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Method: Participants had (a) current elevated but sub-diagnostic depressive symptoms or a past, but fully remitted depressive episode, and(b) a parent/guardian with a recent (past three years) depressive episode, three or more depressive episodes, or a cumulative duration of three or more years of depression during the child’s life. Participants were randomly assigned to usual care (UC) or CBP, which consisted of 8 acute sessions and 6 continuation sessions. Parents and youth completed assessments at baseline, post-acute-phase, post-continuation-phase, and at follow-ups 1 and 2 years after the continuation sessions ended. Global functioning was measured with the clinician-rated Children’s Global Assessment Scale (CGAS); youths completed the Social Adjustment Scale—Self-Report (SAS-SR). Depressive symptoms were measured with the Center for Epidemiological Studies—Depression Scale (CES-D). Latent growth curve models were conducted to evaluate intervention effects on the rates of change (i.e., slopes) of the functioning measures. Two-stage piecewise parallel-process models tested the mediation hypotheses, with confidence intervals for the indirect effects calculated using 50000 Monte Carlo simulations.
Results: Youth in CBP showed significantly greater improvements in clinician-rated global functioning (b = 0.18, SE = 0.07, p = .02) and self-reported family functioning (b = -1.05, SE = 0.50, p = .035) relative to UC, but not on self-reported primary role functioning or peer relationships. There was moderated-mediation such that group differences in both global and family functioning at follow-up were mediated by an intervention effect on the rate of change in depressive symptoms during the intervention phase among adolescents who had a depressed parent at baseline: CGAS: b = 0.09, 95% CI [0.01, 0.21] and SAS-SR-family functioning: b = -0.29, 95% CI [-0.65, -0.04]. There was also a simple mediation effect whereby improvements in global functioning during the intervention phase mediated the relation between condition and depressive symptoms at follow-up: b = -0.50, 95% CI [-0.98, -0.15].
Conclusion: These results indicate that targeted prevention can lead to enduring benefits not only in clinical outcomes, but also in psychosocial functioning. Future research should evaluate whether there is evidence of benefits on objective functioning measures and whether functional improvements precede or follow changes in symptoms.