The bi-directional relationship between parent-child conflict and treatment outcome in treatment-resistant adolescent depression

Manivel Rengasamy, Brandon M. Mansoor, Robert Hilton, Giovanna Porta, Jiayan He, Graham J. Emslie, Taryn Mayes, Gregory N. Clarke, Karen Dineen Wagner, Martin B. Keller, Neal D. Ryan, Boris Birmaher, Wael Shamseddeen, Joan Rosenbaum Asarnow, David A. Brent

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Objective: To examine the bidirectional relationship between parent-child discord and treatment outcome for adolescent treatment-resistant depression. Method: Depressed youth who had not responded to an adequate course of a selective serotonin reuptake inhibitor (SSRI) were randomized to either a switch to another SSRI or venlafaxine, with or without the addition of cognitive behavior therapy (CBT) in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study. The Conflict Behavior Questionnaire was used to assess adolescent (CBQ-A) and parent-reported (CBQ-P) parent-child discord. The impact of remission on parent-child conflict, and the differential impact of medication and CBT on the CBQ-A and CBQ-P, were assessed using generalized linear models. Results: Although there were no differential treatment effects on parent or adolescent-report of conflict, remission was associated with improvement in the CBQ-P. In general, intake family conflict did not predict remission, except in the sub-group of participants whose parents reported clinically significant parent-child conflict at intake, for whom high levels of parent-reported conflict predicted a lower likelihood of remission. Conflict also did not moderate treatment response. Conclusions: Remission of depression may be sufficient to reduce parent-reported parent-child conflict. However, higher parent-reported conflict, in the clinically significant range, predicts a lower likelihood of remission from depression. Clinical trial registration information- Treatment of SSRI-Resistant Depression in Adolescents (TORDIA);; NCT00018902.

Original languageEnglish (US)
Pages (from-to)370-377
Number of pages8
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number4
StatePublished - Apr 2013
Externally publishedYes


  • Cognitive behavior therapy (CBT)
  • Depression
  • Parent-child conflict
  • Selective serotonin reuptake inhibitor (SSRI)
  • Venlafaxine

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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