School Mental Health

, Volume 11, Issue 4, pp 728–740 | Cite as

Effectiveness Trial of Brief Indicated Cognitive-Behavioral Group Depression Prevention in French-Canadian Secondary Schools

  • Frédéric N. BrièreEmail author
  • Anne Reigner
  • Gabrielle Yale-Soulière
  • Lyse Turgeon
Original Paper


Most adolescent depression prevention programs have been tested in the USA and other Anglo-Saxon countries. Their effects in other contexts are less clear. We conducted a pilot trial aimed at testing the effectiveness of the Blues program, a brief indicated cognitive-behavioral (CB) group program to prevent depression originally developed in the USA, in French-Canadian secondary schools. CB group facilitators were endogenous school clinicians. A total of 74 students (mean age= 15.50; 66% female) with elevated depressive symptoms were randomized to CB group (n = 37) or educational brochure control (n = 37). Participants completed diagnostic interviews and surveys at pretest, posttest, and 6-month follow-up. Results showed that CB group had a large, statistically significant effect on MDD onset at 6-month follow-up. CB group also had a positive effect on depressive symptoms, intermediate outcomes (pleasant activities, negative thoughts), and one secondary outcome (improved interaction with parents) at posttest. These effects were not maintained at follow-up. This trial replicates results from a previous US effectiveness trial. The clinically meaningful effects of brief indicated CB group prevention, at least with regard to the prevention of MDD onset, hold in French-Canadian students when the intervention is implemented by school clinicians. Work is still needed to augment and maintain CB effects in real-world practice.


Major depression Prevention Adolescents Cognitive-behavioral Effectiveness French 



This study was supported by a research grant from the Fonds de Recherche Québécois sur la Société et la Culture (FRQSC 2016-NP-191870) and an evaluation contract the not-for-profit organization Boscoville. Thanks go to Paul Rohde, as well as the project research assistants and the participants who made this study possible. This RCT was registered on (FRQSC2016-NP-191870).

Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interests to disclose.

Research Involving Human Participants

All procedures were approved by the Institutional Review Board (IRB) of the University of Montreal. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study. All participants signed a written informed consent, as well as one of their parents.


  1. Albright, L., & Malloy, T. E. (2000). Experimental validity: Brunswik, Campbell, Cronbach, and enduring issues. Review of General Psychology,4, 337.Google Scholar
  2. Baldwin, S. A., Murray, D. M., & Shadish, W. R. (2005). Empirically supported treatments or type I errors? Problems with the analysis of data from group-administered treatments. Journal of Consulting and Clinical Psychology,73, 924–935.PubMedGoogle Scholar
  3. Bauer, D. J., Sterba, S. K., & Hallfors, D. D. (2008). Evaluating group-based interventions when control participants are ungrouped. Multivariate Behavioral Research,43(2), 210–236.PubMedPubMedCentralGoogle Scholar
  4. Beardslee, W. R., Brent, D. A., Weersing, V. R., Clarke, G. N., Porta, G., Hollon, S. D., et al. (2013). Prevention of depression in at-risk adolescents: Longer-term effects. JAMA Psychiatry,70(11), 1161–1170.PubMedPubMedCentralGoogle Scholar
  5. Brière, F. N. (2017). La recherche d’effectivité: Nature, méthodes et rôle dans la validation des interventions fondées sur les preuves. Revue de psychoéducation,46(1), 117–143.Google Scholar
  6. Brière, F. N., Archambault, K., & Janosz, M. (2013). Reciprocal prospective associations between depressive symptoms and perceived relationship with parents in early adolescence. The Canadian Journal of Psychiatry,58, 169–176.PubMedGoogle Scholar
  7. Brière, F. N., Pascal, S., Dupéré, V., Castellanos-Ryan, N., Allard, F., Yale-Soulière, G., et al. (2017). Depressive and anxious symptoms and the risk of secondary school non-completion. The British Journal of Psychiatry,211, 163–168.PubMedGoogle Scholar
  8. Brière, F. N., Rohde, P., Stice, E., & Morizot, J. (2016). Group-based symptom trajectories in indicated prevention of adolescent depression. Depression and Anxiety,33(5), 444–451.PubMedGoogle Scholar
  9. Brunwasser, S. M., & Garber, J. (2016). Programs for the prevention of youth depression: Evaluation of efficacy, effectiveness, and readiness for dissemination. Journal of Clinical Child and Adolescent Psychology,45(6), 763–783.PubMedGoogle Scholar
  10. Capuano, F., Poulin, F., Vitaro, F., Verlaan, P., & Vinet, I. (2010). Le programme de prévention Fluppy: historique, contenu et diffusion au Québec. Revue de psychoéducation,39(1), 1–26.Google Scholar
  11. Clarke, G. N., Hornbrook, M., Lynch, F., Polen, M., Gale, J., Beardslee, W., et al. (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry,58(12), 1127–1134.PubMedGoogle Scholar
  12. Compas, B. E., Forehand, R., Thigpen, J. C., Keller, G., Hardcastle, E. J., Cole, D. A., et al. (2011). Family group cognitive–behavioral preventive intervention for families of depressed parents: 18-and 24-month outcomes. Journal of Consulting and Clinical Psychology,79(4), 488.PubMedPubMedCentralGoogle Scholar
  13. Cummings, J. R., & Druss, B. G. (2011). Racial/ethnic differences in mental health service use among adolescents with major depression. Journal of the American Academy of Child and Adolescent Psychiatry,50(2), 160–170.PubMedGoogle Scholar
  14. Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology,74, 658–670.PubMedGoogle Scholar
  15. Drapeau, M., & Korner, A. (2017). La psychothérapie et les données probantes: quelques enjeux [Psychotherapy and research evidence: Some issues]. Le Journal des psychologues,3, 28–32.Google Scholar
  16. Dumais, A., Lesage, A. D., Lalovic, A., Séguin, M., Tousignant, M., Chawky, N., et al. (2005). Is violent method of suicide a behavioral marker of lifetime aggression? American Journal of Psychiatry,162, 1375–1378.PubMedGoogle Scholar
  17. Dupéré, V., Dion, E., Brière, F. N., Archambault, I., Leventhal, T., & Lesage, A. (2018). Revisiting the link between depression symptoms and high school dropout: Timing of exposure matters. Journal of Adolescent Health,62, 205–211.PubMedGoogle Scholar
  18. Enders, C. K. (2010). Applied missing data analysis. New York, NY: Guilford Press.Google Scholar
  19. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition. (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
  20. Garber, J., Brunwasser, S. M., Zerr, A. A., Schwartz, K. T., Sova, K., & Weersing, V. R. (2016). Treatment and prevention of depression and anxiety in youth: Test of cross-over effects. Depression and Anxiety,33(10), 939–959.PubMedPubMedCentralGoogle Scholar
  21. Gau, J. M., Stice, E., Rohde, P., & Seeley, J. R. (2012). Negative life events and substance use moderate cognitive behavioral adolescent depression prevention intervention. Cognitive Behaviour Therapy,41, 241–250.PubMedPubMedCentralGoogle Scholar
  22. Gauthier, J., Samson, P., Turbide, D., & Lawson, J. S. (1981). Adaptation française du social self-esteem inventory. Canadian Journal of Behavioral Sciences,13, 218–225.Google Scholar
  23. Gladstone, T. R., & Beardslee, W. R. (2009). The prevention of depression in children and adolescents: A review. Canadian Journal of Psychiatry,54(4), 212–221.PubMedGoogle Scholar
  24. Glasgow, R. E., Magid, D. J., Beck, A., Ritzwoller, D., & Estabrooks, P. A. (2005). Practical clinical trials for translating research to practice: Design and measurement recommendations. Medical Care,43, 551–557.PubMedGoogle Scholar
  25. Gottfredson, D. C., Cook, T. D., Gardner, F. E., Gorman-Smith, D., Howe, G. W., Sandler, I. N., et al. (2015). Standards of evidence for efficacy, effectiveness, and scale-up research in prevention science: Next generation. Prevention Science,16(7), 893–926.PubMedPubMedCentralGoogle Scholar
  26. Goulet, M., Archambault, I., Janosz, M., & Christenson, S. L. (2018). Evaluating the implementation of check and connect in various school settings: Is intervention fidelity necessarily associated with positive outcomes? Evaluation and Program Planning,68, 34–46.PubMedGoogle Scholar
  27. Green, L. W., & Glasgow, R. E. (2006). Evaluating the relevance, generalization, and applicability of research: Issues in external validation and translation methodology. Evaluation and the Health Professions,29, 126–153.PubMedGoogle Scholar
  28. Hetrick, S. E., Cox, G. R., Witt, K. G., Bir, J. J., & Merry, S. N. (2016). Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents. Cochrane Database Systematic Review,8, CD003380.Google Scholar
  29. Hollon, S. D., & Kendall, P. C. (1980). Cognitive self-statements in depression: Development of an automatic thoughts questionnaire. Cognitive Therapy and Research,4(4), 383–395.Google Scholar
  30. Jolly, J. B., & Wiesner, D. C. (1996). Psychometric properties of the Automatic Thoughts Questionnaire with inpatient adolescents. Cognitive Therapy and Research,20, 481–498.Google Scholar
  31. Koo, T. K., & Li, M. Y. (2016). A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine,15(2), 155–163.PubMedPubMedCentralGoogle Scholar
  32. Le Blanc, M., McDuff, P., & Fréchette, M. (1996). Manuel sur des mesures de l’adaptation sociale et personnelle pour les adolescents québécois. Montréal: Université de Montréal, Groupe de recherche sur l’inadaptation psychosociale chez l’enfant.Google Scholar
  33. Lewinsohn, P. M., Antonuccio, D. O., Beckenridge, J. S., & Teri, L. (1984). The coping with depression course. Eugene, OR: Castalia Publishing Company.Google Scholar
  34. Lewinsohn, P. M., Rohde, P., Seeley, J. R., Klein, D. N., & Gotlib, I. H. (2003). Psychosocial functioning of young adults who have experienced and recovered from major depressive disorder during adolescence. Journal of Abnormal Psychology,112(3), 353–363.PubMedGoogle Scholar
  35. Lewinsohn, P. M., Solomon, A., Seeley, J. R., & Zeiss, A. (2000). Clinical implications of “subthreshold” depressive symptoms. Journal of Abnormal Psychology,109(2), 345–351.PubMedGoogle Scholar
  36. Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage publications.Google Scholar
  37. MacPhillamy, D. J., & Lewinsohn, P. M. (1982). The pleasant events schedule: Studies on reliability, validity, and scale intercorrelation. Journal of Consulting and Clinical Psychology,50(3), 363–380.Google Scholar
  38. Merry, S. N. (2013). Preventing depression in adolescents: Time for a new approach? JAMA Pediatrics,167(11), 994–995.PubMedGoogle Scholar
  39. Michaud, J., Bégin, H., & McDuff, P. (2006). Construction et évaluation d’un questionnaire sur l’estime de soi sociale destiné aux jeunes adultes. Revue Europeenne de Psychologie Appliquee/European Review of Applied Psychology,56(2), 109–122.Google Scholar
  40. Morin, A. J. S., Moullec, G., Maiano, C., Layet, L., Just, J. L., & Ninot, G. (2011). Psychometric properties of the Center for Epidemiologic Studies Depression Scale (CES-D) in French clinical and nonclinical adults. Revue d’Epidemiologie et de Sante Publique,59, 327–340.PubMedGoogle Scholar
  41. Open Science Collaboration. (2015). Estimating the reproducibility of psychological science. Science,349, aac4716.Google Scholar
  42. Pennant, M. E., Loucas, C. E., Whittington, C., Creswell, C., Fonagy, P., Fuggle, P., et al. (2015). Computerised therapies for anxiety and depression in children and young people: A systematic review and meta-analysis. Behaviour Research and Therapy,67, 1–18.PubMedGoogle Scholar
  43. Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement,1(3), 385–401.Google Scholar
  44. Riddle, A. S., Blais, M. R., & Hess, U. (2002). A multi-group investigation of the CES-D’s measurement structure across adolescents, young adults and middle-aged adults. Montreal: Centre interuniversitaire de recherche en analyse des organisations (CIRANO).Google Scholar
  45. Rohde, P., Brière, F. N., & Stice, E. (2018). Major depression prevention effects for a cognitive-behavioral adolescent indicated prevention group intervention across four trials. Behaviour Research and Therapy,100, 1–6.PubMedGoogle Scholar
  46. Rohde, P., Clarke, G. N., Mace, D. E., Jorgensen, J. S., & Seeley, J. R. (2004). An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry,43, 660–668.PubMedGoogle Scholar
  47. Rohde, P., Lewinsohn, P. M., Klein, D. N., Seeley, J. R., & Gau, J. M. (2013). Key characteristics of major depressive disorder occurring in childhood, adolescence, emerging adulthood, and adulthood. Clinical Psychological Science,1(1), 41–53.Google Scholar
  48. Rohde, P., Stice, E., Shaw, H., & Briere, F. N. (2014a). Indicated cognitive behavioral group depression prevention compared to bibliotherapy and brochure control: Acute effects of an effectiveness trial with adolescents. Journal of Consulting and Clinical Psychology,82(1), 65–74.PubMedGoogle Scholar
  49. Rohde, P., Stice, E., Shaw, H., & Gau, J. M. (2014b). Cognitive-behavioral group depression prevention compared to bibliotherapy and brochure control: Nonsignificant effects in pilot effectiveness trial with college students. Behaviour Research and Therapy,55, 48–53.PubMedPubMedCentralGoogle Scholar
  50. Rohde, P., Stice, E., Shaw, H., & Gau, J. M. (2015). Effectiveness trial of an indicated cognitive-behavioral group adolescent depression prevention program versus bibliotherapy and brochure control at 1-and 2-year follow-up. Journal of Consulting and Clinical Psychology,83(4), 736.PubMedPubMedCentralGoogle Scholar
  51. Rohde, P., Stice, E., Shaw, H., & Gau, J. M. (2016). Pilot trial of a dissonance-based cognitive-behavioral group depression prevention with college students. Behaviour Research and Therapy,82, 21–27.PubMedPubMedCentralGoogle Scholar
  52. Shirk, S. R., Crisostomo, P. S., Jungbluth, N., & Gudmundsen, G. R. (2013). Cognitive mechanisms of change in CBT for adolescent depression: Associations among client involvement, cognitive distortions, and treatment outcome. International Journal of Cognitive Therapy,6, 311–324.Google Scholar
  53. Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy,36(5), 545–566.PubMedGoogle Scholar
  54. Stallard, P., Sayal, K., Phillips, R., Taylor, J. A., Spears, M., Anderson, R., et al. (2012). Classroom based cognitive behavioural therapy in reducing symptoms of depression in high risk adolescents: Pragmatic cluster randomised controlled trial. British Medical Journal,345, e6058.PubMedGoogle Scholar
  55. Stice, E., Rohde, P., Gau, J. M., & Wade, E. (2010a). Efficacy trial of a brief cognitive–behavioral depression prevention program for high-risk adolescents: Effects at 1-and 2-year follow-up. Journal of Consulting and Clinical Psychology,78(6), 856.PubMedPubMedCentralGoogle Scholar
  56. Stice, E., Rohde, P., Seeley, J. R., & Gau, J. M. (2008). Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: A randomized efficacy trial. Journal of Consulting and Clinical Psychology,76(4), 595–606.PubMedPubMedCentralGoogle Scholar
  57. Stice, E., Rohde, P., Seeley, J. R., & Gau, J. M. (2010b). Testing mediators of intervention effects in randomized controlled trials: An evaluation of three depression prevention programs. Journal of Consulting and Clinical Psychology,78(2), 273.PubMedPubMedCentralGoogle Scholar
  58. Stice, E., Shaw, H., Bohon, C., Marti, C. N., & Rohde, P. (2009). A meta-analytic review of depression prevention programs for children and adolescents: Factors that predict magnitude of intervention effects. Journal of Consulting and Clinical Psychology,77(3), 486–593.PubMedPubMedCentralGoogle Scholar
  59. Valentine, J. C., Biglan, A., Boruch, R. F., Castro, F. G., Collins, L. M., Flay, B. R., et al. (2011). Replication in prevention science. Prevention Science,12, 103.PubMedGoogle Scholar
  60. Zanarini, M. C., Skodol, A. E., Bender, D., Dolan, R., Sanislow, C., Schaefer, E., et al. (2000). The collaborative longitudinal personality disorders study: Reliability of axis I and II diagnoses. Journal of Personality Disorders,14, 291–299.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Université de MontréalMontrealCanada

Personalised recommendations