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Prevention of Depression in At-Risk Adolescents: Moderators of Long-term Response

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Abstract

In a randomized controlled trial, we found that a cognitive behavioral program (CBP) was significantly more effective than usual care (UC) in preventing the onset of depressive episodes, although not everyone benefitted from the CBP intervention. The present paper explored this heterogeneity of response. Participants were 316 adolescents (M age = 14.8, SD = 1.4) at risk for depression due to having had a prior depressive episode or having current subsyndromal depressive symptoms and having a parent with a history of depression. Using a recursive partitioning approach to baseline characteristics, we (Weersing et al. 2016) previously had identified distinct risk clusters within conditions that predicted depressive episodes through the end of the continuation phase (month 9). The present study used the same risk clusters that had been derived in the CBP group through month 9 to reclassify the UC group and then to examine group differences in depression through month 33. We found that in this overall very high-risk sample, the CBP program was superior to UC among youth in the low-risk cluster (n = 33), characterized by higher functioning, lower anxiety, and parents not depressed at baseline, but not in the middle (n = 95) and high-risk (n = 25) clusters. Across conditions, significantly more depression-free days were found for youth in the low-risk cluster (M = 951.9, SD = 138.8) as compared to youth in the high-risk cluster (M = 800.5, SD = 226.7). Identification of moderators, based on purely prognostic indices, allows for more efficient use of resources and suggests possible prevention targets so as to increase the power of the intervention.

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Acknowledgments

We would like to acknowledge the National Institute of Mental Health (R01MH064735; R01MH64541; R01MH64503; R01MH64717) for funding this research, the editors of this special section, George Howe, Hilda Pantin, and Tatiana Perrino, and the anonymous reviewers for providing helpful comments on earlier drafts of this manuscript. Finally, we thank the adolescents and parents for their participation in this research.

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Authors and Affiliations

  1. Department of Psychology and Human Development, Vanderbilt University, 552 Peabody, 230 Appleton Pl, Nashville, TN, USA

    J. Garber

  2. Joint Doctoral Program in Clinical Psychiatry, San Diego State University, San Diego, CA, USA

    V. R. Weersing

  3. University of California, San Diego, CA, USA

    V. R. Weersing

  4. Department of Psychology, Vanderbilt University, Nashville, TN, USA

    S. D. Hollon

  5. Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    G. Porta & D. A. Brent

  6. Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA

    G. N. Clarke, J. F. Dickerson & F. L. Lynch

  7. Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA

    W. R. Beardslee

  8. Wellesley Centers for Women, Wellesley College, Wellesley, MA, USA

    T. G. Gladstone

  9. University of Michigan, Ann Arbor, MI, USA

    W. Shamseddeen

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  1. J. Garber
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  2. V. R. Weersing
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  11. D. A. Brent
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Correspondence to J. Garber.

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Funding

The project was supported in part by the National Institute of Mental Health grants (R01MH064735; R01MH64541; R01MH64503; R01MH64717) and by the National Center for Research Resources (UL1 RR024975-01), now at the National Center for Advancing Translational Sciences (Grant 2 UL1 TR000445-06). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in this study 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. This study did not contain any animals.

Informed Consent

Voluntary assent was obtained from all participating youth. Institutional review boards at each site approved the study. Parents and adolescents provided written informed consent and assent, respectively.

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Garber, J., Weersing, V.R., Hollon, S.D. et al. Prevention of Depression in At-Risk Adolescents: Moderators of Long-term Response. Prev Sci 19 (Suppl 1), 6–15 (2018). https://doi.org/10.1007/s11121-015-0626-z

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