A randomized placebo-controlled trial of a school-based depression prevention program.
OBJECTIVE
To conduct a placebo-controlled study of the effectiveness of a universal school-based depression prevention program.


METHODS
Three hundred ninety-two students age 13 to 15 from two schools were randomized to intervention (RAP-Kiwi) and placebo programs run by teachers. RAP-Kiwi was an 11-session manual-based program derived from cognitive-behavioral therapy. The placebo was similar but with cognitive components removed. Outcomes were self-rated depression scales, the Reynolds Adolescent Depression Scale (RADS), and the Beck Depression Inventory II (BDI-II). Follow-up was to 18 months. Analysis was done on an intent-to-treat basis.


RESULTS
Immediately after the intervention, depression scores were reduced significantly more by RAP-Kiwi than by placebo, with a mean difference in change from baseline between groups of 1.5 on BDI-II (CI > 0.38, p =.01) and 2.24 on RADS (CI > 0.22, p =.04). Categorical analysis confirmed significant clinical benefit with an absolute risk reduction of 3% (95% CI, 1-11%, McNemar chi, p =.03), with the "number needed to treat" for short-term benefit of 33. Group differences in depression scores averaged across time to 18 months were significant on RADS but not on BDI-II. Retention rates were 91% at 6 months and 72% at 18 months.


CONCLUSIONS
The RAP-Kiwi program is a potentially effective public health measure. Confirmation of effectiveness measuring episodes of depressive illness and broader measures of adjustment is warranted.
Merry
Sally
S
Department of Psychiatry, University of Auckland, Auckland, New Zealand. s.merry@auckland.ac.nz
McDowell
Heather
H
Wild
Chris J
CJ
Bir
Julliet
J
Cunliffe
Rachel
R
D000293:Adolescent; D003863:Depression / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D011314:Preventive Health Services / Q000458:organization & administration*; D012572:School Health Services / Q000458:organization & administration*; D016037:Single-Blind Method; D014481:United States