Cognitive Prevention Program Trumps Usual Care in “Real World” Trial
• Science Update
At-risk teens exposed to a program that teaches them to counteract their unrealistic and overly negative thoughts experienced significantly less depression than their peers who received usual care, NIMH-funded researchers have found. However, the cognitive behavioral prevention program failed to similarly help adolescents prone to the mood disorder if their parents were currently depressed.
NIMH grantee Judy Garber, Ph.D., of Vanderbilt University, and colleagues, report on the findings of their multi-site clinical trial in the June 3, 2009 issue of the Journal of the American Medical Association.
Only a fourth of depressed youth receive any treatment and at least 20 percent develop a chronic, difficult-to-treat form of the illness. Having a history of the illness substantially increases risk for depression, which soars two to three times among children of depressed parents. An initial study had supported the efficacy of a cognitive behavioral prevention program in reducing risk in such depression-prone teens, but it was unknown whether this would hold up across diverse "real world" settings.
To find out, Garber and Drs. David Brent, the University of Pittsburgh, William Beardslee, Boston Children's Hospital and Judge Baker Children's Center, and Gregory Clarke, Kaiser Permanente Center for Health Research in Portland, OR, randomly assigned 316 at-risk adolescents (aged 13-17) to either the cognitive behavioral program or usual care.
Teens in the cognitive behavioral program received eight weekly 90-minute group cognitive behavioral sessions. Masters or doctoral-level therapists helped them learn to restructure dysfunctional thinking patterns and practice problem solving skills. This was followed by six monthly continuation sessions in which they reviewed the cognitive and problem-solving skills and also learned relaxation, assertiveness and behavioral activation techniques.
Teens in the usual care condition as well as those in the cognitive behavior program were allowed to begin or continue with any mental health or other healthcare services available in their communities.
Results of This Study
Over a 9-month follow-up period, the rate of depression in the cognitive behavioral program group was 11 percent lower than for those in the usual care condition — 21.4 percent vs. 32.7 percent. Adolescents in the prevention program also self-reported lower levels of depression symptoms than those in usual care. Among teens whose parents were not depressed at the beginning of the study, the program was more effective in preventing onset of depression than usual care — 11.7 percent vs. 40.5 percent. However, this advantage did not hold for youth in the cognitive behavioral program if they had a parent who was depressed at the start of the study. Such teens had significantly higher rates of depression than those without a currently depressed parent.
The results demonstrate that the prevention program can be effectively delivered in a variety of "real world" settings, say the researchers.
"For every 9 adolescents who received the cognitive intervention, we would expect to prevent one from developing a depressive episode," explained Garber. "This is comparable to what is seen with treatment response to medication."
Moreover, preventing recurrence of a depressive episode may arguably bring even greater benefits than treating an episode after it has already produced other negative consequences. This suggests that the program may be useful for maintaining recovery, once achieved, she noted.
"Our results also underscore the link between changes in parent and youth depression. Future investigations might explore combining or sequencing parental depression and prevention programs for at-risk teens."
Prevention of depression in at-risk adolescents: a randomized controlled trial . Garber J, Clarke GN, Weersing VR, Beardslee WR, Brent DA, Gladstone TR, DeBar LL, Lynch FL, D'Angelo E, Hollon SD, Shamseddeen W, Iyengar S. JAMA. 2009 Jun 3;301(21):2215-24.PMID: 19491183