title: Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects.
abstract: OBJECTIVE
  To assess predictors and moderators of a cognitive-behavioral prevention (CBP) program for adolescent offspring of parents with depression.
  
  
  METHODS
  This 4-site randomized trial evaluated CBP compared to usual community care (UC) in 310 adolescents with familial (parental depression) and individual (youth history of depression or current subsyndromal symptoms) risk for depression. As previously reported by Garber and colleagues, a significant prevention effect favored CBP through 9 months; however, outcomes of CBP and UC did not significantly differ when parents were depressed at baseline. The current study expanded on these analyses and examined a range of demographic, clinical, and contextual characteristics of families as predictors and moderators and used recursive partitioning to construct a classification tree to organize clinical response subgroups.
  
  
  RESULTS
  Depression onset was predicted by lower functioning (hazard ratio [HR] = 0.95, 95% CI = 0.92-0.98) and higher hopelessness (HR = 1.06, 95% CI = 1.01-1.11) in adolescents. The superior effect of CBP was diminished when parents were currently depressed at baseline (HR = 6.38, 95% CI = 2.38-17.1) or had a history of hypomania (HR = 67.5, 95% CI = 10.9-417.1), or when adolescents reported higher depressive symptoms (HR = 1.04, 95% CI = 1.00-1.08), higher anxiety (HR = 1.05, 95% CI = 1.01-1.08), higher hopelessness (HR = 1.10, 95% CI = 1.01-1.20), or lower functioning (HR = 0.94, 95% CI = 0.89-1.00) at baseline. Onset rates varied significantly by clinical response cluster (0%-57%).
  
  
  CONCLUSIONS
  Depression in adolescents can be prevented, but programs may produce superior effects when timed at moments of relative wellness in high-risk families. Future programs may be enhanced by targeting modifiable negative clinical indicators of response.
  
  
  BACKGROUND
  Prevention of Depression in At-Risk Adolescents; http://clinicaltrials.gov/; NCT00073671.
authors.affiliation: Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego. Electronic address: robin.weersing@mail.sdsu.edu.
authors.forename: V Robin
authors.initials: VR
authors.lastname: Weersing
authors.affiliation: University of Michigan, Ann Arbor.
authors.forename: Wael
authors.initials: W
authors.lastname: Shamseddeen
authors.affiliation: Vanderbilt University, Nashville, TN.
authors.forename: Judy
authors.initials: J
authors.lastname: Garber
authors.affiliation: Vanderbilt University, Nashville, TN.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Hollon
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Clarke
authors.affiliation: Boston Children's Hospital, Boston.
authors.forename: William R
authors.initials: WR
authors.lastname: Beardslee
authors.affiliation: Wellesley Centers for Women, Wellesley College, Wellesley, MA.
authors.forename: Tracy R
authors.initials: TR
authors.lastname: Gladstone
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
authors.forename: Frances L
authors.initials: FL
authors.lastname: Lynch
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Porta
authors.affiliation: University of Pittsburgh.
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh; University of Pittsburgh School of Medicine.
authors.forename: David A
authors.initials: DA
authors.lastname: Brent
mesh_terms: D000293:Adolescent; D015984:Causality; D016241:Child of Impaired Parents / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000517:prevention & control* / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000517:prevention & control*; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D012307:Risk Factors
keywords: adolescents; cognitive-behavioral therapy; depression; prevention