This study will develop an integrated treatment for adolescents who are depressed and suicidal and their parents who are depressed and have a history of suicidality.

Depression, like many psychiatric disorders, has a genetic component that makes it more likely that members of the same family will have the disorder. Depression in parents, particularly mothers, may put the children at greater risk for depression. When an adolescent whose parent is depressed develops depression himself or herself, treating both the parent and the adolescent may be more effective than treating only the adolescent. This study will test a depression treatment that targets depressed suicidal adolescents with a parent or primary caretaker who is also depressed and has a history of suicidality.

Participation in this study will last 6 months. Participants will be randomly assigned to receive either concurrent parent and adolescent treatment or adolescent only treatment. For those assigned to concurrent treatment, both the adolescent participants and one of their parents will receive individual cognitive behavioral therapy (CBT) counseling sessions and joint family counseling sessions. In the adolescent only treatment condition, adolescent participants will receive individual CBT sessions, but parents will not, and both will receive joint family sessions. Counseling sessions will last 1 hour and occur weekly for 3 months, and then every other week for 3 months. CBT identifies and attempts to change problematic thought patterns. All participants will receive medication consultation if necessary.

Participants will complete assessments at baseline, post-treatment, and 6 months after completing treatment. These assessments will include questionnaires and interviews about depression, suicidal thoughts, mood regulation, behavioral problems, and family. At post-treatment and the 6-month follow-up, participants will also be asked to give feedback about the counseling, medication consultation, and their satisfaction.

Inclusion Criteria for Adolescents:

• Lives at home with at least one parent or guardian
• Speaks English
• Must have made a suicide attempt and be diagnosed with major depressive disorder (MDD)

Inclusion Criteria for Primary Caretakers:

• Speaks English
• Current diagnosis of MDD and a history of suicidality

Exclusion Criteria for Adolescents:

• Judged to have developmental or cognitive delays or psychotic disorders on the basis of a standard psychiatric exam
• Diagnosis of bipolar disorder or a substance dependence (people with a diagnosis of substance abuse are eligible)
• Only one adolescent per family is eligible

Exclusion Criteria for Primary Caretakers:

• Diagnosis of bipolar disorder or substance dependence
• If taking antidepressants, not on a stable dose for 3 months

I year

The outcome data from this study must be considered within the context of its limitations including the small sample size which reduces both the power to detect differences between groups as well as the stability of findings.