Nearly one-quarter of young adults will experience a Major Depressive Disorder (MDD) by the age of 18, and about one-half of these individuals will suffer from a recurrence during the two years following the first episode. Because of the debilitating effects of MDD on the individual and society, including the overuse of medical services by these citizens, this is a major national health problem. We will begin by writing an intervention manual for an integrated interpersonal, cognitive, and behavioral program designed to prevent the recurrence of MDD among entering college freshmen. The program consists of 12 weekly group sessions conducted over both semesters of the freshmen year. We will also develop reliable adherence and competence measures to evaluate the fidelity and quality of the implementation of the preventive program. In the proposed pilot study we will randomly assign 96 college freshmen who have had a previous MDD but are not currently depressed to either the recurrence prevention program or to treatment as usual; all these students will participate in standard assessment, including diagnostic interviews, at baseline, 6-, 12-, and 18-months. During the first year we will write the manual, develop the adherence and competence measures, randomly assign 24 participants each to one of the two conditions, and re-assess them at 6 months. During the second year, we will randomly assign 24 more participants to each condition, re-assess them at 6 months, and follow-up the first year participants at 12- and 18-months. During the third year we will follow-up the second year participants at 12- and 18-months, analyze and report the data, and revise the prevention manual. Results from the proposed study should allow us to: develop a revised prevention manual which will be employed in a subsequent large randomized controlled trial studying the prevention of recurrence of MDD in college settings; estimate the effect and sample sizes for the subsequent prevention study; and, begin to develop a manual for prevention of recurrence of MDD among young adults in community mental health centers and HMOs.
