Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects

V Robin Weersing; Wael Shamseddeen; Judy Garber; Steven D Hollon; Gregory N Clarke; William R Beardslee; Tracy R Gladstone; Frances L Lynch; Giovanna Porta; Satish Iyengar; David A Brent

doi:10.1016/j.jaac.2015.12.015

Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects

J Am Acad Child Adolesc Psychiatry. 2016 Mar;55(3):219-26. doi: 10.1016/j.jaac.2015.12.015. Epub 2016 Jan 18.

Authors

Affiliations

¹ Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego. Electronic address: [email protected].
² University of Michigan, Ann Arbor.
³ Vanderbilt University, Nashville, TN.
⁴ Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
⁵ Boston Children's Hospital, Boston.
⁶ Wellesley Centers for Women, Wellesley College, Wellesley, MA.
⁷ Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh.
⁸ University of Pittsburgh.
⁹ Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh; University of Pittsburgh School of Medicine.

Abstract

Objective: To assess predictors and moderators of a cognitive-behavioral prevention (CBP) program for adolescent offspring of parents with depression.

Method: This 4-site randomized trial evaluated CBP compared to usual community care (UC) in 310 adolescents with familial (parental depression) and individual (youth history of depression or current subsyndromal symptoms) risk for depression. As previously reported by Garber and colleagues, a significant prevention effect favored CBP through 9 months; however, outcomes of CBP and UC did not significantly differ when parents were depressed at baseline. The current study expanded on these analyses and examined a range of demographic, clinical, and contextual characteristics of families as predictors and moderators and used recursive partitioning to construct a classification tree to organize clinical response subgroups.

Results: Depression onset was predicted by lower functioning (hazard ratio [HR] = 0.95, 95% CI = 0.92-0.98) and higher hopelessness (HR = 1.06, 95% CI = 1.01-1.11) in adolescents. The superior effect of CBP was diminished when parents were currently depressed at baseline (HR = 6.38, 95% CI = 2.38-17.1) or had a history of hypomania (HR = 67.5, 95% CI = 10.9-417.1), or when adolescents reported higher depressive symptoms (HR = 1.04, 95% CI = 1.00-1.08), higher anxiety (HR = 1.05, 95% CI = 1.01-1.08), higher hopelessness (HR = 1.10, 95% CI = 1.01-1.20), or lower functioning (HR = 0.94, 95% CI = 0.89-1.00) at baseline. Onset rates varied significantly by clinical response cluster (0%-57%).

Conclusion: Depression in adolescents can be prevented, but programs may produce superior effects when timed at moments of relative wellness in high-risk families. Future programs may be enhanced by targeting modifiable negative clinical indicators of response.

Clinical trial registration information: Prevention of Depression in At-Risk Adolescents; http://clinicaltrials.gov/; NCT00073671.

Keywords: adolescents; cognitive-behavioral therapy; depression; prevention.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Causality
Child of Impaired Parents / psychology
Cognitive Behavioral Therapy / methods*
Depression / prevention & control*
Depression / psychology
Depressive Disorder / diagnosis
Depressive Disorder / prevention & control*
Family / psychology
Female
Humans
Male
Parents / psychology
Risk Factors

Associated data

ClinicalTrials.gov/NCT00073671

Abstract

Publication types

MeSH terms

Associated data

Grants and funding