title: Effect of a Cognitive-Behavioral Prevention Program on Depression 6 Years After Implementation Among At-Risk Adolescents: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Adolescents whose parents have a history of depression are at risk for developing depression and functional impairment. The long-term effects of prevention programs on adolescent depression and functioning are not known.
  
  
  OBJECTIVE
  To determine whether a cognitive-behavioral prevention (CBP) program reduced the incidence of depressive episodes, increased depression-free days, and improved developmental competence 6 years after implementation.
  
  
  METHODS
  A 4-site randomized clinical trial compared the effect of CBP plus usual care vs usual care, through follow-up 75 months after the intervention (88% retention), with recruitment from August 2003 through February 2006 at a health maintenance organization, university medical centers, and a community mental health center. A total of 316 participants were 13 to 17 years of age at enrollment and had at least 1 parent with current or prior depressive episodes. Participants could not be in a current depressive episode but had to have subsyndromal depressive symptoms or a prior depressive episode currently in remission. Analysis was conducted between August 2014 and June 2015.
  
  
  METHODS
  The CBP program consisted of 8 weekly 90-minute group sessions followed by 6 monthly continuation sessions. Usual care consisted of any family-initiated mental health treatment.
  
  
  METHODS
  The Depression Symptoms Rating scale was used to assess the primary outcome, new onsets of depressive episodes, and to calculate depression-free days. A modified Status Questionnaire assessed developmental competence (eg, academic or interpersonal) in young adulthood.
  
  
  RESULTS
  Over the 75-month follow-up, youths assigned to CBP had a lower incidence of depression, adjusting for current parental depression at enrollment, site, and all interactions (hazard ratio, 0.71 [95% CI, 0.53-0.96]). The CBP program's overall significant effect was driven by a lower incidence of depressive episodes during the first 9 months after enrollment. The CBP program's benefit was seen in youths whose index parent was not depressed at enrollment, on depression incidence (hazard ratio, 0.54 [95% CI, 0.36-0.81]), depression-free days (d = 0.34, P = .01), and developmental competence (d = 0.36, P = .04); these effects on developmental competence were mediated via the CBP program's effect on depression-free days.
  
  
  CONCLUSIONS
  The effect of CBP on new onsets of depression was strongest early and was maintained throughout the follow-up period; developmental competence was positively affected 6 years later. The effectiveness of CBP may be enhanced by additional booster sessions and concomitant treatment of parental depression.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier:NCT00073671.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania2Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: David A
authors.initials: DA
authors.lastname: Brent
authors.affiliation: Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Brunwasser
authors.affiliation: Department of Psychology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Hollon
authors.affiliation: Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, California, and University of California, San Diego, San Diego.
authors.forename: V Robin
authors.initials: VR
authors.lastname: Weersing
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Clarke
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: John F
authors.initials: JF
authors.lastname: Dickerson
authors.affiliation: Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: William R
authors.initials: WR
authors.lastname: Beardslee
authors.affiliation: Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts.
authors.forename: Tracy R G
authors.initials: TR
authors.lastname: Gladstone
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Porta
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Frances L
authors.initials: FL
authors.lastname: Lynch
authors.affiliation: Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.affiliation: Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee.
authors.forename: Judy
authors.initials: J
authors.lastname: Garber
mesh_terms: D000293:Adolescent; D000328:Adult; D016241:Child of Impaired Parents / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D012306:Risk; D016896:Treatment Outcome; D055815:Young Adult