The specific aims of the proposed project is to develop and pilot a school- based, two-stage prevention program aimed at reducing the incidence of unipolar affective disorders and symptomology in high-school adolescents. This program would consist of: (a) a primary prevention educational component (Stage 1) to provide information about depression, suicide, and treatment efficacy to a normal population of high school adolescents; and (b) a secondary preventive intervention (Stage 2) to prevent affective disorder among a subset of demoralized adolescents who are at greater than normal risk for depression. The proposed investigation will consist of two stages: Stage 1 (primary prevention) and Stage 2 (secondary prevention), which are linked together in a multiple gating procedure. Stage 1 will target 9th and 10th grade students enrolled in regular health classes in the high schools, and will consist of four lectures and two videotapes covering the symptoms, causes and treatments of depression and suicide. Lectures will emphasize the treatable nature of depression, and will encourage adolescents to seek intervention when appropriate. One half of all health classes in each school (n=550) will be randomly selected to receive the active Stage 1 intervention. Adolescents enrolled in the remaining classes (controls; n=550) will receive the usual school curriculum covering depression and associated topics. During Stage 1, both control and experimental adolescents will be administered a brief screening instrument (the core of which is the CES-D) to identify demoralized S's at greatest risk for the development of future affective disorder, who might be candidates for Stage 2. The screener is administered during the first and last of the four lectures (control subjects will be administered the screen in their """"""""usual"""""""" health classes, time-yoked to the experimental S's). Following the completion of Stage 1, all adolescents identified as At-Risk, or demoralized, via the screener (score > 75th percentile) and their parents will be invited by school personnel to participate in a 3 hour psychiatric interview and assessment battery as a prerequisite to taking part in the Stage 2 secondary prevention intervention. We anticipate an initial Stage 2 sample of 148 S's, after drop-out and disqualification. The At-Risk group will be diagnostically heterogeneous, and will include teens with subdiagnostic dysphoria but with no current DSM-III-R diagnoses, as well as those with a variety of other current nonaffective diagnoses (e.g., anxiety disorders, conduct disorder, ADHD, etc.). However, they will all share a common elevated risk for the development of future clinical depressive disorder by virtue of their reported demoralization, and thus are eligible for participation in Stage 2. One-half will be randomly assigned to the active Stage 2 intervention (n=74), and the other half (n=74) to the """"""""usual care"""""""" control group. The Stage 2 experimental condition consists of a 14-session cognitive-restructuring group intervention, modified from the depression tertiary treatment model developed by Beck, Ellis, and others. Adolescents enrolled in the active Stage 2 condition will also be permitted to continue any pre-existing treatment, and/or to seek out any additional treatment they may wish, in order to equate the base level of nonexperimental intervention across both conditions. Following the completion of the intervention, all Stage 2 S's will be re-interviewed at 6 and 12 months post-intervention, to evaluate the impact of primary and secondary preventive interventions on affective symptomology and cases, appropriate treatment-seeking, suicide attempts, school attendance, and other individual and community indices of health and prosocial behaviors. The present study is intended to serve as the pilot foundation for a much larger future experimental of this 2-stage model.
| Clarke, G N; Hawkins, W; Murphy, M et al. (1995) Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomized trial of a group cognitive intervention. J Am Acad Child Adolesc Psychiatry 34:312-21 |
