Prevention of Depression in At-Risk Adolescents: Intervention Non-Responders

Introduction:Depression in adolescents is a common, impairing, and often chronic disorder. Although there is increasing evidence of the efficacy of programs for preventing depression in youth (e.g., Merry et al., 2011), for some adolescents preventive interventions do not appear to work. The purpose of this presentation is to better characterize those youth who received a cognitive behavioral prevention (CBP) program, but who still had an episode of depression during the first 9 months.  

Methods: This four-site randomized controlled trial evaluated the efficacy of a CBP program in contrast to a usual care (UC) comparison condition for preventing depressive disorders. Participants were 316 adolescents (ages 13-17 years old) who were at high risk for mood disorders based on familial (i.e., parental depression) and individual (i.e., history of depression and/or subsyndromal depressive symptoms) vulnerability factors. The CBP program involved eight weekly 90-minute sessions and six monthly continuation sessions

Results:Results revealed a significant prevention effect favoring CBP as compared to UC (incident depression: 21.4% vs. 32.7%, chi-square=4.9, p=0.03). Nevertheless, the rates of onset were still relatively high even within the CBP condition. Therefore, we examined possible moderators of the effects of the CBP program on episode onsets. Of the 159 youth assigned to CBP, 33 had a depression onset between baseline and the 9-month evaluation. These adolescents were characterized as follows: 11 had Global Assessment of Functioning (GAF) scores < 65.5. Of the remaining 22 who had GAF scores > 65.5, 6 were anxious and had a parent who was not depressed at baseline and 16 had a currently depressed parent, 12 of whom were low on hopelessness and the remaining 4 were high on hopelessness. To further characterize these nonresponders, we will identify adolescents in the responder group who are demographically (age, sex, SES) matched to the nonresponders, and then compare them with regard to a range of other individual (e.g., negative cognitions), family (e.g., conflict), and process (e.g., number of sessions attended) variables using an approach similar to that implemented by Coffman, Martell, Dimidjian, Gallop, & Hollon, 2009). 

Conclusions: These results highlight individual and contextual factors that characterize youth for whom the CBP program did not prevent the onset of a depressive episode. The implications of these findings for modifying the existing CBP intervention to further reduce depression onsets will be discussed.