Academic journal article Journal of Cognitive Psychotherapy

The Prevention of Depression in At-Risk Adolescents: Current and Future Directions

Academic journal article Journal of Cognitive Psychotherapy

The Prevention of Depression in At-Risk Adolescents: Current and Future Directions

Article excerpt

Beardslee's (1990) innovative research on preventive intervention for youth depression will be introduced. Beardslee and colleagues have focused their work on families with parental affective disorder, with the goal of preventing the onset of disorder in nonsymptomatic early adolescents aged 8 to 15 years. In a longitudinal study of 100 families, Beardslee and colleagues have developed, implemented, and evaluated two preventive intervention protocols (clinician-facilitated and lecture) designed to promote resilient traits and to modify the risk factors associated with parental affective illness. These protocols are outlined, initial results are reported, and implications for the prevention of disorder in at-risk youth will be discussed. In addition, research directions we are currently pursuing, and future directions for research, are introduced.

Depression in children and adolescents is a serious public health concern. Epidemiologic studies indicate that point prevalence rates of depression in children and adolescents range from 0.4% to 8.3% (Birmaher, Ryan, Williamson, Brent, & Kaufman, 1996), and that lifetime prevalence rates of depression are comparable to adult levels (Fleming & Offord, 1990; Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993). Other data indicate that depression in childhood and adolescence recurs and is associated with other forms of psychopathology, including anxiety disorders, conduct disorder, and attention deficit disorder (Kovacs, Gatsonis, Paulauskas, & Richards, 1989).

Because depression in youth has been correlated with a number of psychiatric and interpersonal difficulties that persist through adolescence and into adulthood (Mufson, Moreau, Weissman, & Klerman, 1993), researchers have focused efforts on the design, implementation, and evaluation of tertiary treatment interventions (i.e., psychosocial responses to the diagnosis of depression in youth). Psychosocial treatments known to be effective with depressed adults have been adapted for adolescents (e.g., Clarke, Lewinsohn, & Hops, 1990), and results from studies testing these treatments generally have been positive (e.g., Birmaher et al., 1996). Several controlled intervention studies have addressed specifically depression in youth, but all have targeted children and adolescents who present with current depressive symptomatology, as identified by elevated scores on self-report measures or teacher reports (e.g., Clarke et al., 1995; Jaycox, Reivich, Gillham, & Seligman, 1994; Moreau, Mufson, Weissman, & Klerman, 1991).

In response to mandates by the Institute of Medicine (IOM; Institute of Medicine, 1989,1994) and the National Institute of Mental Health (NIMH; National Institute of Mental Health, 1993), researchers recently have begun to examine the primary prevention of depression in youth. In fact, Lewinsohn and colleagues (Lewinsohn et al., 1994) note that, while most recent research on youth depression has focused on the etiology and correlates of depression, an important area for depression research involves the development of preventive intervention programs for this age group. Thus, in recent years, research on depression in youth has shifted from tertiary treatment efforts to primary prevention studies, and from primary prevention approaches aimed at general, unselected populations to prevention programs that focus on "targeted" populations (i.e., populations identified as having an increased risk of future depression).

Children of parents with depression represent a "targeted" population that may benefit from preventive intervention strategies. Numerous studies have reported increased rates of psychiatric disorders in children from homes with affectively ill parents, relative to children with nonill parents (Beardslee, Versage, & Gladstone, 1998; Radke-Yarrow, Nottelman, Martinez, Fox, & Belmont, 1992; Weissman, Fendrich, Warner, & Wickramaratne, 1992). Meta-analytic findings indicate that approximately 61% of the offspring of parents with major depressive disorder will develop a psychiatric disorder during childhood or adolescence, and these children are four times more likely to develop an affective disorder than children with nonill parents (Lavoie & Hodgins, 1994). …

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