Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects
Objective To assess predictors and moderators of a cognitive-behavioral prevention (CBP) program for adolescent offspring of parents with depression. Method This 4-site randomized trial evaluated CBP compared to usual community care (UC) in 310 adolescents with familial (parental depression) and ind...
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| Veröffentlicht in: | Journal of the American Academy of Child and Adolescent Psychiatry 2016-03, Vol.55 (3), p.219-226 |
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| creator | Weersing, V. Robin, PhD Shamseddeen, Wael, MD Garber, Judy, PhD Hollon, Steven D., PhD Clarke, Gregory N., PhD Beardslee, William R., MD Gladstone, Tracy R., PhD Lynch, Frances L., PhD Porta, Giovanna, MS Iyengar, Satish, PhD Brent, David A., MD |
| description | Objective To assess predictors and moderators of a cognitive-behavioral prevention (CBP) program for adolescent offspring of parents with depression. Method This 4-site randomized trial evaluated CBP compared to usual community care (UC) in 310 adolescents with familial (parental depression) and individual (youth history of depression or current subsyndromal symptoms) risk for depression. As previously reported by Garber and colleagues, a significant prevention effect favored CBP through 9 months; however, outcomes of CBP and UC did not significantly differ when parents were depressed at baseline. The current study expanded on these analyses and examined a range of demographic, clinical, and contextual characteristics of families as predictors and moderators and used recursive partitioning to construct a classification tree to organize clinical response subgroups. Results Depression onset was predicted by lower functioning (hazard ratio [HR] = 0.95, 95% CI = 0.92–0.98) and higher hopelessness (HR = 1.06, 95% CI = 1.01–1.11) in adolescents. The superior effect of CBP was diminished when parents were currently depressed at baseline (HR = 6.38, 95% CI = 2.38–17.1) or had a history of hypomania (HR = 67.5, 95% CI = 10.9–417.1), or when adolescents reported higher depressive symptoms (HR = 1.04, 95% CI = 1.00–1.08), higher anxiety (HR = 1.05, 95% CI = 1.01–1.08), higher hopelessness (HR = 1.10, 95% CI = 1.01–1.20), or lower functioning (HR = 0.94, 95% CI = 0.89–1.00) at baseline. Onset rates varied significantly by clinical response cluster (0%–57%). Conclusion Depression in adolescents can be prevented, but programs may produce superior effects when timed at moments of relative wellness in high-risk families. Future programs may be enhanced by targeting modifiable negative clinical indicators of response. Clinical trial registration information : Prevention of Depression in At-Risk Adolescents; http://clinicaltrials.gov/ ; NCT00073671 |
| doi_str_mv | 10.1016/j.jaac.2015.12.015 |
| format | Article |
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Robin, PhD ; Shamseddeen, Wael, MD ; Garber, Judy, PhD ; Hollon, Steven D., PhD ; Clarke, Gregory N., PhD ; Beardslee, William R., MD ; Gladstone, Tracy R., PhD ; Lynch, Frances L., PhD ; Porta, Giovanna, MS ; Iyengar, Satish, PhD ; Brent, David A., MD</creator><creatorcontrib>Weersing, V. Robin, PhD ; Shamseddeen, Wael, MD ; Garber, Judy, PhD ; Hollon, Steven D., PhD ; Clarke, Gregory N., PhD ; Beardslee, William R., MD ; Gladstone, Tracy R., PhD ; Lynch, Frances L., PhD ; Porta, Giovanna, MS ; Iyengar, Satish, PhD ; Brent, David A., MD</creatorcontrib><description>Objective To assess predictors and moderators of a cognitive-behavioral prevention (CBP) program for adolescent offspring of parents with depression. Method This 4-site randomized trial evaluated CBP compared to usual community care (UC) in 310 adolescents with familial (parental depression) and individual (youth history of depression or current subsyndromal symptoms) risk for depression. As previously reported by Garber and colleagues, a significant prevention effect favored CBP through 9 months; however, outcomes of CBP and UC did not significantly differ when parents were depressed at baseline. The current study expanded on these analyses and examined a range of demographic, clinical, and contextual characteristics of families as predictors and moderators and used recursive partitioning to construct a classification tree to organize clinical response subgroups. Results Depression onset was predicted by lower functioning (hazard ratio [HR] = 0.95, 95% CI = 0.92–0.98) and higher hopelessness (HR = 1.06, 95% CI = 1.01–1.11) in adolescents. The superior effect of CBP was diminished when parents were currently depressed at baseline (HR = 6.38, 95% CI = 2.38–17.1) or had a history of hypomania (HR = 67.5, 95% CI = 10.9–417.1), or when adolescents reported higher depressive symptoms (HR = 1.04, 95% CI = 1.00–1.08), higher anxiety (HR = 1.05, 95% CI = 1.01–1.08), higher hopelessness (HR = 1.10, 95% CI = 1.01–1.20), or lower functioning (HR = 0.94, 95% CI = 0.89–1.00) at baseline. Onset rates varied significantly by clinical response cluster (0%–57%). Conclusion Depression in adolescents can be prevented, but programs may produce superior effects when timed at moments of relative wellness in high-risk families. Future programs may be enhanced by targeting modifiable negative clinical indicators of response. Clinical trial registration information : Prevention of Depression in At-Risk Adolescents; http://clinicaltrials.gov/ ; NCT00073671</description><identifier>ISSN: 0890-8567</identifier><identifier>EISSN: 1527-5418</identifier><identifier>DOI: 10.1016/j.jaac.2015.12.015</identifier><identifier>PMID: 26903255</identifier><identifier>CODEN: JAAPEE</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute effects ; Adolescent ; Adolescents ; Anxiety ; Anxiety-Depression ; At risk ; At risk youth ; Causality ; Child & adolescent psychiatry ; Child of Impaired Parents - psychology ; Classification ; Clinical indicators ; Cognitive ability ; Cognitive Behavioral Therapy - methods ; Cognitive-behavioral factors ; cognitive-behavioral therapy ; Community health care ; Contextual factors ; Demography ; Depression ; Depression - prevention & control ; Depression - psychology ; Depressive Disorder - diagnosis ; Depressive Disorder - prevention & control ; Family - psychology ; Female ; High risk ; Hopelessness ; Humans ; Hypomania ; Male ; Mental depression ; Moderators ; Parental depression ; Parents & parenting ; Parents - psychology ; Pediatrics ; prevention ; Prevention programs ; Psychiatry ; Risk Factors ; Risk groups</subject><ispartof>Journal of the American Academy of Child and Adolescent Psychiatry, 2016-03, Vol.55 (3), p.219-226</ispartof><rights>American Academy of Child and Adolescent Psychiatry</rights><rights>2016 American Academy of Child and Adolescent Psychiatry</rights><rights>Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Lippincott Williams & Wilkins Mar 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c538t-213d48eaae1f0d7b0f6e7c396bd5cbd2180738f97f7c1805968fa0e8b91183f93</citedby><cites>FETCH-LOGICAL-c538t-213d48eaae1f0d7b0f6e7c396bd5cbd2180738f97f7c1805968fa0e8b91183f93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0890856716000356$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,30976,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26903255$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Weersing, V. Robin, PhD</creatorcontrib><creatorcontrib>Shamseddeen, Wael, MD</creatorcontrib><creatorcontrib>Garber, Judy, PhD</creatorcontrib><creatorcontrib>Hollon, Steven D., PhD</creatorcontrib><creatorcontrib>Clarke, Gregory N., PhD</creatorcontrib><creatorcontrib>Beardslee, William R., MD</creatorcontrib><creatorcontrib>Gladstone, Tracy R., PhD</creatorcontrib><creatorcontrib>Lynch, Frances L., PhD</creatorcontrib><creatorcontrib>Porta, Giovanna, MS</creatorcontrib><creatorcontrib>Iyengar, Satish, PhD</creatorcontrib><creatorcontrib>Brent, David A., MD</creatorcontrib><title>Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects</title><title>Journal of the American Academy of Child and Adolescent Psychiatry</title><addtitle>J Am Acad Child Adolesc Psychiatry</addtitle><description>Objective To assess predictors and moderators of a cognitive-behavioral prevention (CBP) program for adolescent offspring of parents with depression. Method This 4-site randomized trial evaluated CBP compared to usual community care (UC) in 310 adolescents with familial (parental depression) and individual (youth history of depression or current subsyndromal symptoms) risk for depression. As previously reported by Garber and colleagues, a significant prevention effect favored CBP through 9 months; however, outcomes of CBP and UC did not significantly differ when parents were depressed at baseline. The current study expanded on these analyses and examined a range of demographic, clinical, and contextual characteristics of families as predictors and moderators and used recursive partitioning to construct a classification tree to organize clinical response subgroups. Results Depression onset was predicted by lower functioning (hazard ratio [HR] = 0.95, 95% CI = 0.92–0.98) and higher hopelessness (HR = 1.06, 95% CI = 1.01–1.11) in adolescents. The superior effect of CBP was diminished when parents were currently depressed at baseline (HR = 6.38, 95% CI = 2.38–17.1) or had a history of hypomania (HR = 67.5, 95% CI = 10.9–417.1), or when adolescents reported higher depressive symptoms (HR = 1.04, 95% CI = 1.00–1.08), higher anxiety (HR = 1.05, 95% CI = 1.01–1.08), higher hopelessness (HR = 1.10, 95% CI = 1.01–1.20), or lower functioning (HR = 0.94, 95% CI = 0.89–1.00) at baseline. Onset rates varied significantly by clinical response cluster (0%–57%). Conclusion Depression in adolescents can be prevented, but programs may produce superior effects when timed at moments of relative wellness in high-risk families. Future programs may be enhanced by targeting modifiable negative clinical indicators of response. Clinical trial registration information : Prevention of Depression in At-Risk Adolescents; http://clinicaltrials.gov/ ; NCT00073671</description><subject>Acute effects</subject><subject>Adolescent</subject><subject>Adolescents</subject><subject>Anxiety</subject><subject>Anxiety-Depression</subject><subject>At risk</subject><subject>At risk youth</subject><subject>Causality</subject><subject>Child & adolescent psychiatry</subject><subject>Child of Impaired Parents - psychology</subject><subject>Classification</subject><subject>Clinical indicators</subject><subject>Cognitive ability</subject><subject>Cognitive Behavioral Therapy - methods</subject><subject>Cognitive-behavioral factors</subject><subject>cognitive-behavioral therapy</subject><subject>Community health care</subject><subject>Contextual factors</subject><subject>Demography</subject><subject>Depression</subject><subject>Depression - prevention & control</subject><subject>Depression - psychology</subject><subject>Depressive Disorder - diagnosis</subject><subject>Depressive Disorder - prevention & control</subject><subject>Family - psychology</subject><subject>Female</subject><subject>High risk</subject><subject>Hopelessness</subject><subject>Humans</subject><subject>Hypomania</subject><subject>Male</subject><subject>Mental depression</subject><subject>Moderators</subject><subject>Parental depression</subject><subject>Parents & parenting</subject><subject>Parents - psychology</subject><subject>Pediatrics</subject><subject>prevention</subject><subject>Prevention programs</subject><subject>Psychiatry</subject><subject>Risk Factors</subject><subject>Risk groups</subject><issn>0890-8567</issn><issn>1527-5418</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNp9Uk1v1DAQtRCILoU_wAFF4sIlwR_r2Eao0qqUD6kIxMeJg-XYY3Cajbd2slL_PQ5bCvTAaTzye0_z5g1CjwluCCbt877pjbENxYQ3hDal3EErwqmo-ZrIu2iFpcK15K04Qg9y7jHGREh5Hx3RVmFGOV-hbx8T7GGcQhyr6KtXsEuQ89KFsdpM9aeQL6qNiwNkW2D5RVUILtgpplyZ0VXvo4NkfrWFv7HzBNWZ92Cn_BDd82bI8Oi6HqOvr8--nL6tzz-8eXe6Oa8tZ3KqKWFuLcEYIB470WHfgrBMtZ3jtnOUSCyY9Ep4Ycubq1Z6g0F2ihDJvGLH6OSgu5u7LbhlzmQGvUtha9KVjibof3_G8EN_j3u9FpIRvgg8uxZI8XKGPOltKHaHwYwQ56yJaIUia6ZIgT69Be3jnMZir6AEVgxLSQuKHlA2xZwT-JthCNZLdrrXS3Z6yU4TqksppCd_27ih_A6rAF4eAFCWuQ-QdLYBRlvySGXf2sXwf_2TW3Q7hDFYM1zAFeQ_PnQuBP15uZ7leEhbDofxlv0EGYS_xg</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Weersing, V. Robin, PhD</creator><creator>Shamseddeen, Wael, MD</creator><creator>Garber, Judy, PhD</creator><creator>Hollon, Steven D., PhD</creator><creator>Clarke, Gregory N., PhD</creator><creator>Beardslee, William R., MD</creator><creator>Gladstone, Tracy R., PhD</creator><creator>Lynch, Frances L., PhD</creator><creator>Porta, Giovanna, MS</creator><creator>Iyengar, Satish, PhD</creator><creator>Brent, David A., MD</creator><general>Elsevier Inc</general><general>Elsevier BV</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160301</creationdate><title>Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects</title><author>Weersing, V. Robin, PhD ; Shamseddeen, Wael, MD ; Garber, Judy, PhD ; Hollon, Steven D., PhD ; Clarke, Gregory N., PhD ; Beardslee, William R., MD ; Gladstone, Tracy R., PhD ; Lynch, Frances L., PhD ; Porta, Giovanna, MS ; Iyengar, Satish, PhD ; Brent, David A., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c538t-213d48eaae1f0d7b0f6e7c396bd5cbd2180738f97f7c1805968fa0e8b91183f93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acute effects</topic><topic>Adolescent</topic><topic>Adolescents</topic><topic>Anxiety</topic><topic>Anxiety-Depression</topic><topic>At risk</topic><topic>At risk youth</topic><topic>Causality</topic><topic>Child & adolescent psychiatry</topic><topic>Child of Impaired Parents - psychology</topic><topic>Classification</topic><topic>Clinical indicators</topic><topic>Cognitive ability</topic><topic>Cognitive Behavioral Therapy - methods</topic><topic>Cognitive-behavioral factors</topic><topic>cognitive-behavioral therapy</topic><topic>Community health care</topic><topic>Contextual factors</topic><topic>Demography</topic><topic>Depression</topic><topic>Depression - prevention & control</topic><topic>Depression - psychology</topic><topic>Depressive Disorder - diagnosis</topic><topic>Depressive Disorder - prevention & control</topic><topic>Family - psychology</topic><topic>Female</topic><topic>High risk</topic><topic>Hopelessness</topic><topic>Humans</topic><topic>Hypomania</topic><topic>Male</topic><topic>Mental depression</topic><topic>Moderators</topic><topic>Parental depression</topic><topic>Parents & parenting</topic><topic>Parents - psychology</topic><topic>Pediatrics</topic><topic>prevention</topic><topic>Prevention programs</topic><topic>Psychiatry</topic><topic>Risk Factors</topic><topic>Risk groups</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Weersing, V. Robin, PhD</creatorcontrib><creatorcontrib>Shamseddeen, Wael, MD</creatorcontrib><creatorcontrib>Garber, Judy, PhD</creatorcontrib><creatorcontrib>Hollon, Steven D., PhD</creatorcontrib><creatorcontrib>Clarke, Gregory N., PhD</creatorcontrib><creatorcontrib>Beardslee, William R., MD</creatorcontrib><creatorcontrib>Gladstone, Tracy R., PhD</creatorcontrib><creatorcontrib>Lynch, Frances L., PhD</creatorcontrib><creatorcontrib>Porta, Giovanna, MS</creatorcontrib><creatorcontrib>Iyengar, Satish, PhD</creatorcontrib><creatorcontrib>Brent, David A., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American Academy of Child and Adolescent Psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Weersing, V. Robin, PhD</au><au>Shamseddeen, Wael, MD</au><au>Garber, Judy, PhD</au><au>Hollon, Steven D., PhD</au><au>Clarke, Gregory N., PhD</au><au>Beardslee, William R., MD</au><au>Gladstone, Tracy R., PhD</au><au>Lynch, Frances L., PhD</au><au>Porta, Giovanna, MS</au><au>Iyengar, Satish, PhD</au><au>Brent, David A., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects</atitle><jtitle>Journal of the American Academy of Child and Adolescent Psychiatry</jtitle><addtitle>J Am Acad Child Adolesc Psychiatry</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>55</volume><issue>3</issue><spage>219</spage><epage>226</epage><pages>219-226</pages><issn>0890-8567</issn><eissn>1527-5418</eissn><coden>JAAPEE</coden><abstract>Objective To assess predictors and moderators of a cognitive-behavioral prevention (CBP) program for adolescent offspring of parents with depression. Method This 4-site randomized trial evaluated CBP compared to usual community care (UC) in 310 adolescents with familial (parental depression) and individual (youth history of depression or current subsyndromal symptoms) risk for depression. As previously reported by Garber and colleagues, a significant prevention effect favored CBP through 9 months; however, outcomes of CBP and UC did not significantly differ when parents were depressed at baseline. The current study expanded on these analyses and examined a range of demographic, clinical, and contextual characteristics of families as predictors and moderators and used recursive partitioning to construct a classification tree to organize clinical response subgroups. Results Depression onset was predicted by lower functioning (hazard ratio [HR] = 0.95, 95% CI = 0.92–0.98) and higher hopelessness (HR = 1.06, 95% CI = 1.01–1.11) in adolescents. The superior effect of CBP was diminished when parents were currently depressed at baseline (HR = 6.38, 95% CI = 2.38–17.1) or had a history of hypomania (HR = 67.5, 95% CI = 10.9–417.1), or when adolescents reported higher depressive symptoms (HR = 1.04, 95% CI = 1.00–1.08), higher anxiety (HR = 1.05, 95% CI = 1.01–1.08), higher hopelessness (HR = 1.10, 95% CI = 1.01–1.20), or lower functioning (HR = 0.94, 95% CI = 0.89–1.00) at baseline. Onset rates varied significantly by clinical response cluster (0%–57%). Conclusion Depression in adolescents can be prevented, but programs may produce superior effects when timed at moments of relative wellness in high-risk families. Future programs may be enhanced by targeting modifiable negative clinical indicators of response. Clinical trial registration information : Prevention of Depression in At-Risk Adolescents; http://clinicaltrials.gov/ ; NCT00073671</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26903255</pmid><doi>10.1016/j.jaac.2015.12.015</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute effects Adolescent Adolescents Anxiety Anxiety-Depression At risk At risk youth Causality Child & adolescent psychiatry Child of Impaired Parents - psychology Classification Clinical indicators Cognitive ability Cognitive Behavioral Therapy - methods Cognitive-behavioral factors cognitive-behavioral therapy Community health care Contextual factors Demography Depression Depression - prevention & control Depression - psychology Depressive Disorder - diagnosis Depressive Disorder - prevention & control Family - psychology Female High risk Hopelessness Humans Hypomania Male Mental depression Moderators Parental depression Parents & parenting Parents - psychology Pediatrics prevention Prevention programs Psychiatry Risk Factors Risk groups |
| title | Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects |
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