This proposal aims to extend the follow-up of 152 depressed youth ages 12 to 18 who have already been enrolled in a randomized controlled trial of a collaborative cognitive-behavioral treatment (CBT) program for youth who have initiated SSRI pharmacotherapy for their depression. This study, called STEADY (Study for Testing Effective Approaches for Depressed Youth), has completed subject recruitment (N= 152). Enrolled subjects are currently in various stages of their follow-up assessments. This application is to obtain timely funding to extend the follow-up from the current 12-months to 24-months post-randomization. The rationale for requesting this extended follow-up is to examine more fully the persistence of positive findings detected in preliminary outcome analyses at the 12-month assessment point (the final assessment point funded by the original award). The pattern of results observed in the preliminary analyses that the main advantage of the CBT program in this study seemed to be later (at month 12 post-enrollment) rather than earlier (within the first 6 months post-enrollment). This is contrary to what is typically observed in randomized mental health trials-where the experimental arm often has the largest advantage immediately after acute treatment. Our interpretation is that the CBT program adds little to acute recovery from the index depression episode (at least beyond the improvement attributable to usual care SSRIs that are employed in both conditions), but that the emerging significant advantage seen at the 12-month point may be an early sign of delaying or preventing depression relapse/recurrence during a longer-term continuation period. This advantage of the CBT treatment is consistent with the recent conclusions about the advantages of combined pharmacotherapy and psychotherapy treatment for depression in adults, particularly when CBT is added to pharmacotherapy. We argue that this result justifies funding for continued follow-up through the period of greatest risk of relapse back into depression (the first two years post-recovery), in order to confirm that this relapse/recurrence prevention is genuine and enduring. This is a particularly important question, given the high risk of depression relapse/recurrence in these youth.
