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Brent & Colleagues

Dr. David Brent

Prevention of Depression in At-Risk Adolescents: Longer-term Effects
Beardslee WR, Brent DA, Weersing VR, Clarke GN, Porta G, Hollon SD, Gladstone TRG, Gallop R, Lynch FL, Iyengar S, DeBar L, Garber J

Depression is a major public health problem with first onset often occurring during adolescence and affecting close to a quarter of all adults during their lifetime. Children of depressed parents are at high risk for experiencing depressive disorders themselves. Prevention of the onset of depression may be more cost effective than waiting until a depressive already has occurred to intervene.

Researchers in Pittsburgh, Nashville, Portland (Oregon) and Boston investigated whether there were any enduring effects of a group cognitive-behavioral program (CBP) compared to usual care in randomized clinical trial of 316 adolescent offspring of currently or previously depressed parents. These youth had histories of depression, current elevated depressive symptoms, or both - but who did not currently meet criteria for a depressive disorder. Over the 33-month follow-up period, youths in CBP had significantly fewer onsets of depressive episodes compared with those in usual care. However, in those youths whose parents were depressed at intake into the study, CBP was no better than usual care in preventing depressive episodes.

"We know that adolescents whose parents have a history of depression are at risk themselves for a depressive episode. This study shows that when at risk youth participate in a brief group cognitive behavior intervention program that their risk for having a depressive episode is substantially lower than similar youth who got usual care, and that these effects persisted almost 3 years after the delivery of the intervention," Dr. Brent said. "However, if the youth had a mother who was depressed at the time of the intervention, there was no preventive effect. From this we learn that depression can be prevented, but that interventions that also help a depressed parent along with the at-risk child may be even more effective. Preventing the onset of depression during the adolescent and young adult years may be a cost-effective preventive intervention worth considering. Next steps to be considered are how to integrate treatment of parental depression into this intervention, and to what extent the intervention can be delivered on-line, which would make it even more cost-effective and readily available."

This study shows that brief CBP can lower the rate of future depressive episodes in high-risk youth for up to nearly three years. However, CBP was no better than usual care for those youths whose mothers were depressed at the time of the intervention. While CBP can prevent depression, interventions that also help a depressed parent along with the at-risk child may be even more effective. Next steps to be considered are how to integrate treatment of parental depression into this intervention, and to what extent this intervention could be delivered on-line, which would make it even more cost-effective and readily available.

Contributors:

William R. Beardslee, MD (Department of Psychiatry, Harvard University)

David A. Brent, MDa, Satish Iyengar, PhDb and Giovanna Portaa (aDepartment of Psychiatry, bDepartment of Statistics, University of Pittsburgh)

V. Robin Weersing, PhD (University of California/San Diego)

Gregory N. Clarke, PhD, Lynn DeBar, PhD and Frances L. Lynch, PhD (Center for Health Research, Kaiser Permanente Northwest)

Steven D. Hollon, PhD and Judy Garber, PhD (Department of Psychology, Vanderbilt University)

Tracy R.G. Gladstone, PhD (Wellesley Center for Women, Wellesley College)

Robert Gallop, PhD (Department of Mathematics, West Chester University)

The results of this investigation were published in the November 2013 issue of JAMA Psychiatry. Click here for a link to the abstract.