Prevention of depressive symptoms in adolescents: A randomized trial of cognitive-behavioral and interpersonal prevention programs.

This study evaluated the efficacy of 2 programs for preventing depressive symptoms in adolescents. Participants were 380 high school students randomly assigned to a cognitive-behavioral program (CB), an interpersonal psychotherapy-adolescent skills training program (IPT-AST), or a no-intervention control. The interventions involved eight 90-min weekly sessions run in small groups during wellness classes. At postintervention, students in both the CB and IPT-AST groups reported significantly lower levels of depressive symptoms than did those in the no-intervention group, controlling for baseline depression scores; the 2 intervention groups did not differ significantly from each other. The effect sizes, using Cohen's d, for the CB intervention and the IPT-AST intervention were 0.37 and 0.26, respectively. Differences between control and intervention groups were largest for adolescents with high levels of depressive symptoms at baseline. For a high-risk subgroup, defined as having scored in the top 25th percentile on the baseline depression measure, the effect sizes for the CB and the IPT-AST interventions were 0.89 and 0.84, respectively. For the whole sample, sociotropy and achievement orientation moderated the effect of the interventions. Intervention effects were short term and were not maintained at 6-month follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prevention of depressive symptoms in rural school children: A randomized controlled trial.

A controlled trial was conducted to evaluate a prevention program aimed at reducing depressive and anxious symptoms in rural school children. Seventh-grade children with elevated depression were selected. Nine primary schools (n=90) were randomly assigned to receive the program, and 9 control schools (n=99) received their usual health education classes. Children completed questionnaires on depression, anxiety, explanatory style, and social skills. Parents completed the Child Behavior Checklist (T. M. Achenbach, 1991). No intervention effects were found for depression. Intervention group children reported less anxiety than the control group after the program and at 6-month follow-up and more optimistic explanations at postintervention. Intervention group parents reported fewer child internalizing and externalizing symptoms at postintervention only. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prevention of depressive symptoms in children and adolescents: A meta-analytic review.

Research on the prevention of depressive symptoms in children and adolescents was reviewed and synthesized with meta-analysis. When all 30 studies were included, selective prevention programs were found to be more effective than universal programs immediately following intervention. Both selective and indicated prevention programs were more effective than universal programs at follow-up, even when the 2 studies with college students were excluded. Effect sizes for selective and indicated prevention programs tended to be small to moderate, both immediately postintervention and at an average follow-up of 6 months. Most effective interventions are more accurately described as treatment rather than prevention. Suggestions for future research include testing potential moderators (e.g., age, gender, anxiety, parental depression) and mechanisms, designing programs that are developmentally appropriate and gender and culturally sensitive, including longer follow-ups, and using multiple measures and methods to assess both symptoms and diagnoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Universal-based prevention of syndromal and subsyndromal social anxiety: A randomized controlled study.

This article reports results from a universal preventive program aimed at (a) reducing social anxiety and (b) preventing the development of syndromal social anxiety among a population-based sample of older children and young adolescents during a 1-year period. Pupils (N = 1,748) from 2 counties were cluster randomized to either an intervention or a control condition. In the intervention condition, the Norwegian Universal Preventive Program for Social Anxiety (NUPP-SA)—which educates pupils, parents/guardians, teachers/school staff, and county health workers—was administered. The results indicate that NUPP-SA had a significant specific intervention effect for reducing social anxiety in the total sample as well as among the syndromal subjects. Further, significantly fewer subjects from the intervention county developed syndromal social anxiety during the 1-year period, thus showing a prevention effect. The results demonstrate the value of an intervention specifically aimed at reducing social anxiety and preventing the development of syndromal social anxiety among young people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: A randomized efficacy trial.

In this depression prevention trial, 341 high-risk adolescents (mean age = 15.6 years, SD = 1.2) with elevated depressive symptoms were randomized to a brief group cognitive-behavioral (CB) intervention, group supportive-expressive intervention, bibliotherapy, or assessment-only control condition. CB participants showed significantly greater reductions in depressive symptoms than did supportive-expressive, bibliotherapy, and assessment-only participants at posttest, though only the difference compared with assessment controls was significant at 6-month follow-up. CB participants showed significantly greater improvements in social adjustment and reductions in substance use at posttest and 6-month follow-up than did participants in all 3 other conditions. Supportive-expressive and bibliotherapy participants showed greater reductions in depressive symptoms than did assessment-only controls at certain follow-up assessments but produced no effects for social adjustment and substance use. CB, supportive-expressive, and bibliotherapy participants showed a significantly lower risk for major depression onset over the 6-month follow-up than did assessment-only controls. The evidence that this brief CB intervention reduced risk for future depression onset and outperformed alternative interventions for certain ecologically important outcomes suggests that this intervention may have clinical utility. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of comorbidity in prevention of adolescent depressive symptoms.

Despite the well-known relevance of comorbidity, few studies have examined the impact of comorbid anxiety or externalizing symptoms on the prevention of depressive symptoms in adolescents. To replicate earlier positive effects of a cognitive-behavioral prevention program of depressive symptoms and to test the hypothesis that the prevention program would be less effective in adolescents with comorbid anxiety and externalizing symptoms, the authors conducted a study involving 301 8th-grade students randomly divided into an intervention group and a nonintervention control group. The randomized design included baseline, postintervention, and 6-month follow-up. The prevention program included 10 sessions held in a regular school setting. The prevention program showed positive effects on depressive symptoms independent of comorbid symptoms. These effects were found mainly with girls independent of their depressive symptoms at baseline, and in part with boys with less severe depressive symptoms at baseline. It is surprising that negative effects of the prevention program on depressive symptoms were found on the depression of boys with more severe depressive symptoms at baseline. The prevention program's low rate of attrition and high recruitment rate support the generalizability of the results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized controlled trial of a family cognitive-behavioral preventive intervention for children of depressed parents.

A family cognitive-behavioral preventive intervention for parents with a history of depression and their 9–15-year-old children was compared with a self-study written information condition in a randomized clinical trial (n = 111 families). Outcomes were assessed at postintervention (2 months), after completion of 4 monthly booster sessions (6 months), and at 12-month follow-up. Children were assessed by child reports on depressive symptoms, internalizing problems, and externalizing problems; by parent reports on internalizing and externalizing problems; and by child and parent reports on a standardized diagnostic interview. Parent depressive symptoms and parent episodes of major depression also were assessed. Evidence emerged for significant differences favoring the family group intervention on both child and parent outcomes; strongest effects for child outcomes were found at the 12-month assessment with medium effect sizes on most measures. Implications for the prevention of adverse outcomes in children of depressed parents are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults.

The authors used a randomized trial to compare cognitive-behavioral therapy (CBT) and supportive counseling (SC) in the treatment of anxiety symptoms in older adults who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for anxiety disorders. Both conditions had a 6-week baseline no-treatment phase. Treatment was delivered primarily in patients' own homes and in an individual format. Outcomes were assessed at posttreatment and at 3-, 6-, and 12-month follow-ups. There was no spontaneous improvement during the baseline phase. Both groups showed improvement on anxiety measures following treatment, with a better outcome for the CBT group on self-rating of anxiety and depression. Over the follow-up period, the CBT group maintained improvement and had significantly greater improvement than the SC group on anxiety and 1 depression measure. Treatment response for anxiety was also superior for the CBT group, although there was no difference between groups in endstate functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using the internet to assist smoking prevention and cessation in schools: A randomized, controlled trial.

Objective: To evaluate the impact of a classroom-based, Web-assisted tobacco intervention addressing smoking prevention and cessation with adolescents. Design: A two-group randomized control trial with 1,402 male and female students in grades 9 through 11 from 14 secondary schools in Toronto, Canada. Participants were randomly assigned to a tailored Web-assisted tobacco intervention or an interactive control condition task conducted during a single classroom session with e-mail follow-up. The cornerstone of the intervention was a five-stage interactive Web site called the Smoking Zine (http://www.smokingzine.org) integrated into a program that included a paper-based journal, a small group form of motivational interviewing, and tailored e-mails. Main Outcome Measure: Resistance to smoking, behavioral intentions to smoke, and cigarette use were assessed at baseline, postintervention, and three- and six-month follow-up. Multilevel logistic growth modeling was used to assess the effect of the intervention on change over time. Results: The integrated Smoking Zine program helped smokers significantly reduce the likelihood of having high intentions to smoke and increased their likelihood of high resistance to continued cigarette use at 6 months. The intervention also significantly reduced the likelihood of heavy cigarette use adoption by nonsmokers during the study period. Conclusion: The Smoking Zine intervention provided cessation motivation for smokers most resistant to quitting at baseline and prevented nonsmoking adolescents from becoming heavy smokers at 6 months. By providing an accessible and attractive method of engaging young people in smoking prevention and cessation, this interactive and integrated program provides a novel vehicle for school- and population-level health promotion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediation of a middle school skin cancer prevention program.

This study tested potential mediators of a school-based skin cancer prevention intervention for middle school children (6th-8th grades; N = 1,788). Ten variables were tested on 4 criteria to establish mediation, including (a) intervention related to outcome, (b) intervention related to mediators, (c) mediators related to outcome, and (d) mediated effect statistically significant. Sun-safe behaviors (e.g., sunscreen use) and potential mediators were measured with a self-report questionnaire. All criteria were met for Barriers--Sunscreen, Perceived Self-Efficacy, and Knowledge when the mediators were tested separately. In multiple mediator analyses, barriers to sunscreen use and self-efficacy satisfied Criteria 1-3 but were not statistically significant (Criterion 4). Barriers to sunscreen use, perceived self-efficacy for sun-safe behavior, and knowledge may serve as mediators. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing perinatal depression in low-income home visiting clients: A randomized controlled trial.

Objective: To assess the efficacy of a 6-week cognitive-behavioral intervention in preventing the onset of perinatal depression and reducing depressive symptoms among low-income women in home visitation programs. Method: Sixty-one women who were pregnant or who had a child less than 6 months of age and who were assessed as at risk for perinatal depression were randomized to a 6-week, group-based cognitive-behavioral intervention or usual home visiting services. Study participants were predominately African American, unmarried, and unemployed. Intervention sessions were led by a licensed clinical social worker or clinical psychologist. Home visitors provided 1-on-1 reinforcement of key intervention messages between group sessions. Depressive symptoms were measured with the Beck Depression Inventory–II (Beck, Steer, & Brown, 1996), and major depressive episodes were measured with the Maternal Mood Screener (MMS; Le & Mu?oz, 1998). Outcomes were assessed at baseline and at 1 week and 3 months postintervention. Results: Repeated measures analysis of variance indicated that there was a significant Time × Condition interaction, F(2, 112) = 4.1, p = .02. At 3 months postintervention, 9 of 27 (33%) women receiving usual care reported levels of depressive symptoms that met clinical cutoff for depression on the MMS compared with 3 of 32 (9%) women in the intervention condition, χ2(1, N = 59) = 5.18, p     

A randomized trial of skin cancer prevention in aquatics settings: The pool cool program.

Skin cancer is increasing, and prevention programs are essential. This study evaluated the impact of a skin cancer prevention program on sun-protection habits and swimming pool environments. The intervention included staff training; sun-safety lessons; interactive activities; providing sunscreen, shade, and signage; and promoting sun-safe environments. A randomized trial at 28 swimming pools in Hawaii and Massachusetts tested the efficacy of this program (Pool Cool) compared with an attention-matched injury-prevention control program. Results showed significant positive changes in children's use of sunscreen and shade, overall sun-protection habits, and number of sunburns and improvements in parents' hat use, sun-protection habits, and reported sun-protection policies and environments. Observations corroborated the positive findings. Pool Cool had significant positive effects at swimming pools in diverse audiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Co-occurring delinquency and depressive symptoms of adolescent boys and girls: A dual trajectory modeling approach.

Co-occurring trajectories of delinquent behavior and depressive symptoms and their correlates were examined in a longitudinal sample of 985 middle-adolescent boys and girls (mean age = 15.54 years at Time 1). Dual trajectory analysis was used to identify the co-occurring trajectories. For boys (n = 472), 4 delinquency and 4 depression trajectory groups were found. For girls (n = 513), 3 delinquency and 3 depression trajectory groups were identified. The linkage between co-occurring trajectories was higher for girls than for boys. Stressful life events and childhood precursors of the outcomes predicted trajectory group membership for both genders fairly consistently. Findings suggest heterogeneity in developmental courses of delinquent behavior and depressive symptoms across adolescent boys and girls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The YouthMood Project: A cluster randomized controlled trial of an online cognitive behavioral program with adolescents.

The aim in the current study was to investigate the effectiveness of an online, self-directed cognitive–behavioral therapy program (MoodGYM) in preventing and reducing the symptoms of anxiety and depression in an adolescent school-based population. A cluster randomized controlled trial was conducted with 30 schools (N = 1,477) from across Australia, with each school randomly allocated to the intervention or wait-list control condition. At postintervention and 6-month follow-up, participants in the intervention condition had significantly lower levels of anxiety than did participants in the wait-list control condition (Cohen’s d = 0.15–0.25). The effects of the MoodGYM program on depressive symptoms were less strong, with only male participants in the intervention condition exhibiting significant reductions in depressive symptoms at postintervention and 6-month follow-up (Cohen’s d = 0.27–0.43). Although small to moderate, the effects obtained in the current study provide support for the utility of universal prevention programs in schools. The effectiveness of booster sessions should be explored in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive vulnerability to depressive symptoms in adolescents in urban and rural Hunan, China: A multiwave longitudinal study.

The current multiwave longitudinal study examined the applicability of two cognitive vulnerability-stress models of depression—Beck's (1967, 1983) cognitive theory and the hopelessness theory (Abramson, Metalsky, & Alloy, 1989)—in two independent samples of adolescents from Hunan Province, China (one rural and one urban). During an initial assessment, participants completed measures assessing dysfunctional attitudes (Beck, 1967, 1983), negative cognitive style (Abramson et al., 1989), neuroticism (Costa & McCrae, 1992), depressive symptoms, and anxiety symptoms. Once a month for the subsequent 6 months, participants completed measures assessing the occurrence of different types of negative events, depressive symptoms, and anxiety symptoms. Results provided support for cognitive vulnerability factors as predictors of increases in depressive symptoms following the occurrence of higher than average levels of negative events in Chinese adolescents. The results also supported the specificity of these two cognitive vulnerability factors as predictors of depressive versus anxiety symptoms following the occurrence of higher than average levels of negative events (i.e., symptom specificity), and the ability of cognitive vulnerability factors to predict prospective change in depressive symptoms above and beyond the effects of trait neuroticism (i.e., etiological specificity). (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evaluating a prevention program for teenagers on sexual coercion: A differential effectiveness approach.

The authors evaluated a coeducational program for teenagers on preventing sexual coercion in dating situations. Students examined individual and social attitudes underlying coercive sexual behavior and learned communication skills aimed at preventing or dealing with unwanted sexual advances. Instruction was enhanced by video and an interactive video "virtual date." Outcomes were assessed using sexual attitude scales with a sample of 458 high school students. Student health education classes were randomly assigned to either a treatment or a control condition. Findings, based on a latent variable model of differential effectiveness, showed that students in the treatment group with initial coercive attitude scores at or above the mean benefited significantly more than students with the same range of scores in the control group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social problem solving and depressive symptoms over time: A randomized clinical trial of cognitive-behavioral analysis system of psychotherapy, brief supportive psychotherapy, and pharmacotherapy.

Objective: Depression is associated with poor social problem solving, and psychotherapies that focus on problem-solving skills are efficacious in treating depression. We examined the associations between treatment, social problem solving, and depression in a randomized clinical trial testing the efficacy of psychotherapy augmentation for chronically depressed patients who failed to fully respond to an initial trial of pharmacotherapy (Kocsis et al., 2009). Method: Participants with chronic depression (n = 491) received cognitive-behavioral analysis system of psychotherapy (CBASP; McCullough, 2000), which emphasizes interpersonal problem solving, plus medication; brief supportive psychotherapy (BSP) plus medication; or medication alone for 12 weeks. Results: CBASP plus pharmacotherapy was associated with significantly greater improvement in social problem solving than BSP plus pharmacotherapy, and a trend for greater improvement in problem solving than pharmacotherapy alone. In addition, change in social problem solving predicted subsequent change in depressive symptoms over time. However, the magnitude of the associations between changes in social problem solving and subsequent depressive symptoms did not differ across treatment conditions. Conclusions: It does not appear that improved social problem solving is a mechanism that uniquely distinguishes CBASP from other treatment approaches. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls.

Efficacy trials indicate that an eating disorder prevention program involving dissonance-inducing activities that decrease thin-ideal internalization reduces risk for current and future eating pathology, yet it is unclear whether this program produces effects under real-world conditions. The present effectiveness trial tested whether this program produced effects when school staff recruit participants and deliver the intervention. Adolescent girls with body image concerns (N = 306; M age = 15.7, SD = 1.1) randomized to the dissonance intervention showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, dieting attempts, and eating disorder symptoms from pretest to posttest than did those assigned to a psychoeducational brochure control condition, with the effects for body dissatisfaction, dieting, and eating disorder symptoms persisting through 1-year follow-up. Effects were slightly smaller than those observed in a prior efficacy trial, suggesting that this program is effective under real-world conditions, but that facilitator selection, training, and supervision could be improved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial study of the ABRACADABRA reading intervention program in grade 1.

This study reports a randomized controlled trial evaluation of a computer-based balanced literacy intervention, ABRACADABRA (http://grover.concordia.ca/abra/version1/abracadabra.html). Children (N = 144) in Grade 1 were exposed either to computer activities for word analysis, text comprehension, and fluency, alongside shared stories (experimental groups), or to balanced literacy approaches delivered by their classroom teachers (control group). Two computer-based interventions—a phoneme-based synthetic phonics method and a rime-based analytic phonics method—were contrasted. Children were taught 4 times per week for 12 weeks in small groups. There were significant improvements in letter knowledge in the analytic phonics program and significant improvements in phonological awareness, listening comprehension, and reading comprehension at immediate posttest and in phonological awareness and reading fluency at a delayed posttest in the synthetic phonics program. Effect size analyses confirmed that both interventions had a significant impact on literacy at both posttests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward bridging the science and practice of depression prevention: What can we learn from cognitive vulnerability?

Depression is a widespread disorder with devastating individual and societal consequences. Although a great deal of research and theory has focused on treatment of acute episodes, progress needs to be made in preventing the emergence of first episodes of the disorder. There has been considerable advancement in understanding psychological vulnerability factors associated with this mood disorder, especially on the basis of cognitive behavioural models and research findings based on this theoretical model. In this paper we review the concept of cognitive vulnerability, with a particular focus on what this body of research work suggests clinically for the prevention of depression. We outline, based on this science, what the effective ingredients of a prevention program could be. We also discuss some of the pragmatic aspects of developing an effective prevention program for depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)