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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    • "Maternal depression is associated with conflict in both marital and mother– child relationships (Goodman & Gotlib, 1999), as well as lower shared positivity and higher disengagement in mothers' interactions with depressed adolescents (Dietz et al., 2008a). Maternal depression may sustain negative mother– child interactions that contribute to adolescent depressive symptoms (Hammen, Shih, & Brennan, 2004; Shelton & Harold, 2008) and may impair the adaptation and generalization of effective cognitive and interpersonal skills that are often taught in empirically supported psychotherapies for depression (Brent, Holder, & Kolko, 1998; Garber et al., 2009). Depressed mothers may present as less responsive and less skilled social partners to youths who are learning to engage, negotiate, and communicate their needs in relationships. "

    Full-text · Dataset · Nov 2015
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    • "Here 48.3% of the children and adolescents admitted to psychiatric care had a parent with a mental illness. Garber et al. (2009) showed that offspring of depressed parents are at a two-to three-fold increased risk of developing depressive disorders (Garber et al., 2009). Indeed, longitudinal studies have shown that the life time risk for developing a serious mental illness ranged from 40 to 77% for children of mentally ill parents, and this could be shown for the whole range of psychiatric disorders (review: Hosman et al., 2009). "
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    ABSTRACT: Objective: The transgenerational transmission of mental disorders is one of the most prominent risk factors for the development of psychological disorders. Children of mentally ill parents are a vulnerable high risk group with overall impaired development and high rates of psychological disorders. To date there are only a few evidence based intervention programs for this group overall and hardly any in Germany. We translated the evidence based Family Talk Intervention by Beardslee (2009) and adapted it for groups. First results of this pilot study are presented. Method: This investigation evaluates a preventive group intervention for children of mentally ill parents. In a quasi-experimental design three groups are compared: an intervention group (Family Talk Intervention group: n = 28), a Wait Control group (n = 9), and a control group of healthy children (n = 40). Mean age of children was 10.41 years and parental disorders were mostly depressive/affective disorders (n = 30), but a small number also presented with Attention-Deficit/Hyperactivity Disorder (n = 7). Results: Children of mentally ill parents showed higher rates of internalizing/externalizing disorders before and after the intervention compared to children of parents with no disorders. Post intervention children's knowledge on mental disorders was significantly enhanced in the Family Talk Intervention group compared to the Wait Control group and the healthy control group. Parental ratings of externalizing symptoms in the children were reduced to normal levels after the intervention in the Family Talk Intervention group, but not in the Wait Control group. Discussion: This pilot study of a group intervention for children of mentally ill parents highlights the importance of psycho-education on parental mental disorders for children. Long-term effects of children's enhanced knowledge about parental psychopathology need to be explored in future studies.
    Full-text · Article · Nov 2015 · Frontiers in Psychology
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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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    ABSTRACT: The Family Check Up (FCU) is a family-centered intervention for reducing children's problem behavior through improving parenting skills and family interactions. Although the FCU was designed to prevent conduct problems, we have also found the program to be effective in preventing escalating symptoms of depression in early adolescence. The current analyses examine heterogeneous patterns of response to treatment in an effort to identify factors associated with differential response to family intervention. We examined heterogeneity in trajectories of youth-reported depressive symptoms from grades 6 to 9, using a Latent Growth Mixture Modeling framework to identify patterns of treatment response and non-response. Three symptom trajectories were identified, including the following: (1) a large class exhibiting stable, low symptom levels, (2) a class exhibiting high and stable depressive symptoms, and (3) a class exhibiting low initial symptoms that increased over time. Significant intervention effects were identified only among the third class, as a preventive effect on depression from 7th to 9th grade for youth with low initial symptoms. No effect of intervention was observed in the other two classes. Comparisons of classes 2 and 3 suggested that class 3 members were more likely to be females with high baseline antisocial behavior, but lower initial levels of depression. The findings suggest the importance of exploring heterogeneity within a prevention design, as well as the importance of tailored approaches to the prevention of adolescent depression.
    Full-text · Article · Aug 2015 · Prevention Science
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