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Erschienen in: Prevention Science 1/2018

01.02.2016

Prevention of Depression in At-Risk Adolescents: Moderators of Long-term Response

verfasst von: J. Garber, V. R. Weersing, S. D. Hollon, G. Porta, G. N. Clarke, J. F. Dickerson, W. R. Beardslee, F. L. Lynch, T. G. Gladstone, W. Shamseddeen, D. A. Brent

Erschienen in: Prevention Science | Sonderheft 1/2018

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Abstract

In a randomized controlled trial, we found that a cognitive behavioral program (CBP) was significantly more effective than usual care (UC) in preventing the onset of depressive episodes, although not everyone benefitted from the CBP intervention. The present paper explored this heterogeneity of response. Participants were 316 adolescents (M age = 14.8, SD = 1.4) at risk for depression due to having had a prior depressive episode or having current subsyndromal depressive symptoms and having a parent with a history of depression. Using a recursive partitioning approach to baseline characteristics, we (Weersing et al. 2016) previously had identified distinct risk clusters within conditions that predicted depressive episodes through the end of the continuation phase (month 9). The present study used the same risk clusters that had been derived in the CBP group through month 9 to reclassify the UC group and then to examine group differences in depression through month 33. We found that in this overall very high-risk sample, the CBP program was superior to UC among youth in the low-risk cluster (n = 33), characterized by higher functioning, lower anxiety, and parents not depressed at baseline, but not in the middle (n = 95) and high-risk (n = 25) clusters. Across conditions, significantly more depression-free days were found for youth in the low-risk cluster (M = 951.9, SD = 138.8) as compared to youth in the high-risk cluster (M = 800.5, SD = 226.7). Identification of moderators, based on purely prognostic indices, allows for more efficient use of resources and suggests possible prevention targets so as to increase the power of the intervention.
Literatur
Zurück zum Zitat Ascher, B. H., Farmer, E. M., Burns, B. J., & Angold, A. (1996). The Child and Adolescent Services Assessment (CASA): Description and psychometrics. Journal of Emotional and Behavioral Disorders, 4, 12–20.CrossRef Ascher, B. H., Farmer, E. M., Burns, B. J., & Angold, A. (1996). The Child and Adolescent Services Assessment (CASA): Description and psychometrics. Journal of Emotional and Behavioral Disorders, 4, 12–20.CrossRef
Zurück zum Zitat Avenevoli, S., Knight, E., Kessler, R. C., & Merikangas, K. R. (2008). Epidemiology of depression in children and adolescents. In J. R. Z. Abela & B. L. Hankin (Eds.), Handbook of depression in children and adolescents (pp. 6–32). New York: Guilford Press. Avenevoli, S., Knight, E., Kessler, R. C., & Merikangas, K. R. (2008). Epidemiology of depression in children and adolescents. In J. R. Z. Abela & B. L. Hankin (Eds.), Handbook of depression in children and adolescents (pp. 6–32). New York: Guilford Press.
Zurück zum Zitat Beardslee, W. R., Brent, D. A., Weersing, V. R., Clarke, G. N., Porta, G., Hollon, S. D., Gladstone, T. R. G., Gallop, R., Lynch, F. L., Iyengar, S., DeBar, L., & Garber, J. (2013). Prevention of depression in at-risk adolescents: Longer-term effects. Journal of the American Medical Association - Psychiatry, 70, 1161–1170. Beardslee, W. R., Brent, D. A., Weersing, V. R., Clarke, G. N., Porta, G., Hollon, S. D., Gladstone, T. R. G., Gallop, R., Lynch, F. L., Iyengar, S., DeBar, L., & Garber, J. (2013). Prevention of depression in at-risk adolescents: Longer-term effects. Journal of the American Medical Association - Psychiatry, 70, 1161–1170.
Zurück zum Zitat Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology, 42, 861.CrossRefPubMed Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology, 42, 861.CrossRefPubMed
Zurück zum Zitat Begg, C. B., & Iglewicz, B. (1980). A treatment allocation procedure for sequential clinical trials. Biometrics, 36, 81–90.CrossRefPubMed Begg, C. B., & Iglewicz, B. (1980). A treatment allocation procedure for sequential clinical trials. Biometrics, 36, 81–90.CrossRefPubMed
Zurück zum Zitat Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., & Neer, S. M. (1997). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 545–553.CrossRefPubMed Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., & Neer, S. M. (1997). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 545–553.CrossRefPubMed
Zurück zum Zitat Brent, D. A., Emslie, G., Clarke, G., Wagner, K. D., Asarnow, J. R., Keller, M., & Zelazny, J. (2008). Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: The TORDIA randomized controlled trial. JAMA: Journal of the American Medical Association, 299, 901–913.CrossRefPubMedPubMedCentral Brent, D. A., Emslie, G., Clarke, G., Wagner, K. D., Asarnow, J. R., Keller, M., & Zelazny, J. (2008). Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: The TORDIA randomized controlled trial. JAMA: Journal of the American Medical Association, 299, 901–913.CrossRefPubMedPubMedCentral
Zurück zum Zitat Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47, 372–394.CrossRefPubMed Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47, 372–394.CrossRefPubMed
Zurück zum Zitat Buss, A. H., & Perry, M. (1992). The aggression questionnaire. Journal of Personality and Social Psychology, 63, 452.CrossRefPubMed Buss, A. H., & Perry, M. (1992). The aggression questionnaire. Journal of Personality and Social Psychology, 63, 452.CrossRefPubMed
Zurück zum Zitat Carskadon, M. A., & Acebo, C. (1993). A self-administered rating scale for pubertal development. Journal of Adolescent Health, 14, 190–195.CrossRefPubMed Carskadon, M. A., & Acebo, C. (1993). A self-administered rating scale for pubertal development. Journal of Adolescent Health, 14, 190–195.CrossRefPubMed
Zurück zum Zitat Clark, T. G., Bradburn, M. J., Love, S. B., & Altman, D. G. (2003). Survival analysis part IV: Further concepts and methods in survival analysis. British Journal of Cancer, 89, 781–786.CrossRefPubMedPubMedCentral Clark, T. G., Bradburn, M. J., Love, S. B., & Altman, D. G. (2003). Survival analysis part IV: Further concepts and methods in survival analysis. British Journal of Cancer, 89, 781–786.CrossRefPubMedPubMedCentral
Zurück zum Zitat Clarke, G. N., Hawkins, W., Murphy, M., Sheeber, L. B., Lewinsohn, P. M., & Seeley, J. R. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 312–321.CrossRefPubMed Clarke, G. N., Hawkins, W., Murphy, M., Sheeber, L. B., Lewinsohn, P. M., & Seeley, J. R. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 312–321.CrossRefPubMed
Zurück zum Zitat Clarke, G. N., Hornbrook, M., Lynch, F., Polen, M., Gale, J., Beardslee, W., & Seeley, J. (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry, 58, 1127–1134.CrossRefPubMed Clarke, G. N., Hornbrook, M., Lynch, F., Polen, M., Gale, J., Beardslee, W., & Seeley, J. (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry, 58, 1127–1134.CrossRefPubMed
Zurück zum Zitat Efron, B. (1971). Forcing a sequential experiment to be balanced. Biometrika, 58, 403–417.CrossRef Efron, B. (1971). Forcing a sequential experiment to be balanced. Biometrika, 58, 403–417.CrossRef
Zurück zum Zitat Farmer, E. M., Angold, A., Burns, B. J., & Costello, E. J. (1994). Reliability of self-reported service use: Test-retest consistency of children’s responses to the Child and Adolescent Services Assessment (CASA). Journal of Child and Family Studies, 3, 307–325.CrossRef Farmer, E. M., Angold, A., Burns, B. J., & Costello, E. J. (1994). Reliability of self-reported service use: Test-retest consistency of children’s responses to the Child and Adolescent Services Assessment (CASA). Journal of Child and Family Studies, 3, 307–325.CrossRef
Zurück zum Zitat First, M., Spitzer, R., Gibbon, M., & Williams, J. (1997). Structured clinical interview for DSM-IVAxis I disorders—patient edition (SCID-I/P) version 2.0. New York: Biometrics Research Department, New York State Psychiatric Institute. First, M., Spitzer, R., Gibbon, M., & Williams, J. (1997). Structured clinical interview for DSM-IVAxis I disorders—patient edition (SCID-I/P) version 2.0. New York: Biometrics Research Department, New York State Psychiatric Institute.
Zurück zum Zitat Fournier, J. C., DeRubeis, R. J., Shelton, R. C., Hollon, S. D., Amsterdam, J. D., & Gallop, R. (2009). Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression. Journal of Consulting and Clinical Psychology, 77, 775–787.CrossRefPubMedPubMedCentral Fournier, J. C., DeRubeis, R. J., Shelton, R. C., Hollon, S. D., Amsterdam, J. D., & Gallop, R. (2009). Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression. Journal of Consulting and Clinical Psychology, 77, 775–787.CrossRefPubMedPubMedCentral
Zurück zum Zitat Garber, J., Clarke, G., Weersing, V. R., Beardslee, W. R., Brent, D., Gladstone, T., Debar, L., Lynch, F., D'Angelo, E., Hollon, S.D., Shamseddeen, W., & Iyengar, S. (2009). Prevention of depression in at-risk adolescents: A randomized controlled trial. Journal of the American Medical Association, 301, 2215–2224. Garber, J., Clarke, G., Weersing, V. R., Beardslee, W. R., Brent, D., Gladstone, T., Debar, L., Lynch, F., D'Angelo, E., Hollon, S.D., Shamseddeen, W.,  & Iyengar, S. (2009). Prevention of depression in at-risk adolescents: A randomized controlled trial. Journal of the American Medical Association, 301, 2215–2224.
Zurück zum Zitat Garber, J., & Weersing, V. R. (2010). Comorbidity of anxiety and depression in youth: Implications for treatment and prevention. Clinical Psychology: Science and Practice, 17, 293–306. Garber, J., & Weersing, V. R. (2010). Comorbidity of anxiety and depression in youth: Implications for treatment and prevention. Clinical Psychology: Science and Practice, 17, 293–306.
Zurück zum Zitat Jaycox, L. H., Stein, B. D., Paddock, S., Miles, J. N., Chandra, A., Meredith, L. S., & Burnam, M. A. (2009). Impact of teen depression on academic, social, and physical functioning. Pediatrics, 124, e596–e605.CrossRefPubMed Jaycox, L. H., Stein, B. D., Paddock, S., Miles, J. N., Chandra, A., Meredith, L. S., & Burnam, M. A. (2009). Impact of teen depression on academic, social, and physical functioning. Pediatrics, 124, e596–e605.CrossRefPubMed
Zurück zum Zitat Johnson, J. H., & McCutcheon, S. M. (1980). Assessing life stress in older children and adolescents: Preliminary findings with the life events checklist. In I. G. Sarason & C. D. Spielberger (Eds.), Stress and anxiety (pp. 111–125). Washington: Hemisphere. Johnson, J. H., & McCutcheon, S. M. (1980). Assessing life stress in older children and adolescents: Preliminary findings with the life events checklist. In I. G. Sarason & C. D. Spielberger (Eds.), Stress and anxiety (pp. 111–125). Washington: Hemisphere.
Zurück zum Zitat Kaufman, J., Birmaher, B., Brent, D., Rao, U. M. A., Flynn, C., Moreci, P., & Ryan, N. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.CrossRefPubMed Kaufman, J., Birmaher, B., Brent, D., Rao, U. M. A., Flynn, C., Moreci, P., & Ryan, N. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.CrossRefPubMed
Zurück zum Zitat Keller, M. B., Lavori, P. W., Friedman, B., Nielsen, E., Endicott, J., McDonald-Scott, P., & Andreasen, N. C. (1987). The longitudinal interval follow-up evaluation: A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 44, 540–548.CrossRefPubMed Keller, M. B., Lavori, P. W., Friedman, B., Nielsen, E., Endicott, J., McDonald-Scott, P., & Andreasen, N. C. (1987). The longitudinal interval follow-up evaluation: A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 44, 540–548.CrossRefPubMed
Zurück zum Zitat Kovacs, M. (1996). Presentation and course of major depressive disorder during childhood and later years of the life span. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 705–715.CrossRefPubMed Kovacs, M. (1996). Presentation and course of major depressive disorder during childhood and later years of the life span. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 705–715.CrossRefPubMed
Zurück zum Zitat Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry, 59, 877–883.CrossRefPubMed Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry, 59, 877–883.CrossRefPubMed
Zurück zum Zitat Lave, J. R., Frank, R. G., Schulberg, H. C., & Kamlet, M. S. (1998). Cost-effectiveness of treatments for major depression in primary care practice. Archives of General Psychiatry, 55, 645–651.CrossRefPubMed Lave, J. R., Frank, R. G., Schulberg, H. C., & Kamlet, M. S. (1998). Cost-effectiveness of treatments for major depression in primary care practice. Archives of General Psychiatry, 55, 645–651.CrossRefPubMed
Zurück zum Zitat Lynch, F. L., Dickerson, J. F., Clarke, G., Vitiello, B., Porta, G., Wagner, K. D., Emslie, G., & Brent, D. (2011). Incremental cost-effectiveness of combined therapy versus medication only for youth with SSRI resistant depression: Findings from the TORDIA trial. Archives of General Psychiatry, 68, 253–262.CrossRefPubMedPubMedCentral Lynch, F. L., Dickerson, J. F., Clarke, G., Vitiello, B., Porta, G., Wagner, K. D., Emslie, G., & Brent, D. (2011). Incremental cost-effectiveness of combined therapy versus medication only for youth with SSRI resistant depression: Findings from the TORDIA trial. Archives of General Psychiatry, 68, 253–262.CrossRefPubMedPubMedCentral
Zurück zum Zitat Merry, S. N., Hetrick, S. E., Cox, G. R., Brudevold-Iversen, T., Bir, J. J., & McDowell, H. (2012). Psychological and educational interventions for preventing depression in children and adolescents (Review). Evidence-based Child Health: A Cochrane Review Journal, 7, 1409–1685.CrossRef Merry, S. N., Hetrick, S. E., Cox, G. R., Brudevold-Iversen, T., Bir, J. J., & McDowell, H. (2012). Psychological and educational interventions for preventing depression in children and adolescents (Review). Evidence-based Child Health: A Cochrane Review Journal, 7, 1409–1685.CrossRef
Zurück zum Zitat Radloff, L. (1991). The use of the center for epidemiologic studies depression scale in adolescents and young adults. Journal of Youth and Adolescence, 20, 149–166.CrossRefPubMed Radloff, L. (1991). The use of the center for epidemiologic studies depression scale in adolescents and young adults. Journal of Youth and Adolescence, 20, 149–166.CrossRefPubMed
Zurück zum Zitat Rice, F., Lifford, K. J., Thomas, H. V., & Thapar, A. (2007). Mental health and functional outcomes of maternal and adolescent reports of adolescent depressive symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1162–1170.CrossRefPubMed Rice, F., Lifford, K. J., Thomas, H. V., & Thapar, A. (2007). Mental health and functional outcomes of maternal and adolescent reports of adolescent depressive symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1162–1170.CrossRefPubMed
Zurück zum Zitat Robin, A. L., & Weiss, J. G. (1980). Criterion-related validity of behavioral and self-report measures of problem-solving communication skills in distressed and nondistressed parent-adolescent dyads. Behavioral Assessment, 2, 339–352. Robin, A. L., & Weiss, J. G. (1980). Criterion-related validity of behavioral and self-report measures of problem-solving communication skills in distressed and nondistressed parent-adolescent dyads. Behavioral Assessment, 2, 339–352.
Zurück zum Zitat Schludermann, E., & Schludermann, S. (1970). Replicability of factors in children’s report of parent behavior (CRPBI). Journal of Psychology, 76, 239–249.CrossRef Schludermann, E., & Schludermann, S. (1970). Replicability of factors in children’s report of parent behavior (CRPBI). Journal of Psychology, 76, 239–249.CrossRef
Zurück zum Zitat Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., & Aluwahlia, S. (1983). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228–31.CrossRefPubMed Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., & Aluwahlia, S. (1983). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228–31.CrossRefPubMed
Zurück zum Zitat Silva, R. R., Alpert, M., Pouget, E., Silva, V., Trosper, S., Reyes, K., & Dummit, S. (2005). A rating scale for disruptive behavior disorders, based on the DSM-IV item pool. Psychiatric Quarterly, 76, 327–339.CrossRefPubMed Silva, R. R., Alpert, M., Pouget, E., Silva, V., Trosper, S., Reyes, K., & Dummit, S. (2005). A rating scale for disruptive behavior disorders, based on the DSM-IV item pool. Psychiatric Quarterly, 76, 327–339.CrossRefPubMed
Zurück zum Zitat Stice, E., Shaw, H., Bohon, C., Marti, C. N., & Rohde, P. (2009). A meta-analytic review of depression prevention programs for children and adolescents: Factors that predict magnitude of intervention effects. Journal of Consulting and Clinical Psychology, 77, 486–503.CrossRefPubMedPubMedCentral Stice, E., Shaw, H., Bohon, C., Marti, C. N., & Rohde, P. (2009). A meta-analytic review of depression prevention programs for children and adolescents: Factors that predict magnitude of intervention effects. Journal of Consulting and Clinical Psychology, 77, 486–503.CrossRefPubMedPubMedCentral
Zurück zum Zitat Vannoy, S., Arean, P., & Unützer, J. (2010). Advantages of using estimated depression-free days for evaluating treatment efficacy. Psychiatric Services, 61, 160–163.CrossRefPubMedPubMedCentral Vannoy, S., Arean, P., & Unützer, J. (2010). Advantages of using estimated depression-free days for evaluating treatment efficacy. Psychiatric Services, 61, 160–163.CrossRefPubMedPubMedCentral
Zurück zum Zitat Weersing, V. R., Shamseddeen, W., Garber, J., Hollon, S. D., Clarke, G. N., Beardslee, W. R., Gladstone, T. R., Lynch, F. L., Porta, G., Iyengar, S., & Brent, D. A. (2016). Prevention of depression in at-risk adolescents: Predictors and moderators of acute effects. Journal of the American Academy of Child and Adolescent Psychiatry. Weersing, V. R., Shamseddeen, W., Garber, J., Hollon, S. D., Clarke, G. N., Beardslee, W. R., Gladstone, T. R., Lynch, F. L., Porta, G., Iyengar, S., & Brent, D. A. (2016). Prevention of depression in at-risk adolescents: Predictors and moderators of acute effects.  Journal of the American Academy of Child and Adolescent Psychiatry.
Zurück zum Zitat Zhang, H. P., & Singer, B. (1999). Recursive partitioning in the health sciences. New York: Springer.CrossRef Zhang, H. P., & Singer, B. (1999). Recursive partitioning in the health sciences. New York: Springer.CrossRef
Metadaten
Titel
Prevention of Depression in At-Risk Adolescents: Moderators of Long-term Response
verfasst von
J. Garber
V. R. Weersing
S. D. Hollon
G. Porta
G. N. Clarke
J. F. Dickerson
W. R. Beardslee
F. L. Lynch
T. G. Gladstone
W. Shamseddeen
D. A. Brent
Publikationsdatum
01.02.2016
Verlag
Springer US
Erschienen in
Prevention Science / Ausgabe Sonderheft 1/2018
Print ISSN: 1389-4986
Elektronische ISSN: 1573-6695
DOI
https://doi.org/10.1007/s11121-015-0626-z

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