Depression is one of the most prevalent mental disorders to afflict adolescents. It seriously impacts role functioning and typically takes a recurrent or chronic course. Because most depressed youth never receive treatment, there is a critical need to develop effective prevention programs that can be easily implemented and widely disseminated. The proposed project will complete development of an interactive multimedia (IMM) cognitive-behavioral therapy (CBT) program for preventing clinical depression and ameliorating depressive symptomatology in young adolescents aged 12 to 15 years old. The program will be accessible via the Internet or CD-ROM. Adapted from an empirically validated intervention, the program will include six CBT weekly sessions, additional browser modules related to youth depression, and an online support system. The six CBT sessions will include: education about moods and depression; mood and activity monitoring; increasing positive thinking; scheduling and engaging pleasant activities; relating mood, activities, and thoughts; and planning for the future. The competency-based instructional design will be structured for repeat sessions using self-paced tutorials, supportive peer testimonials, and behavior modeling vignettes. Additional browser modules include depression self-screening, learning to relax, enhancing social skills, and improving communication and problem solving. The online support system will include an electronic bulletin board, personal weekly conferences with an intervention coach, and an ask-an-expert forum. The program will include four target populations: adolescent boys and girls in school/community settings and in juvenile justice settings. The basic structure of the program will be the same for each target population, but specific content will be customized to each user group. The Phase I prototype provided training on understanding depression, tracking mood and activity levels, and engaging in pleasant activities. The Phase I program was targeted to female and male youth in juvenile justice settings. Compared to an information-only control group, the results showed significant pre-post changes in knowledge, self-efficacy, and intentions to use the skills taught, with a large multivariate effect size. At one-week follow-up, youth reported significant increases for the engagement in pleasant activities over the past week. In Phase II, the scope of the program will be expanded to included additional skills training, with targeted versions for each of the four user groups. The Phase II product will be designed for use on the Internet/CD-ROM. The fully developed program will be evaluated in large a randomized trial (n = 300) on the Internet with a six-month follow-up period to compare change in depressive symptoms and incidence rates of depression between intervention and control conditions. ? ? ?
