Prevention of Depression and Aggression Among Adolescents in Low-Income, Urban Neighborhoods: Evaluation of the Adapted Coping with Stress Course

Introduction: Stressors common in low-income, urban communities increase the risk for mental health problems among youth (Grant et al., 2004; Tiet et al., 2001). The presence of shared risk factors, such as neighborhood stress, is also likely to contribute to high rates of comorbidity (Angold et al., 1999; Wolff & Ollendick, 2006), particularly in low-income, urban communities (Tolan & Henry, 1996). Given the broad mental health implications of growing up in poor communities, there is a great need to intervene with these youth. This study was designed to evaluate the effectiveness of an adapted version of the evidence-based Coping With Stress course (CWS; Clarke & Lewinsohn, 1995), which was modified to prevent both depressive symptoms and aggressive behavior among adolescents by addressing the socio-cultural risks associated with urban poverty. Methods: Eighty-six youth (M (SD) age = 15.41 (1.11); 64% female; 95% Non-Hispanic Black/African American) and their primary caregivers from a high-risk urban community in the northeast participated in a randomized controlled trial evaluating the RISE (Resilient In spite of Stressful Events) Program, which was adapted with permission from the CWS course. Outcome measures included: parent-ratings of youth internalizing and externalizing behavior problems on the CBCL (Achenbach, 1991a), self-reported depressive symptoms on the CESD (Faulstich et al., 1986), and self-reported aggressive behavior on the Aggression Scale (Orpinas & Frankowski, 2001). Results: Data for 4 of 6 cohorts in the study are available for analysis at this time. (Data collection will be complete in December 2012, at which time the study will be sufficiently powered to test the significance of program effects.) Since there is currently insufficient power to detect significance, a series of 2 x 2 repeated measures ANOVAs (Group by Time) were used to explore the size of the intervention effect. The magnitude of the effect for the RISE program was small for parent-rated internalizing problems (Ƞ²_p = .02) and self-reported depressive symptoms (Ƞ²_p = .05) and medium for parent-rated externalizing problems (Ƞ²_p = .08). There was no meaningful effect for self-reported aggression. Conclusions: A preliminary evaluation of the effectiveness of RISE indicates that adolescents who participate in RISE may be protected from increases in depression and aggression, as intended. These results suggest that a prevention program targeting adolescents living in poverty may impact multiple outcomes and also address a significant gap in prevention research (National Research Council & IOM, 2009, p. 219).