Prevention of depression in at-risk adolescents: a randomized controlled trial.
BACKGROUND
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.


OBJECTIVE
To determine the effects of a group cognitive behavioral (CB) prevention program compared with usual care in preventing the onset of depression.


METHODS
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.


METHODS
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.


BACKGROUND
clinicaltrials.gov Identifier: NCT00073671.
Garber
Judy
J
Department of Psychology and Human Development, Vanderbilt University, 552 Peabody, 230 Appleton Pl, Nashville, TN 37203-5721, USA. judy.garber@vanderbilt.edu
Clarke
Gregory N
GN
Weersing
V Robin
VR
Beardslee
William R
WR
Brent
David A
DA
Gladstone
Tracy R G
TR
DeBar
Lynn L
LL
Lynch
Frances L
FL
D'Angelo
Eugene
E
Hollon
Steven D
SD
Shamseddeen
Wael
W
Iyengar
Satish
S
D000293:Adolescent; D016241:Child of Impaired Parents; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group; D012307:Risk Factors