Randomized Pilot Trial of an Indicated Depression Prevention Program for Japanese College Students

Objectives: The mental health of college students is a growing public health concern in the U.S. as well as in Japan. Depression may be the most prevalent psychiatric disorder experienced by Japanese college students (Kitamura et al., 1999). It has been linked to academic difficulties, social problems in college, and suicidal risk (Heiligenstein et al., 1996; Uchida et al., 2004). Buchanan (2012) reviewed depression preventive trials for college students in the U.S. and indicated the efficacy of psychological prevention. This study was the first step in developing and testing a psychological prevention program for Japanese college students at risk of future depression. Methods: High-risk Japanese college students were selected with a two-stage case-finding procedure based on Clarke et al. (1995). The Center for Epidemiologic Studies-Depression Scale was administered to 1,007 participants (mean age = 19.3 years, SD = 1.4), and 33 participants with elevated depressive symptoms were interviewed in terms of DSM-IV-TR with the Japanese version of the Mini-International Neuropsychiatric Interview. Participants with current mood disorders (major depressive disorder, dysthymic disorder, and bipolar disorder) or severe suicidal risk were excluded from the trial. The remaining 27 participants were randomized to either a group depression prevention program based on cognitive behavior therapy (CBT) or a usual care control condition. The CBT program consisted of five weekly 90-minute sessions derived from the Adolescent Coping with Depression Course (Clarke et al., 1990). Participants completed assessments for DSM-IV-TR diagnostic status, depressive symptoms, and suicidal ideations at baseline and after the intervention. Results: CBT participants showed significantly greater reductions in depressive symptoms and suicidal ideations than usual care participants at posttest. There were no incidences of depressive disorders at posttest in both groups. Conclusion: The prevention program based on CBT had a significant effect on the reduction of risks for depression and suicide (i.e. depressive symptoms and suicidal ideations) in Japanese college students at least at posttest. We are currently under study for reassessment of a follow-up data to evaluate long-term outcomes for the prevention program.