Depression in adults is a public health problem of major proportions. Children of parents with affective will experience depression at alarmingly high rates; as much as 50% by the end of adolescence. This application requests funds to continue the evaluation of the efficacy of two forms of interventions for prevention of depression for youngsters in families with affective disorder who have been enrolled at ages 8-15, before the age of highest risk. We propose to do this by continuing the serial longitudinal assessment of our sample of youngsters and their parents through the age of very high risk for onset of affective disorder, that is adolescence into early adulthood. The average age of the youngsters at the end of the current funding period will be 14.8, and at the end of the proposed period 18.8. Through both a pilot study (begun in 1989) and our current five-year RO1 (begun in 1992), a sample of 100 families (132 children, 183 parents) have been enrolled, randomized, and assessed. All have or will shortly receive one of two interventions, before the end our current funding in April, 1997. The two interventions were designed to be compatible with the practices of a wide range of professionals, given the high prevalence of depression in both medical and mental health settings. The interventions are: (1) a manual-based program involving six to ten sessions with a family, conducted by a clinician; and (2) presentation of the same material in a standardized multiple family lecture-group discussion format. Our central hypothesis is that both interventions will help families, but there will be a greater effect in the clinician-facilitated intervention. Both children and parents have been assessed blind to one another with a battery of standard instruments derived from risk research, supplemented by an instrument designed to assess response to intervention, administered initially and then every 8 months thereafter. An extremely high rate of follow-up participation (over 95% after 18 months) has been obtained. Analyses of data to date indicate that in both the pilot sample and in one half of the NIMH sample both interventions have been well tolerated and have had positive effects on family functioning, but significantly greater effects have been reported for both parents and children in the clinician-facilitated intervention 70 weeks after intervention. The pilot families, who have been followed for three to four years, have reported sustained effects. Differences between groups were also sustained.
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