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Original Investigation |

Prevention of Depression in At-Risk Adolescents:  Longer-term Effects

William R. Beardslee, MD1,2; David A. Brent, MD3; V. Robin Weersing, PhD4; Gregory N. Clarke, PhD5; Giovanna Porta, MS6; Steven D. Hollon, PhD7; Tracy R. G. Gladstone, PhD1,2,8; Robert Gallop, PhD9; Frances L. Lynch, PhD5; Satish Iyengar, PhD10; Lynn DeBar, PhD5; Judy Garber, PhD11
[+] Author Affiliations
1Department of Psychiatry, Boston Children’s Hospital, Boston, Massachusetts
2Judge Baker Children’s Center, Boston, Massachusetts
3Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
4Joint Doctoral Program in Clinical Psychiatry, San Diego State University and University of California, San Diego, San Diego, California
5Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
6Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
7Department of Psychology, Vanderbilt University, Nashville, Tennessee
8Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts
9Department of Mathematics, West Chester University, West Chester, Pennsylvania
10Statistics Department, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
11Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
JAMA Psychiatry. 2013;70(11):1161-1170. doi:10.1001/jamapsychiatry.2013.295.
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Importance  Adolescent offspring of depressed parents are at high risk for experiencing depressive disorders themselves.

Objective  To determine whether the positive effects of a group cognitive-behavioral prevention (CBP) program extended to longer-term (multiyear) follow-up.

Design  A 4-site randomized clinical trial with 33 months of follow-up was conducted. Recruitment of participants was from August 2003 through February 2006.

Setting  The study settings included a health maintenance organization, university medical centers, and a community mental health center.

Participants  Three hundred sixteen adolescent (aged 13-17 years) offspring of parents with current and/or prior depressive disorders; adolescents had histories of depression, current elevated depressive symptoms, or both but did not currently meet criteria for a depressive disorder.

Interventions  The CBP program consisted of 8 weekly 90-minute group sessions followed by 6 monthly continuation sessions. Adolescents were randomly assigned to either the CBP program or usual care (UC).

Main Outcomes and Measures  The primary outcome was a probable or definite episode of depression (Depression Symptom Rating score ≥4) for at least 2 weeks through the month 33 follow-up evaluation.

Results  Over the 33-month follow-up period, youths in the CBP condition had significantly fewer onsets of depressive episodes compared with those in UC. Parental depression at baseline significantly moderated the intervention effect. When parents were not depressed at intake, CBP was superior to UC (number needed to treat, 6), whereas when parents were actively depressed at baseline, average onset rates between CBP and UC were not significantly different. A 3-way interaction among intervention, baseline parental depression, and site indicated that the impact of parental depression on intervention effectiveness varied across sites.

Conclusions and Relevance  The CBP program showed significant sustained effects compared with UC in preventing the onset of depressive episodes in at-risk youth over a nearly 3-year period. Important next steps will be to strengthen the CBP intervention to further enhance its preventive effects, improve intervention outcomes when parents are currently depressed, and conduct larger implementation trials to test the broader public health impact of the CBP program for preventing depression in youth.

Trial Registration  clinicaltrials.gov Identifier: NCT00073671

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Figure 1.
Consolidated Standards of Reporting Trials Study Flow of Participants: Screening to Analysis
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Figure 2.
Risk of Incident Depression by Intervention Condition

Incident depression was defined as a probable or definite depressive episode (ie, Depression Symptom Rating score ≥4). CBP indicates cognitive-behavioral prevention and UC, usual care.

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Figure 3.
Comparison of Cognitive-Behavioral Prevention (CBP) vs Usual Care (UC) for Adolescents Whose Parents Were Not Depressed at Baseline (A) and for Those Whose Parents Were Depressed at Baseline (B)
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