Prevention of Adolescent Depressionby Jennifer Gibson, PharmD | June 30, 2009
Children and adolescents of depressed parents are four to six times more likely to develop depressive symptoms themselves than children of non-depressed parents. This translates to approximately 61% of children of parents with depression developing a psychiatric disorder during their life. Strikingly, more than one-quarter of children in America will experience at least one episode of depression by the time they reach adulthood. Overall, an estimated 1 in 5 Americans will experience depression sometime in their lives, equating to a large number of children with depressed parents. Many studies have focused on the treatment of depression in both adults and children and adolescents, but few focus on its prevention. A new study reported in the Journal of the American Medical Association (JAMA) examines the efficacy of preventive interventions in adolescents with depressed parents.
The current JAMA study concluded that cognitive behavioral therapy (CBT) –- one of the most studied and proven-effective interventions for the treatment of depression in adolescents -– is effective at reducing the risk of depression symptoms in adolescents with depressed parents. The study group consisted of 316 adolescents aged 13 to 17 years who had at least one parent or caregiver with a current or past diagnosis of a depressive disorder. All of the patients, themselves, also had a history of current or past subdiagnostic depressive symptoms.
The group was randomly assigned to either receive sessions of group CBT or continue their current treatment. The intervention group participated in 8 weekly CBT sessions, followed by 6 monthly sessions, that focused on learning new coping and cognitive restructuring techniques and problem-solving skills. The study leaders measured the rate of occurrence of depressive episodes that lasted at least 2 weeks. At the conclusion of the study and follow-up period, the overall incidence of depressive episodes in the intervention group was 21.4%, versus 32.7% in the control group. The intervention group also self-reported improvement in depressive symptoms more often than the control group.
However, factoring in parental mental health during the study confounds the results. The adolescents of non-depressed parents experienced significantly better results than the children of currently-depressed parents at the start of the study. For adolescents whose parents were not depressed at baseline, the incidence of depression in the intervention group was only 11.7%, compared to 40.5% in the control group. For adolescents whose parents were depressed at baseline, the incidence of depression was not significantly different in the intervention group versus the control group.
Many studies have shown CBT to be effective treatment for children and adolescents with depression, and a few have shown it to be effective prevention, also. Family-based therapies have, likewise, produced positive results in the prevention of depression in children with depressed parents. One study showed that simply increasing the child’s understanding of the parent’s mental illness and enhancing communication skills and encouraging parent-child dialogue about depression, children and adolescents experienced more resilience and a reduced risk of depressive symptoms. Studies like these highlight the value of parent and child therapies for depression treatment and prevention. In fact, effectively treating parents for depression first may reduce the need to treat children at all.
The symptoms associated with childhood and adolescent depression can be debilitating long into adulthood, and many young people with depression experience more serious affective disorders and psychopathology later in life. Additionally, many pharmacological treatment options available today pose unwelcome risks to children and adolescent patients. In this case, as with most health care interventions, prevention is better than a cure.
Beardslee, W., Gladstone, T., Wright, E., & Cooper, A. (2003). A Family-Based Approach to the Prevention of Depressive Symptoms in Children at Risk: Evidence of Parental and Child Change PEDIATRICS, 112 (2) DOI: 10.1542/peds.112.2.e119
Clarke, G. (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 DOI: 10.1001/archpsyc.58.12.1127
David-Ferdon, C., & Kaslow, N. (2008). Evidence-Based Psychosocial Treatments for Child and Adolescent Depression Journal of Clinical Child & Adolescent Psychology, 37 (1), 62-104 DOI: 10.1080/15374410701817865
Garber, J., Clarke, G., Weersing, V., Beardslee, W., Brent, D., Gladstone, T., DeBar, L., Lynch, F., D’Angelo, E., Hollon, S., Shamseddeen, W., & Iyengar, S. (2009). Prevention of Depression in At-Risk Adolescents: A Randomized Controlled Trial JAMA: The Journal of the American Medical Association, 301 (21), 2215-2224 DOI: 10.1001/jama.2009.788
Lakhan, S., & Hagger-Johnson, G. (2007). The impact of prescribed psychotropics on youth Clinical Practice and Epidemiology in Mental Health, 3 (1) DOI: 10.1186/1745-0179-3-21
WEERSING, V. (2006). Cognitive Behavioral Therapy for Depression in Youth Child and Adolescent Psychiatric Clinics of North America, 15 (4), 939-957 DOI: 10.1016/j.chc.2006.05.008
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