October 02, 2015
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Cognitive-behavioral prevention program improves depression onset in at-risk adolescents

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Results from a four-site randomized clinical trial show a cognitive-behavioral prevention program improved onset of depression and positively affected developmental competence 6 years after treatment among adolescents at risk for depression.

“Single-site studies have demonstrated the efficacy of an adaptation of the Coping with Depression for Adolescents intervention in preventing the onset of depression relative to usual care in adolescents with subsyndromal depressive symptoms and in those with a parental history of depression,” David A. Brent, MD, of Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, and colleagues wrote.

To assess the efficacy of a cognitive-behavioral prevention (CBP) program in reducing incidence of depressive episodes, researchers randomly assigned 316 individuals to treatment plus usual care or usual care only. The CBP program was a modified version of the Coping with Depression for Adolescents intervention that emphasized cognitive restructuring and problem solving delivered in a structured, educational format that allowed for skill practice. Study participants were aged 13 to 17 years, had subsyndromal depressive symptoms or prior depressive episode currently in remission and had at least one parent with current or prior depressive episodes. The CBP program was delivered in eight weekly 90-minute group sessions followed by 6 monthly continuation sessions.

Over the 75-month follow-up, participants who received CBP had lower incidence of depression when adjusting for current parental depression at enrollment, site and all interactions (HR = 0.71; 95% CI, 0.53-0.96).

The overall significant effect of the CBP program was driven by a lower incidence of depressive episodes during the first 9 months after enrollment, according to researchers.

Participants whose index parent was not depressed at enrollment benefitted from CBP in terms of depression incidence (HR = 0.54; 95% CI, 0.36-0.81) and depression-free days (P = .01).  There was also a benefit on developmental competence (P = .04) which was mediated via the program’s effect on depression-free days, according to researchers.

“Overall, these findings demonstrate the effectiveness of CBP for preventing depression and promoting competence, but they also highlight three potential improvements to CBP,” Brent and colleagues wrote. “First, the main beneficial effect on the onset of new depression episodes occurred over the course of the intervention, suggesting that booster sessions might help extend these effects on new onsets even further in time. Second, CBP was not effective if the index parent was depressed at baseline, highlighting the possible importance of treating parental depression, either prior to or concomitant with their children’s participation in the CBP program. Third, CBP is focused exclusively on the adolescent… Nevertheless, the current findings showed that CBP forms the basis of a promising intervention and that the prevention of depression is possible and can have longer-term developmental consequences.” – by Amanda Oldt

Disclosure: Brent reports serving on the editorial board of UpToDate and receiving royalties from the Guilford Press and eRT. All authors report no relevant financial disclosures.