title: Prevention of Depression in At-Risk Adolescents: Moderators of Long-term Response.
abstract: In a randomized controlled trial, we found that a cognitive behavioral program (CBP) was significantly more effective than usual care (UC) in preventing the onset of depressive episodes, although not everyone benefitted from the CBP intervention. The present paper explored this heterogeneity of response. Participants were 316 adolescents (Mage= 14.8, SD = 1.4) at risk for depression due to having had a prior depressive episode or having current subsyndromal depressive symptoms and having a parent with a history of depression. Using a recursive partitioning approach to baseline characteristics, we (Weersing et al. 2016) previously had identified distinct risk clusters within conditions that predicted depressive episodes through the end of the continuation phase (month 9). The present study used the same risk clusters that had been derived in the CBP group through month 9 to reclassify the UC group and then to examine group differences in depression through month 33. We found that in this overall very high-risk sample, the CBP program was superior to UC among youth in the low-risk cluster (n = 33), characterized by higher functioning, lower anxiety, and parents not depressed at baseline, but not in the middle (n = 95) and high-risk (n = 25) clusters. Across conditions, significantly more depression-free days were found for youth in the low-risk cluster (M = 951.9, SD = 138.8) as compared to youth in the high-risk cluster (M = 800.5, SD = 226.7). Identification of moderators, based on purely prognostic indices, allows for more efficient use of resources and suggests possible prevention targets so as to increase the power of the intervention.
authors.affiliation: Department of Psychology and Human Development, Vanderbilt University, 552 Peabody, 230 Appleton Pl, Nashville, TN, USA. judy.garber@vanderbilt.edu.
authors.forename: J
authors.initials: J
authors.lastname: Garber
authors.affiliation: Joint Doctoral Program in Clinical Psychiatry, San Diego State University, San Diego, CA, USA.|University of California, San Diego, CA, USA.
authors.forename: V R
authors.initials: VR
authors.lastname: Weersing
authors.affiliation: Department of Psychology, Vanderbilt University, Nashville, TN, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Hollon
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: G
authors.initials: G
authors.lastname: Porta
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
authors.forename: G N
authors.initials: GN
authors.lastname: Clarke
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Dickerson
authors.affiliation: Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.
authors.forename: W R
authors.initials: WR
authors.lastname: Beardslee
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
authors.forename: F L
authors.initials: FL
authors.lastname: Lynch
authors.affiliation: Wellesley Centers for Women, Wellesley College, Wellesley, MA, USA.
authors.forename: T G
authors.initials: TG
authors.lastname: Gladstone
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: W
authors.initials: W
authors.lastname: Shamseddeen
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Brent
mesh_terms: D000293:Adolescent; D003863:Depression / Q000517:prevention & control*; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment
keywords: Adolescents; Depression; Moderators; Prevention
references.citation: J Am Acad Child Adolesc Psychiatry. 2016 Mar;55(3):219-26
references.pmid: 26903255
references.citation: J Am Acad Child Adolesc Psychiatry. 1995 Mar;34(3):312-21
references.pmid: 7896672
references.citation: Cochrane Database Syst Rev. 2011 Dec 07;(12):CD003380
references.pmid: 22161377
references.citation: Am Psychol. 2012 May-Jun;67(4):285-95
references.pmid: 22583342
references.citation: Pediatrics. 2009 Oct;124(4):e596-605
references.pmid: 19736259
references.citation: Psychiatr Serv. 2010 Feb;61(2):160-3
references.pmid: 20123821
references.citation: J Pers Soc Psychol. 1992 Sep;63(3):452-9
references.pmid: 1403624
references.citation: Biometrics. 1980 Mar;36(1):81-90
references.pmid: 7370375
references.citation: J Consult Clin Psychol. 2009 Jun;77(3):486-503
references.pmid: 19485590
references.citation: Psychiatr Q. 2005 Winter;76(4):327-39
references.pmid: 16217627
references.citation: J Am Acad Child Adolesc Psychiatry. 1997 Jul;36(7):980-8
references.pmid: 9204677
references.citation: Arch Gen Psychiatry. 1987 Jun;44(6):540-8
references.pmid: 3579500
references.citation: J Consult Clin Psychol. 1974 Dec;42(6):861-5
references.pmid: 4436473
references.citation: J Consult Clin Psychol. 2009 Aug;77(4):775-87
references.pmid: 19634969
references.citation: Arch Gen Psychiatry. 2002 Oct;59(10):877-83
references.pmid: 12365874
references.citation: J Am Acad Child Adolesc Psychiatry. 2007 Sep;46(9):1162-1170
references.pmid: 17712239
references.citation: JAMA. 2009 Jun 3;301(21):2215-24
references.pmid: 19491183
references.citation: JAMA. 2008 Feb 27;299(8):901-913
references.pmid: 18314433
references.citation: Clin Psychol (New York). 2010 Dec;17(4):293-306
references.pmid: 21499544
references.citation: J Am Acad Child Adolesc Psychiatry. 1997 Apr;36(4):545-53
references.pmid: 9100430
references.citation: Arch Gen Psychiatry. 2011 Mar;68(3):253-62
references.pmid: 21383263
references.citation: J Am Acad Child Adolesc Psychiatry. 1996 Jun;35(6):705-15
references.pmid: 8682751
references.citation: Arch Gen Psychiatry. 1998 Jul;55(7):645-51
references.pmid: 9672056
references.citation: Arch Gen Psychiatry. 1983 Nov;40(11):1228-31
references.pmid: 6639293
references.citation: J Youth Adolesc. 1991 Apr;20(2):149-66
references.pmid: 24265004
references.citation: Arch Gen Psychiatry. 2001 Dec;58(12):1127-34
references.pmid: 11735841
references.citation: JAMA Psychiatry. 2013 Nov;70(11):1161-70
references.pmid: 24005242
references.citation: J Adolesc Health. 1993 May;14(3):190-5
references.pmid: 8323929
references.citation: J Child Psychol Psychiatry. 2006 Mar-Apr;47(3-4):372-94
references.pmid: 16492264
references.citation: Br J Cancer. 2003 Sep 1;89(5):781-6
references.pmid: 12942105