Depression is a major public health problem affecting over 15 million U.S. adults annually and is especially prevalent in those of parenting age. Offspring of depressed parents are at increased risk of depression and therefore are a critical target for preventive interventions. Informed in part by the investigators'prior work, the field is now poised to make significant advances toward reducing the rate of depression by adopting an innovative, family-based approach to simultaneously preventing depression in at-risk children and in their affected parents. The rationale for this approach is based on (a) our conceptual model that integrates parenting processes, stressors (particularly those associated with parental depression), and children's self-regulatory skills in the face of stress, (b) strong evidence of the familial nature of depression, (c) promising results from family- and child-focused depression prevention programs, (d) evidence that in adults, cognitive-behavioral therapy (CBT) reduces both depressive episodes and their recurrence, and (e) growing consensus among scientists, clinicians, and policymakers on the need for family-based models of healthcare. The proposed 5- year, two-site randomized controlled trial will test a Family Depression Prevention (FDP) program for children (ages 9-15) and their parents with depressive disorders (past or current). This "dual prevention" approach is a novel synthesis of existing evidence-based intervention techniques drawn from child prevention and adult treatment models. Participating families (N=300) will be randomized to either FDP (12 weekly + 3 monthly sessions) or a written information control (WI) condition. Parents and children will be evaluated at pre-, mid-, and immediately post-intervention, and at 6-, 12-, 18-, and 24-months from baseline. This single integrated intervention aims to prevent depressive symptoms and episodes in both children and parents, reduce associated disorders, and improve functioning (Aim 1). We also will assess the cost-effectiveness (CE) of FDP relative to the WI control and benchmarked against the CE of landmark studies in child prevention and adult depression treatment (Aim 1). Additionally, we will examine mediators (e.g., parenting behaviors;parents' cognitions;children's coping) and evaluate bidirectional effects between child and parent processes and outcomes (Aim 2). Finally, we will explore moderators [e.g., parental depression severity (Aim 3)] of the intervention-outcome relation.
Depression in parents constitutes a substantial threat to the mental health of their children. The National Research Council/Institute of Medicine (2009) asserted that eliminating parental depression and its negative effects on children is a public health priority. Responding to the call by the American Association of Pediatrics for coordinated, family-focused mental health services, this study will be the first test of this innovative integraed intervention designed to simultaneously reduce the incidence of depression in parents and their children.