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Reducing Depression and Anxiety during Adolescence: Prevention Effects Compared to a Natural History Control Group

Thu, April 8, 1:10 to 2:40pm EDT (1:10 to 2:40pm EDT), Virtual

Abstract

Adolescent depression is a significant public health problem. As such, it is important to examine whether depression prevention programs can reduce depressive symptoms and prevent the onset of depressive disorders during this critical stage of development. Given the high comorbidity between depression and anxiety, and preliminary evidence that depression prevention programs may have a transdiagnostic effect on a range of symptoms, it is also important to examine whether preventive interventions for depression alter trajectories of anxiety symptoms. In the current study, adolescents were randomized to one of two evidence-based depression prevention programs and compared to a propensity-score-matched natural history control group. The primary outcome was the prospective incidence of depressive disorders. Secondary outcomes were rates of change in depression and anxiety symptoms. We hypothesized that adolescents receiving a prevention program would show lower rates of depression disorder onset and reductions in depression and anxiety symptoms over time compared to the control group.

In a two-site randomized controlled trial, 204 adolescents (M = 14.26 years, 56% female) were randomized to Coping with Stress (CWS), a cognitive-behavioral program, or Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), an interpersonal program. The 204 prevention adolescents who received either CWS or IPT-AST were compared to a matched natural history control group of 204 adolescents (M = 13.74 years, 55% female) who were assessed prospectively in an accelerated longitudinal cohort study. Depression diagnoses and depression and anxiety symptoms were assessed through 21-month follow-up.

We used logistic regression to examine differences in rates of depression diagnoses over 21 months between the 204 adolescents who received a prevention program and the 204 matched controls. To examine differences in rates of change in depression and anxiety symptoms over time, we implemented a piecewise 2-level hierarchical linear model (HLM). Prevention adolescents had significantly fewer depression diagnoses than control adolescents during the study period (18% versus 35%), t(402) = 3.36, p < .001, Number Needed to Treat (NNT) = 5.88, Incidence Rate Ratio (IRR) = .51. From baseline through post-intervention, prevention youth showed greater reductions in anxiety symptoms, but not depression symptoms, than control youth. Interestingly, from post-intervention through 21-month follow-up youth in the control group showed greater reductions in depression and anxiety symptoms than youth in the prevention group (see Tables 1 and 2). This resulted in no significant differences in rates of change in depression or anxiety symptoms between prevention and control youth over the entire study period (baseline through 21 months).

Based on the IRR, our findings indicate that evidence-based depression prevention programs can reduce the incidence of depression by 49% as compared to a natural history control group. Despite large effects for reducing incidence of depression diagnoses, we found minimal impact of these prevention programs on depressive symptoms and short-term effects on anxiety symptoms, which did not persist through follow-up. Study results underscore the potential benefits and public health impact of depression prevention programs, particularly on depressive disorder incidence.

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