Prevention Programs for Youth Most Effective When At-Risk Families Are Clinically Stable

Programs that teach stress management and cognitive-restructuring skills may help to prevent the onset of depression in teens at high risk for depression, but how effective they are appears to depend largely on the mental health of youth and their parents when the intervention begins, according to a study published online this week in the Journal of the American Academy of Child and Adolescent Psychiatry. Understanding the factors that influence these outcomes may help to guide future program development for youth with a family history of depression.

A multi-site, randomized trial targeting adolescents with a family or individual history of depression previously found that youth who participated in a cognitive-behavioral prevention (CBP) program (eight 90-minute group sessions that focused on teaching cognitive-restructuring skills for negative thoughts and stress management held weekly and six additional sessions held monthly) were less likely to report depressive symptoms compared with those who received usual community care when followed up nine months later. However, the trial also revealed that parental depression at baseline moderated the intervention effects.

As a follow-up to this trial, V. Robin Weersing, Ph.D., of San Diego State University, and colleagues took at closer look at the demographic, clinical, and contextual characteristics of the families of the 310 adolescents (aged 13 to 17) who were randomly assigned to participate in CBP or usual community care in search of predictors and moderators of acute response to CBP.

Their analysis revealed that both parent and adolescent clinical characteristics negatively moderated the effects of CBP: current depression (MDD or dysthymia) and history of hypomania in parents at baseline were significant moderators; for adolescents, higher depressive symptoms, higher anxiety symptoms, lower functioning, and higher hopelessness reported at baseline moderated the effects of the CBP intervention on major depression episodes.

“Clinically, this pattern of effects has both positive and negative implications. First, there is a clear indication for the use of CBP in at-risk families when they are clinically stable. Second, it is promising that all of the negative prognostic indicators and significant moderators were potentially modifiable; no demographic factors or historical characteristics (e.g., trauma history, history of past onsets) were associated with response,” the study authors wrote. “The negative implication of these findings, however, is that the version of the CBP intervention used in this trial may be less indicated when families are in the most distress.

They concluded, “Further research aimed at understanding the mediators underlying differences in outcome between these subgroups would provide useful guidance for additional program development.”

For related information, see the Psychiatric News article “Family-Based Intervention May Help Prevent Anxiety Disorders in Children.”

(Image: auremar/Shutterstock)