Long-Term Benefits with Cognitive-Behavioral Program for Depression

The effects of a cognitive-behavioral prevention program for depression appear to be maintained for more than 6 years among teens who are at risk for developing depression and functional impairment, according to the results of a study published online September 30, 2015 in JAMA Psychiatry.

Whereas prior research has shown that adolescents whose parents have a history of depression are at risk for developing depression and functional impairment, the long-term effects of prevention programs on adolescent depression and functioning have not been well known.

For the study, David A. Brent, MD, Endowed Chair in Suicide Studies and Professor of Psychiatry, Pediatrics, Epidemiology, and Clinical and Translational Science at the University of Pittsburgh School of Medicine, and colleagues, randomly assigned 316 patients aged 13 to 17 years at enrollment who had at least one parent with current or prior depressive episodes to a cognitive-behavioral prevention program or usual care.

Participants could not be in a current depressive episode but had to have subsyndromal depressive symptoms or a prior depressive episode currently in remission. The program included eight weekly, 90-minute group sessions followed by six monthly continuation sessions. Usual care consisted of any family-initiated mental health treatment.

During the 75-month follow-up period, teens assigned to the cognitive behavioral program had a lower incidence of depression, even after adjustment for current parental depression at enrollment, site, and all interactions. The program’s overall significant effect was driven by a lower incidence of depressive episodes during the first 9 months after enrollment.

Benefits of the program were also seen in teens whose index parent was not depressed at the time of enrollment into the study, on depression incidence, and on developmental competence, or educational and occupational attainment, romantic relationships, family and peer relationships, and life satisfaction; these effects on developmental competence were mediated via the program’s effect on depression-free days.

“Overall, these findings demonstrate the effectiveness of [cognitive-behavioral programs] for preventing depression and promoting competence, but they also highlight 3 potential improvements to [cognitive-behavioral programs],” wrote the authors.

“First, the main beneficial effect on the onset of new depression episodes occurred over the course of the intervention, suggesting that booster sessions might help extend these effects on new onsets even further in time,” they wrote.

“Second, [the cognitive-behavioral program] was not effective if the index parent was depressed at baseline, highlighting the possible importance of treating parental depression, either prior to or concomitant with their children's participation in the [cognitive-behavioral] program. Third, [program] is focused exclusively on the adolescent. Interventions that also improve parenting and the quality of the parent-child relationship have been shown to have long-lasting benefits on a range of both externalizing and internalizing symptoms. Nevertheless, the current findings showed that [the program] forms the basis of a promising intervention and that the prevention of depression is possible and can have longer-term developmental consequences,” the authors concluded.