Prevention of Depression in At-Risk Adolescents: A Randomized Controlled Trial

Department of Psychology and Human Development, Vanderbilt University, 552 Peabody, 230 Appleton Pl, Nashville, TN 37203-5721, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/2009; 301(21):2215-24. DOI: 10.1001/jama.2009.788
Source: PubMed


Adolescent offspring of depressed parents are at markedly increased risk of developing depressive disorders. Although some smaller targeted prevention trials have found that depression risk can be reduced, these results have yet to be replicated and extended to large-scale, at-risk populations in different settings.
To determine the effects of a group cognitive behavioral (CB) prevention program compared with usual care in preventing the onset of depression.
A multicenter randomized controlled trial conducted in 4 US cities in which 316 adolescent (aged 13-17 years) offspring of parents with current or prior depressive disorders were recruited from August 2003 through February 2006. Adolescents had a past history of depression, current elevated but subdiagnostic depressive symptoms, or both. Assessments were conducted at baseline, after the 8-week intervention, and after the 6-month continuation phase.
Adolescents were randomly assigned to the CB prevention program consisting of 8 weekly, 90-minute group sessions followed by 6 monthly continuation sessions or assigned to receive usual care alone.
Rate and hazard ratio (HR) of a probable or definite depressive episode (ie, depressive symptom rating score of > or = 4) for at least 2 weeks as diagnosed by clinical interviewers.
Through the postcontinuation session follow-up, the rate and HR of incident depressive episodes were lower for those in the CB prevention program than for those in usual care (21.4% vs 32.7%; HR, 0.63; 95% confidence interval [CI], 0.40-0.98). Adolescents in the CB prevention program also showed significantly greater improvement in self-reported depressive symptoms than those in usual care (coefficient, -1.1; z = -2.2; P = .03). Current parental depression at baseline moderated intervention effects (HR, 5.98; 95% CI, 2.29-15.58; P = .001). Among adolescents whose parents were not depressed at baseline, the CB prevention program was more effective in preventing onset of depression than usual care (11.7% vs 40.5%; HR, 0.24; 95% CI, 0.11-0.50), whereas for adolescents with a currently depressed parent, the CB prevention program was not more effective than usual care in preventing incident depression (31.2% vs 24.3%; HR, 1.43; 95% CI, 0.76-2.67).
The CB prevention program had a significant prevention effect through the 9-month follow-up period based on both clinical diagnoses and self-reported depressive symptoms, but this effect was not evident for adolescents with a currently depressed parent. Identifier: NCT00073671.

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Available from: Judy Garber, Oct 06, 2015
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    • "The intensity and focus of such sessions varied widely, from brief psychoeducation efforts (e.g., Brent et al. 1997) to parent sessions (generally between two and six sessions) in parallel to youth-only sessions (e.g., Garber et al. 2009; Shochet et al. 2001) to more directly family-focused sessions (e.g., Compas et al. 2009). Engaging parents into such adjunctive treatments emerged as one common challenge. "
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    • "Mood disorders in particular fall into this gray area. Although there is no definitive early treatment for mood disorders, controlled trials have demonstrated reduction of symptom severity or of probability of clinical onset during follow-up in children who were considered to be at high risk because of symptoms and behavior and who received school- or family-based psychotherapies (e.g., Arnarson and Craighead 2011; Stice et al. 2010; Garber et al. 2009; Miklowitz and Chang 2008). Some parents will be interested in having children tested early in life for their predisposition to a condition that has been diagnosed in one or more close relatives, even if predictive power is modest, age of onset is highly variable and options for prevention or treatment remain uncertain. "
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    • "Results emphasize the importance of early intervention for those who experience higher levels of emotional abuse. Individuals with a history of abuse may especially benefit from therapy that focuses on understanding the relationship between stress and depression and effectively coping with negative life events, which has been found to be efficacious in the treatment and prevention of depression (Nemeroff et al., 2003; Garber et al., 2009). Although the finding of a specific relationship between childhood emotional abuse and stress reactivity warrants further replication, this study highlights the particular pathogenic nature of emotional abuse. "
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