First, cultural stress was associated with self-concept for boys, such that higher cultural stress predicted lower self-concept. Second, among girls, cultural stress moderated the relation between ethnic identity and self-concept. Specifically, for girls experiencing high cultural stress, exploration and resolution of their ethnic identity was associated with higher ratings of self-concept. CONCLUSIONS: Although cultural stress has been widely understood as a phenomena associated with immigrants, our study indicated that cultural stress is important in understanding self-concept of youth living in Puerto Rico. For boys, cultural stress, but not ethnic identity, is particularly important to their self-concept. Among girls experiencing high cultural stress, exploration and resolution of ethnic identity was associated with higher self-concept. Results suggested that the cultural stress associated with the colonial context of Puerto Rico is salient in ethnic identity and self-concept development, even though Puerto Rican youth are the ethnic majority in the island. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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This work reviews the progress and current state of a research program on Diabetes and youth depression in Puerto Rico. Given the high depression rate, its impact in youth with Type 1 Diabetes (T1D), and the lack of interventions to target this link in an integrative way, the manual titled Cognitive-Behavioral Treatment for Depression in Adolescents with T1D was developed. After its first use in an Open Trial, we currently assess the initial efficacy of its revised version to reduce depression and improve glycemic control, self-care, and quality of life. We present its approach, and initial data on its feasibility, acceptability and potential to reduce emotional problems in T1D youth. We discuss implications of this line of research for health psychology, and its utility to model the development of interventions alike focused on other chronic illnesses.

Este trabajo reseña el progreso y estado actual de un programa investigativo sobre la Diabetes y la depresión juvenil en Puerto Rico. Ante la alta prevalencia y el impacto de la depresión en menores con Diabetes Tipo 1 (DT1) y la falta de intervenciones que atiendan de modo integrado este vínculo, se desarrolló el Manual para el Tratamiento Cognitivo-Conductual de la Depresión en Adolescentes con DT1. Tras su uso original en un ensayo clínico abierto, evaluamos ahora la eficacia inicial de su versión revisada para reducir la depresión y mejorar el control glucémico, el autocuidado, y la calidad de vida. Presentamos su enfoque junto a datos iniciales que apoyan su viabilidad, aceptación y potencial para reducir los problemas emocionales en jóvenes con DT1. Discutimos algunas implicaciones de esta línea investigativa para la psicología de la salud y su utilidad para modelar el diseño de intervenciones similares para otras enfermedades crónicas.

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OBJECTIVE: This study was aimed at determining the prevalence of overweight; of class 1 and class 2/3 obesity; and of the symptoms of depression in adults in Puerto Rico. The study also evaluated the relationship between the symptoms of depression and weight status. METHODS: The sample for this study consists of 6,025 adults (3,851 females and 2,174 males) who lived in Puerto Rico at the time of and who participated in either the 2006 or the 2010 BRFSS. RESULTS: In this sample 70.0% of the respondents were either overweight or obese. About 39.6% of them were considered overweight, while 18.1% were obese class 1 and 12.3% were obese class 2 or 3. When compared by gender, the prevalence rate of overweight was higher for males (46.9%) than it was for females (35.5%), but females (14.1%) had a higher rate of class 2/3 obesity than did males (9.2%). There were no significant gender-based differences in the class 1 (BMI between 30 and 35) obesity group. According to the study's findings, depression symptoms and class 1 obesity are not strongly associated. A positive relationship between depression and weight was found only in women with class 2/3 obesity (BMI>35). CONCLUSION: In summary, the results of this study show that depressive symptoms are associated with obesity, and this correlation seems to be more significant in women, especially those with severe obesity, less education, and lower incomes. Findings point to the existence of a high risk of comorbid obesity and depression of adults in Puerto Rico.

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