Major depression is one of the most prevalent mental disorders to afflict adults. It seriously impacts role functioning and often takes a recurrent or chronic course. Given the high prevalence and associated impairments, major depression has become a critical public health concern. Indeed, the Healthy People 2010 Initiative includes the reduction of depression and suicide as national objectives. Although there have been significant advances in the diagnosis and treatment of depression, the design and evaluation of preventive interventions for depression has received little attention to date. Because most adults who suffer from depression never receive treatment, there is a critical need to develop prevention programs that can be easily implemented and widely disseminated. This project will develop and test an interactive multimedia intervention aimed at preventing depression by modifying risk factors and promoting protective factors among high-risk adults. In order to reach wide-ranging target populations, the program will be developed for delivery via the workplace. An empirically tested framework will be adapted for self-administration via the Internet or CD-ROM. The intervention will consist of knowledge- and skills-based modules including: understanding depression, self-screening, mood monitoring, behavioral activation, cognitive restructuring, interpersonal relations, relaxation, and planning for the future. The competency-based instructional design will be structured for multiple sessions using video-based tutorials, peer testimonials, and behavior modeling vignettes. The Phase I prototype, targeted to women 18 to 39 years of age, with modules on understanding depression, mood monitoring, and behavioral activation will be evaluated using a within-subjects pretest-posttest trial. The anticipated results from the Phase I trial will demonstrate clinically significant pre-post change with respect to knowledge, intentions, attitudes, and self-efficacy regarding the skills presented. In Phase II, all 8 modules will be developed and targeted to 6 age and gender groups, and evaluated in a large randomized trial with a 12-month follow-up period. The Phase II trial is expected to show reductions in depressive symptoms, onset of major depressive episodes, and increases in occupational functioning, and these changes in the outcome measures are anticipated to be mediated by changes in the specific skills acquired through the intervention. The potential commercial applications of the Phase II product are to employers, behavioral health organizations, employee assistance programs, and health insurance companies. ? ?
