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| |  Cognitive Behavioural Intervention Helps Prevent Depression Among At-Risk Teens NEW YORK -- June 2, 2009 -- Adolescents at an increased risk of depression who participated in a group cognitive behavioural (CB) intervention significantly reduced their symptoms and episodes of depression compared with teens who received usual care, although this effect was not seen for adolescents with a parent with current depression, according to a study published in the June 3 issue of JAMA. "The serious developmental consequences of adolescent depression and the associated treatment challenges once it has developed underscore the need for programs aimed at prevention," the authors wrote. They add that 1 of the most potent risk factors for the development of depression in youth is a parent who experiences depression, which increases the risk for adolescent depression by 2- to 3-fold. Although some smaller trials have found that depression risk can be reduced in this population, these results have yet to be replicated in larger studies. Judy Garber, PhD, Vanderbilt University, Nashville, Tennessee, and colleagues examined the effectiveness of a CB program for preventing depression in at-risk adolescents. The multicentre trial included 316 adolescents, aged 13 to 17 years, who had parents with current or prior depressive disorders. Adolescents had a past history of depression, current elevated but subdiagnostic depressive symptoms, or both. Assessments were conducted at the beginning of the study, after the 8-week intervention, and after a 6-month continuation phase, with symptoms and disorders being measured with questionnaires and clinical interviews, respectively. Adolescents were randomly assigned to the CB prevention program (n = 159) or to usual care (n = 157). The intervention consisted of 8 weekly 90-minute group sessions (followed by 6 monthly continuation sessions), led by a therapist, in which adolescents were taught problem-solving skills and cognitive restructuring techniques to identify and challenge unrealistic and overly negative thoughts. The researchers found that the rate for new depressive episodes was lower for those in the CB prevention program than for those in usual care through the post-continuation follow-up (21.4% vs 32.7%). Self-reported change in the symptoms of depression declined at a significantly greater rate for youth in the CB prevention program than for those in usual care. Having a parent with depression at the beginning of the study significantly moderated the effect of the CB prevention program, with analyses indicating that the CB program was significantly better than usual care in preventing depressive episodes if a parent did not have a current depressive episode (11.7% vs 40.5%). When parents were actively depressed at the start of the study, rates of youth depression did not differ significantly between the CB program and usual care (31.2% vs. 24.3%). Comparisons within the CB prevention program condition indicated that offspring of currently depressed parents had a significantly higher rate of incident depression than adolescents of currently nondepressed parents. Within the usual care group, rates of depression did not differ significantly between offspring of currently depressed versus nondepressed parents. "… these positive findings support the clinical utility of this CB prevention program as a preventive intervention to reduce or delay the incidence of depression in offspring of depressed parents," the authors wrote. "Most youth in the current study had a history of depression and thus the CB prevention program prevented recurrence. Therefore, this program may be useful as a continuation or maintenance intervention." SOURCE: JAMA
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