The Depression Prevention Initiative: Preliminary Outcomes from a School-Based Randomized Controlled Trial Comparing IPT-AST and Group Counseling

Background: In recognition of the considerable risk and impairment associated with elevated depressive symptoms in adolescence, there has been a call for an increase in indicated preventive intervention research. Based on the need for innovative depression prevention programs, we developed a school-based indicated preventive intervention, Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST; Young & Mufson, 2003).

Methods: This paper describes an ongoing randomized controlled trial, comparing IPT-AST (N = 95) and usual group counseling (GC; N = 91), which is being conducted in 10 middle and high schools. Screening and enrollment data will be described. Changes in depression (as measured by the Center for Epidemiologic Studies Depression Scale [CES-D] and Children’s Depression Rating Scale Revised [CDRS-R]) and functioning (as measured by the Children’s Global Assessment Scale [CGAS]) from pre to post-intervention will be examined using hierarchical linear modeling to accommodate the clustered data (repeated observations within person nested within group assigned to an intervention arm).

Results: We have screened 2,923 youth in the 7^th to 10^th grades. Twenty percent of these youth had a CES-D score of 16 or higher, indicating elevated depressive symptoms. One hundred eighty-six youth with elevated symptoms were randomly assigned to IPT-AST or GC. Regarding change from pre to post-intervention, there was a significant difference in rates of change, favoring IPT-AST, on the CES-D and CGAS, controlling for school, gender, and income. More specifically, adolescents in IPT-AST showed significantly greater rates of improvement on the CES-D (t(357) = 2.65, p = 0.01) and CGAS (t(173) = -2.11, p = 0.04) from baseline to post-intervention. There were no significant differences in rates of change on the CDRS-R, a clinician administered measure of depression, likely due to floor effects.

Conclusions: Our findings indicate that 20% of youth in 7^th to 10^th grades report elevated symptoms of depression. This supports the need for continued preventive efforts to address depression in adolescence. Preliminary findings suggest that IPT-AST leads to more significant improvements in depression and functioning than groups that were run by school counselors. This finding is noteworthy given that GC is a stringent comparison group since these groups were matched to IPT-AST groups on frequency and duration of sessions. We will continue to analyze the data to determine whether these differences persist over time and to examine moderators and mediators of intervention outcome.