This application for an R34 award proposes to refine and conduct a pilot RCT of a peer-led cognitive-behavioral intervention to determine the feasibility, acceptability, and outcomes for preventing depression and other negative outcomes among out-of-school inner-city adolescents and young adults in a community-based employment training program.
The specific aims of this study are: (1) to refine the intervention protocol for the peer-led cognitive behavioral intervention, develop an intervention fidelity checklist, develop a training manual for peer leaders who deliver the intervention, and train peer leaders to deliver the intervention;(2) to conduct a pilot RCT of 142 adolescents and young adults, aged 16-22, that compares outcomes for youth involved with our peer-led cognitive-behavioral intervention with outcomes from youth participating in an attention control condition;and (3) to obtain the information and experiences required for designing and implementing a larger randomized trial. To achieve Specific Aim 1, will refine our peer-led intervention, develop an intervention fidelity checklist, develop a training manual for peer interventionists, and train peer interventionists. To achieve Specific Aim 2, we will conduct a pilot RCT of our peer-led cognitive behavioral intervention. 142 adolescents and young adults with elevated depressive symptoms but without a current depressive episode will be randomized to our 9-session intervention or a 9-week life skills attention control. Assessments post- intervention, 6 months, and 12 months post-intervention will measure depressive symptoms, depressive episodes, anxiety and PTSD symptoms, cognitive appraisals, engaged coping strategies, quality of life, and education and employment milestones. To achieve Specific Aim 3, we will use findings from our pilot RCT (e.g., implementation fidelity, recruitment, attendance) to develop a R01 application to be submitted during the final year of our R34 project. The public health significance of this project is substantial. Given consistent evidence that depression is a debilitating and chronic condition, interventions must attempt to prevent initial depressive episodes from occurring. Adolescence and young adulthood is an ideal time for preventive interventions to occur given the high depression incidence rate in this age group. The innovation of this project is also notable, as it brings mental health services to employment training programs that are being promulgated with new federal funding initiatives. These employment training programs serve large numbers of adolescents and young adults who are not reached by existing mental health interventions. This project is consistent with the goal of the R34 mechanism to encourage research on the development and/or pilot testing of new or adapted interventions and with two high priority areas of NIMH'S Division of Services and Intervention Research to develop innovative interventions and personalize them for optimal use in diverse populations and to employ strategic partnerships and community participation to enhance research capacity and infrastructure.

Public Health Relevance

Depression is a significant public health problem, with adolescents and young adults among the most affected. This project tests a peer-led intervention that aims to prevent the onset and worsening of depression in adolescents and young adults (16-22) who are out-of-school and not in the workforce and enrolled in an employment training program-a group that has not been the focus of previous mental health research. Our intervention may have great benefits to society, as preventing depression among this population has the potential to increase the employability, and ultimately, economic self-sufficiency of participants.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Interventions Committee for Disorders Involving Children and Their Families (ITVC)
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Goldstein, Amy B
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Johns Hopkins University
Schools of Medicine
United States
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