Adolescent Coping with Stress

ADOLESCENT COPING WITH STRESS

OVERVIEW

A cognitive-behavioral therapy program was developed to prevent depression among adolescents who had had an episode of depression or who were found to be at-risk for depression by teaching strategies to identify and question negative, pessimistic and irrational thoughts related to their parents’ mental health. In the initial experimental study, the offspring of adults currently or recently treated for depression were randomly assigned to a treatment or control group. Significantly fewer adolescents randomly assigned to attend group therapy sessions developed depression or had depressive episodes compared with adolescents assigned to the control group. Though the magnitude of the impacts diminished over time, these impacts were significant at 12, 18, and 24 months following the intervention. Overall findings from this study were replicated in a 2009 study across four sites. Among those in the prevention program, the incidence of depressive episodes was significantly lower compared with those in the usual care control group. However, while the prevention program was more effective than usual care in preventing the onset of depression among participants whose parents were not currently depressed, the authors found that the prevention program was not more effective than usual care among participants whose parents were currently depressed.

DESCRIPTION OF PROGRAM

Target population: adolescents and youth at-risk for depressive episodes.

Clarke and Lewinsohn’s Adolescent Coping with Stress depression prevention program consists of 15 one-hour sessions for groups of six to ten adolescents. These sessions are led by a trained therapist and are intended to teach adolescents specific techniques to help them identify and overcome negative and unrealistic thoughts related to their parents’ depression. The 2009 study used a modified approach, comprising 8 weekly 90-minute sessions (acute) followed by 6 monthly sessions (continuation). Adolescents, regardless of their randomization condition in the study, were permitted to continue any mental health services or their usual care.

A 2005 study by Lynch, et al. determined the average cost per participant was $1,632

EVALUATION(S) OF PROGRAM

Clarke GN, Hornbrook MC, Lynch F, Polen M, Gale J, Beardslee W, O'Connor E, 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(12), 1127-1134.

Evaluated population: 31 male and 56 female offspring of adults recently or currently treated for depression aged 13 to 18 served as the subjects for this study.

Approach: Adolescents were recruited though adults who had received antidepressant medication, mental health care visits, or a diagnosis of depression in the past 12 months through one health maintenance organization (HMO). Of all contacted offspring, 94 agreed to participate and were randomly assigned to the treatment group (47) or the control group (40).

The treatment group participated in 15 therapist-led one-hour sessions in groups of 6-10. Therapists used the Adolescents Coping with Stress curriculum to teach adolescents on how to overcome unrealistic, irrational and negative thoughts related to their parents’ depression. The control group and treatment groups were both allowed to participate in their otherwise usual care.

Results: Pre-intervention, there were no significant differences between groups on current or past psychiatric disorders or other demographic or psychosocial measures.

Post-intervention measures of depression revealed a significant difference between measures of depression between adolescents in the treatment group and in the control group.

Adolescents in the treatment group had significantly fewer depressive episodes by the 1-year follow-up when compared with adolescents in the control group (9.3% vs. 28.8%, a medium effect size of 0.57). This difference between the treatment and control groups persisted at the 18- and 24-month follow-ups but the difference between the groups was not as great. The authors call for strategies to extend the preventive impacts.

Self-report of the number of depressed days experienced by adolescents in the year after intake was significantly less for adolescents in the treatment group compared with the control group. Also, fewer suicide items were reported by adolescents in the treatment condition.

There was no difference between groups in behavior problems, non-affective disorders, or the time to the development of a new episode of a nonaffective disorder.

Garber J, Clarke GN, Weersing VR, Beardslee WR, Brent DA, Gladstone TRG, DeBar LL, Lynch FL, D’Angelo E, Hollon SD, Shamseddeen W, Iyengar S (2009). Prevention of depression in at-risk adolescents: A randomized control trial. Journal of the American Medical Association, 301(21):2215-2224.

Evaluated population: 316 adolescents (13 to 17 years of age) from Nashville, TN; Pittsburgh, PA; Portland, OR; and Boston, MA. Adolescents had a past history of depression and/or current depressive symptoms, parent(s) with current or past depressive disorder. More than one-half of adolescents (59%) were female; more than 80% were white and approximately 7% were Latino. More than three-quarters of adolescents’ parents (77%) had a high school education or below.

Approach: Participants were recruited through HMO computerized databases, letters to physicians and parents, and media advertisements. Researchers randomly assigned participants either to the cognitive-behavioral prevention program group (n=159) or the usual care control group (n=157). Participants were equally broken down among the sites (approximately n=79).

Results: Through the 9-month follow-up, the incidence of depressive episodes was significantly lower for those in the prevention program compared with those in usual care (21.4% and 32.7%, respectively). Additionally, participants in the prevention program showed significantly greater improvement in self-reported depressive symptoms compared with usual care. However, while the prevention program was more effective than usual care in preventing the onset of depression among participants whose parents were not currently depressed (11.7% and 40.5%, respectively), the authors found that the prevention program was not significantly more effective than usual care among participants whose parents were currently depressed at study entry (31.2% and 24.3%, respectively). The authors note these latter findings suggest the need for additional studies examining combined or sequential parental and adolescent depression treatment and prevention.

SOURCES FOR MORE INFORMATION

Program materials are available free of charge from the Kaiser Permanente Center for Health Research at http://www.kpchr.org/public/acwd/acwd.html

The 15-session curriculum developed by Clarke and Lewinsohn (1995), and included in the noted studies, is available at the following link: http://www.mentalhealthpromotion.net/resources/copingwithstress_therapistmanual.pdf

References:

Lynch, Frances L., Mark Hornbrook, Gregory N. Clarke, Nancy Perrin, Michael R. Polen, Elizabeth O'Connor, and John Dickerson, "Cost-Effectiveness of an Intervention to Prevent Depression in At-Risk Teens," Archives of General Psychiatry, Vol. 62, No. 11, 2005, pp. 1241-1248.

Program categorized in this guide according to the following:

Evaluated participant ages: 13-18

Program age ranges in the guide: Adolescence, Youth

Program components: Counseling/Therapy, Clinic/Provider-Based

Measured outcomes: Mental Health

KEYWORDS: Adolescence (12-17), Young Adulthood (17-24), Youth (16+), High-Risk, High School, White or Caucasian, Clinic-based, Counseling/Therapy, Urban, Suburban, Mental Health, Social Emotional Health, Depression, Anxiety, Mood Disorder, Bipolar, Behavioral Problems, Disruptive Behavior Disorders, Oppositional Defiant Disorder, Attention-Deficit Hyperactivity Disorder, Conduct Disorder, Substance Use, Alcohol Use, Marijuana Use, Physical Health, Social/Emotional Health, cost, manual

Program information last updated on 7/1/09.

		© Child Trends 2003