Preventing Depression Among Early Adolescents in the Primary Care Setting: A Randomized Controlled Study of the Penn Resiliency Program

This study evaluated the Penn Resiliency Program's effectiveness in preventing depression when delivered by therapists in a primary care setting. Two-hundred and seventy-one 11- and 12-year-olds, with elevated depressive symptoms, were randomized to PRP or usual care. Over the 2-year follow-up, PRP improved explanatory style for positive events. PRP's effects on depressive symptoms and explanatory style for negative events were moderated by sex, with girls benefiting more than boys. Stronger effects were seen in high-fidelity groups than low-fidelity groups. PRP did not significantly prevent depressive disorders but significantly prevented depression, anxiety, and adjustment disorders (when combined) among high-symptom participants. Findings are discussed in relation to previous PRP studies and research on the dissemination of psychological interventions.

[1]  M. Thompson,et al.  Applying the criteria for empirically supported treatments to studies of psychosocial interventions for child and adolescent depression. , 1998, Journal of clinical child psychology.

[2]  Alan E. Kazdin,et al.  Concluding thoughts: Present and future of evidence-based psychotherapies for children and adolescents , 2003 .

[3]  I. Gotlib,et al.  Symptoms versus a diagnosis of depression: differences in psychosocial functioning. , 1995, Journal of consulting and clinical psychology.

[4]  E J Costello,et al.  Puberty and depression: the roles of age, pubertal status and pubertal timing , 1998, Psychological Medicine.

[5]  Alan E. Kazdin,et al.  Evidence-based psychotherapies for children and adolescents , 2003 .

[6]  M. Seligman,et al.  From Helplessness to Optimism , 2005 .

[7]  Harrington Rc.  Adult outcomes of childhood and adolescent depression. , 1991 .

[8]  B. Kable.  Mental health. , 2005, Australian family physician.

[9]  M. Seligman,et al.  Preventing depressive symptoms in Chinese children. , 2002 .

[10]  B. Compas,et al.  Prevention of Depression. , 1997 .

[11]  A. Beck,et al.  Screening for major depression disorders in adolescent medical outpatients with the Beck Depression Inventory for Primary Care. , 1999, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[12]  S. Spence,et al.  Preventing adolescent depression: an evaluation of the problem solving for life program. , 2003, Journal of consulting and clinical psychology.

[13]  S. Schoenwald,et al.  Effectiveness, transportability, and dissemination of interventions: what matters when? , 2001, Psychiatric services.

[14]  A. Petersen,et al.  Adolescent depression: Why more girls? , 1991, Journal of youth and adolescence.

[15]  B. Chorpita.  The frontier of evidence-based practice. , 2003 .

[16]  IDENTIFYING PSYCHOSOCIAL DYSFUNCTION IN SCHOOL-AGE CHILDREN: THE PEDIATRIC SYMPTOM CHECKLIST AS A SELF-REPORT MEASURE. , 2000, Psychology in the schools.

[17]  W. Hawkins,et al.  School-Based Primary Prevention of Depressive Symptomatology in Adolescents , 1993 .

[18]  M. Dadds,et al.  Training school personnel to implement a universal school-based prevention of depression program under real-world conditions , 2004 .

[19]  A. Pickles,et al.  Adult outcomes of childhood and adolescent depression. I. Psychiatric status. , 1990, Archives of general psychiatry.

[20]  J. Seeley,et al.  A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. , 2001, Archives of general psychiatry.

[21]  N. Ryan,et al.  Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: a review and meta-analysis. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[22]  R. Lynd-Stevenson,et al.  The Prevention of Depressive Symptoms in Children: The Immediate and Long-term Outcomes of a School-based Program , 2001 .

[23]  G. Elder,et al.  Pubertal transition, stressful life events, and the emergence of gender differences in adolescent depressive symptoms. , 2001, Developmental psychology.

[24]  M. Seligman,et al.  The Prevention of Depressive Symptoms in Low-Income Minority Middle School Students , 2002 .

[25]  M. Seligman,et al.  Prevention of depressive symptoms in school children. , 1994, Behaviour research and therapy.

[26]  K. Hurrelmann,et al.  Health Risks and Developmental Transitions during Adolescence , 1999 .

[27]  W. Hawkins,et al.  Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomized trial of a group cognitive intervention. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[28]  S. Merry,et al.  Psychological and/or educational interventions for the prevention of depression in children and adolescents. , 2004, The Cochrane database of systematic reviews.

[29]  J. Gillham,et al.  Preventing depression: A review of cognitive-behavioral and family interventions , 2000 .

[30]  K. Reivich.  The prevention of depressive symptoms in adolescents , 1996 .

[31]  J. Kaprio,et al.  Major depressive episode and health care use among adolescents and young adults , 2003, Social Psychiatry and Psychiatric Epidemiology.

[32]  J. Bridge,et al.  Outcome at 6 months for 50 adolescents with major depression treated in a health maintenance organization. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[33]  S. Nolen-Hoeksema,et al.  Children's Attributional Style Questionnaire—Revised: Psychometric examination. , 1998 .

[34]  M. Seligman,et al.  School-Based Prevention Of Depression And Anxiety Symptoms In Early Adolescence: A Pilot Of A Parent Intervention Component , 2006 .

[35]  A. Beck.  Cognitive therapy and the emotional disorders: A. T. Beck , 1987, British Journal of Psychiatry.

[36]  K. Dobson,et al.  The Prevention of Anxiety and Depression: Theory, Research, and Practice , 2004 .

[37]  W. Reich.  Diagnostic interview for children and adolescents (DICA) , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[38]  A. Ellis.  Reason and emotion in psychotherapy , 1962 .

[39]  C. Wild,et al.  A randomized placebo-controlled trial of a school-based depression prevention program. , 2004, Journal of the American Academy of Child and Adolescent Psychiatry.

[40]  M. Thase,et al.  The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. , 1997, JAMA.

[41]  M. Seligman,et al.  The prevention of depression and anxiety. , 1999 .

[42]  E. Cunningham.  Psychometric Properties of the Children's Attributional Style Questionnaire , 2003, Psychological reports.

[43]  J. Weisz,et al.  Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. , 1995, Journal of consulting and clinical psychology.

[44]  S. Dziurawiec,et al.  The effect of an optimism and lifeskills program on depressive symptoms in preadolescence , 2001 .

[45]  P. Lewinsohn,et al.  Comorbidity of unipolar depression: II. Comorbidity with other mental disorders in adolescents and adults. , 1991, Journal of abnormal psychology.

[46]  J. Weisz,et al.  Finding, evaluating, refining, and applying empirically supported treatments for children and adolescents. , 1998, Journal of clinical child psychology.

[47]  L. Abramson,et al.  Development of gender differences in depression: an elaborated cognitive vulnerability-transactional stress theory. , 2001, Psychological bulletin.

[48]  J. Garber,et al.  Recurrent depression in adolescents: a follow-up study. , 1988, Journal of the American Academy of Child and Adolescent Psychiatry.

[49]  M. Seligman,et al.  Prevention of Depressive Symptoms in Schoolchildren: Two-Year Follow-Up , 1995 .

[50]  R. Kane,et al.  The prevention of depressive symptoms in rural school children: a randomized controlled trial. , 2003, Journal of consulting and clinical psychology.

[51]  S. Raudenbush,et al.  Effects of study duration, frequency of observation, and sample size on power in studies of group differences in polynomial change. , 2001, Psychological methods.

[52]  M. Dadds,et al.  The Efficacy of a Universal School-Based Program to Prevent Adolescent Depression , 2001, Journal of clinical child psychology.

[53]  R. Ingram,et al.  Secondary prevention of depression: Risk, vulnerability, and intervention. , 2004 .

[54]  H. Kraemer,et al.  Lowering the burden of suffering from child psychiatric disorder: trade-offs among clinical, targeted, and universal interventions. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[55]  T. Achenbach.  Manual for the child behavior checklist/4-18 and 1991 profile , 1991 .

[56]  M. Seligman,et al.  Attributional style and depressive symptoms among children. , 1984, Journal of abnormal psychology.

[57]  R. DeRubeis,et al.  Cognitive Therapy for Depression: A Review of Its Efficacy , 2001, Journal of Cognitive Psychotherapy.

[58]  M. Schluchter,et al.  Epidemiology of depressive symptoms in young adolescents. , 1989, Journal of the American Academy of Child and Adolescent Psychiatry.

[59]  L. Abramson,et al.  Measuring Cognitive Vulnerability to Depression in Adolescence: Reliability, Validity, and Gender Differences , 2002, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[60]  J. Aboudarham,et al.  Psychosocial morbidity: the economic burden in a pediatric health maintenance organization sample. , 2000, Archives of pediatrics & adolescent medicine.

[61]  J. Gillham,et al.  The K-SADS and diagnosis of major depressive disorder. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[62]  Kimberly Hoagwood,et al.  Development and natural history of mood disorders , 2002, Biological Psychiatry.

[63]  Benedetto Vitiello,et al.  Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. , 2004, JAMA.

[64]  S. Shapiro,et al.  An Analysis of Variance Test for Normality (Complete Samples) , 1965 .

[65]  C. Essau.  Primary prevention of depression. , 2004 .

[66]  P. Lewinsohn,et al.  Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. , 1993, Journal of abnormal psychology.

[67]  S. Goldstein,et al.  Handbook of Resilience in Children , 2005 .

[68]  N. Ryan,et al.  Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[69]  Age-cohort changes in the lifetime occurrence of depression and other mental disorders. , 1993 .

[70]  E. Perez-stable,et al.  Prevention of depression with primary care patients: A randomized controlled trial , 1995, American journal of community psychology.

[71]  John R. Weisz,et al.  Psychotherapy for Children and Adolescents: Evidence-Based Treatments and Case Examples , 2004 .