Development and efficacy of a family-focused treatment for depression in childhood

•Family-Focused Treatment for Childhood Depression is an evidence-based, developmentally adapted intervention for the treatment of depressed youth ages 7–14.•Family-Focused Treatment for Childhood Depression is based on an interpersonal model that utilizes the idea of upward and downward interactional spirals in which family interactions impact mood and vice versa.•Using an interpersonal framework, Family-Focused Treatment for Childhood Depression assists families in developing skills to improve their interpersonal functioning, built resilience and combat depression.•Compared to individual supportive therapy, Family-Focused Treatment for Childhood Depression has demonstrated quicker recovery from depression. Depression in childhood frequently involves significant impairment, comorbidity, stress, and mental health problems within the family. Family-Focused Treatment for Childhood Depression (FFT-CD) is a 15-session developmentally-informed, evidence-based intervention targeting family interactions to enhance resiliency within the family system to improve and manage childhood depression. We present the conceptual framework underlying FFT-CD, the treatment development process, the intervention strategies, a case illustration, and efficacy data from a recent 2-site randomized clinical trial (N = 134) of 7–14 year old children randomly assigned to FFT-CD or individual supportive psychotherapy (IP) conditions. Compared to children randomized to IP, those randomized to FFT-CD showed higher rates of depression response (≥50% Children's Depression Rating Scale-Revised reduction) across the course of acute treatment (77.7% vs. 59.9%, t = 1.97, p = .0498). The rate of improvement overall leveled off following treatment with a high rate of recovery from index depressive episodes in both groups (estimated 76% FFT-CD, 77% IP), and there was an attenuation of observed group differences. By final follow-up (9 months post-treatment), one FFT-CD child and six IP children had suffered depressive recurrences, and four IP children attempted suicide. Without a no treatment control group it is not possible to disentangle the impact of the interventions from time alone. While seldom evaluated, family interventions may be particularly appropriate for childhood depression. FFT-CD has demonstrated efficacy compared to individual supportive therapy. However, findings underscore the need for an extended/chronic disease model to enhance outcomes and reduce risk over time.