This study evaluated the Penn Resiliency Program's effectiveness in preventing depression when delivered by therapists in a primary care setting. Two-hundred and seventy-one 11- and 12-year-olds, with elevated depressive symptoms, were randomized to PRP or usual care. Over the 2-year follow-up, PRP improved explanatory style for positive events. PRP's effects on depressive symptoms and explanatory style for negative events were moderated by sex, with girls benefiting more than boys. Stronger effects were seen in high-fidelity groups than low-fidelity groups. PRP did not significantly prevent depressive disorders but significantly prevented depression, anxiety, and adjustment disorders (when combined) among high-symptom participants. Findings are discussed in relation to previous PRP studies and research on the dissemination of psychological interventions.
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Achenbach, T. M. (1991). Manual for the child behavior checklist/4–18 and 1991 child behavior profile. Burlington: University of Vermont, Department of Psychiatry.
Angold, A., Costello, E. J., & Worthman, C. M. (1998). Puberty and depression: The roles of age, pubertal status, and pubertal timing. Psychological Medicine, 28, 51–61.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.
Bernal, P., Estroff, D. B., Aboudarham, J. F., Murphy, M., Keller, A., & Jellinek, M. S. (2000). Psychosocial morbidity: The economic burden in a pediatric health maintenance organization sample. Archives of Pediatric and Adolescent Medicine, 154, 261–266.
Cardemil, E. V., Reivich, K. J., & Seligman, M. E. P. (2002). The prevention of depressive symptoms in low-income minority middle school students. Prevention and Treatment, 5, np.
Chorpita, B. F. (2003). The frontier of evidence-based practice. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents. New York: Guilford Press (42–59).
Clarke, G. N., Hawkins, W., Murphy, M., & Sheeber, L. (1993). School-based primary prevention of depressive symptomatology in adolescents: Findings from two studies. Journal of Adolescent Research, 8, 183–204.
Clarke, G. N., Hawkins, W., Murphy, M., Sheeber, L. B., Lewinsohn, P. M., & Seeley, J. R. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 312–321.
Clarke, G. N., Hornbrook, M., Lynch, F., Polen, M., Gale, J., Beardslee, W., et al. (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry, 58, 1127–1134.
Costello, E. J., Pine, D. S., Hammen, C., March, J. S., Plotsky, P. M., Weissman, M. M., et al. (2002). Development and natural history of mood disorders. Biological Psychiatry, 52, 529–542.
Cunningham, E. G. (2003). Psychometric properties of the Children's Attributional Style Questionnaire. Psychological Reports, 93, 481–485.
Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.
Essau, C. A. (2004). Primary prevention of depression. In D. J. A. Dozois & K. S. Dobson (Eds.), The prevention of anxiety and depression: Theory, research and practice. (pp. 185–204) Washington, DC: American Psychological Association.
Garber, J., Kriss, M. R., Koch, M., & Lindholm, L. (1988). Recurrent depression in adolescents: A follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 49–54.
Garrison, C. Z., Schluchter, M. D., Schoenbach, V. J., & Kaplan, B. K. (1989). Epidemiology of depressive symptoms in young adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 343–351.
Ge, X., Conger, R. D., & Elder, G. H. (2001). Pubertal transition, stressful life events, and the emergence of gender differences in adolescent depressive symptoms. Developmental Psychology, 37, 404–417.
Gillham, J. E., Reivich, K. J., Freres, D. R., Lascher, M., Litzinger, S., Shatté, A., et al. (in press). School-based prevention of depression and anxiety symptoms in early adolescence: A pilot of a parent intervention component. School Psychology Quarterly.
Gillham, J. E., Reivich, K. J., Jaycox, L. H., & Seligman, M. E. P. (1995). Preventing depressive symptoms in schoolchildren: Two year follow-up. Psychological Science, 6, 343–351.
Gillham, J. E., Shatté, A. J., & Freres, D. R. (2000). Depression prevention: A review of cognitive-behavioral and family interventions. Applied and Preventive Psychology, 9, 63–88.
Gotlib, I. H., Lewinsohn, P. M., & Seeley, J. R. (1995). Symptoms versus a diagnosis of depression: Differences in psychosocial functioning. Journal of Consulting and Clinical Psychology, 63, 90–100.
Haarasilta, L., Marttunen, M., Kaprio, J., & Aro, H. (2003). Major depressive episode and health care use among adolescents and young adults. Social Psychology and Psychiatric Epidemiology, 38, 366–372.
Hamilton, J., & Bridge, J. (1999). Outcome at 6 months for 50 adolescents with major depression treated in a health maintenance organization. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1340–1346.
Hamilton, J., & Gillham, J. (1999). The K-SADS and diagnosis of major depressive disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1065–1066.
Hankin, B. L., & Abramson, L. Y. (2001). Development of gender differences in depression: An elaborated cognitive vulnerability-transactional stress theory. Psychological Bulletin, 127, 773–796.
Hankin, B. L., & Abramson, L. Y. (2002). Measuring cognitive vulnerability to depression in adolescence: Reliability, validity, and gender differences. Journal of Clinical Child and Adolescent Psychology, 31, 491–504.
Harnett, P. H., & Dadds, M. R. (2004). Training school personnel to implement a universal school-based prevention of depression program under real-world conditions. Journal of School Psychology, 42, 343–357.
Harrington, R., Fudge, H., Rutter, M., Pickles, A., & Hill, J. (1990). Adult outcomes of childhood and adolescent depression. Archives of General Psychiatry, 47, 465–473.
Hirshfeld, R., Keller, M., Panico, S., Arons, B., Barlow, D., Davidoff, F., et al. (1997). The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. Journal of the American Medical Association, 277, 333–340.
Ingram, R. E., Odom, M., & Mitchusson, T. (2004). Secondary prevention of depression: Risk, vulnerability, and intervention. In D. J. Dozois & K. S. Dobson (Eds.), The prevention of anxiety and depression: Theory, research, and practice (pp. 205–231). Washington, DC: American Psychological Association.
Jaycox, L. H., Reivich, K. J., Gillham, J., & Seligman, M. E. P. (1994). Prevention of depressive symptoms in school children. Behaviour Research and Therapy, 32, 801–816.
Kaslow, N. J., & Thompson, M. P. (1998). Applying the criteria for empirically supported treatments to studies of psychosocial interventions for child and adolescent depression. Journal of Clinical Child Psychology, 27, 146–155.
Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., & Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.
Kovacs, M. (2001). Children's Depression Inventory Manual. North Tonawanda, NY: Multi-Health Systems.
Lewinsohn, P. M., Hops, H., Roberts, R., & Seeley, J. (1993). Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology, 102, 110–120.
Merry, S., McDowell, H., Hetrick, S., Bir, J., & Muller, N. (2004). Psychological and/or educational interventions for the prevention of depression in children and adolescents. The Cochrane Library, 2, np.
Merry, S., McDowell, H., Wild, C. J., Bir, J., & Cunliffe, R. (2004). A randomized placebo-controlled trial of a school-based depression prevention program. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 538–547.
Muñoz, R. F., Ying, Y., Bernal, G., Perez-Stable, E. J., Sorensen, J. L., Hargreaves. W. A., et al. (1995). Prevention of depression with primary care patients: A randomized controlled trial. American Journal of Community Psychology, 23, 199–222.
National Institute of Mental Health. (2000). Depression in children and adolescents: A fact sheet for physicians. Retrieved April 2004, from http://www.nimh.nih.gov/publicat/depchildresfact.cfm.
Offord, D. R., Kraemer, H. C., Kazdin, A. E., Jensen, P. S., & Harrington, R. (1998). Lowering the burden of suffering from child psychiatric disorder: Trade-offs among clinical, targeted, and universal interventions. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 686–694.
Pagano, M. E., Cassidy, L. J., Little, M., Murphy, J. M., & Jellinek, M. S. (2000). Identifying psychosocial dysfunction in school-age children: The Pediatric Symptom Checklist as a self-report measure. Psychology in the Schools, 37, 91–106.
Pattison, C., & Lynd-Stevenson, R. M. (2001). The prevention of depressive symptoms in children: The immediate and long-term outcomes of a school based program. Behaviour Change, 18, 92–102.
Petersen, A. C., Leffert, N., Graham, B., Alwin, J., & Ding, S. (1997). Promoting mental health during the transition into adolescence. In J. Schulenberg, J. L. Maggs, & A. K. Hierrelmann (Eds.), Health risks and developmental transitions during adolescence (pp. 471–497). New York: Cambridge University Press.
Petersen, A. C., Sarigiani, P. A., & Kennedy, R. E. (1991). Adolescent depression: Why more girls? Journal of Youth and Adolescence, 20, 247–271.
Quayle, D., Dziurawiec, S., Roberts, C., Kane, R., & Ebsworthy, G. (2001). The effect of an optimism and lifeskills program on depressive symptoms in preadolescence. Behaviour Change, 18, 194–203.
Raudenbush, S. W., & Xiao-Feng, L. (2001). Effects of study duration, frequency of observation, and sample size on power in studies of group differences in polynomial change. Psychological Methods, 6, 387–401.
Reich, W. (2000). Diagnostic Interview for Children and Adolescents (DICA). Journal of the American Academy of Child and Adolescent Psychiatry, 39: 59–66.
Reinecke, M. A., Ryan, N. E., & DuBois, D. L. (1997). Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: A review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 26–34.
Reivich, K. J. (1996). The prevention of depressive symptoms in adolescents. Unpublished doctoral dissertation, University of Pennsylvania, Philadelphia.
Reivich, K. J., Gillham, J. E., Chaplin, T. M., & Seligman, M. E. P. (2005). From helplessness to optimism: The role of resilience in treating and preventing depression in youth. In S. Goldstein & R. Brooks (Eds.), Handbook of Resilience in Children. (pp. 223–237). New York: Kluwer Academic/Plenum Publishers.
Roberts, C., Kane, R., Thomson, H., Bishop, B., & Hart, B. (2003). The prevention of depressive symptoms in rural school children: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 71, 622–628.
Rohde, P., Lewinsohn, P. M., & Seeley, J. R. (1991). Comorbidity of unipolar depression: II. Comorbidity with other mental disorders in adolescents and adults. Journal of Abnormal Psychology, 100, 214–222.
Shapiro, S. S., & Wilk, M. B. (1965). An analysis of variance test for normality. Biometrika, 52, 591–611.
Shochet, I. M., Dadds, M. R., Holland, D., Whitefield, K., Harnett, P. H., & Osgarby, S. M. (2001). The efficacy of a universal school-based program to prevent adolescent depression. Journal of Clinical Child Psychology, 30, 303–315.
Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Psychiatric Services, 52, 1190–1197.
Seligman, M. E. P. (1991). Learned optimism. New York: Knopf.
Seligman, M. E. P., Peterson, C., Kaslow, N. J., Tanenbaum, R. L., Alloy, L. B., & Abramson, L. Y. (1984). Explanatory style and depressive symptoms among school children. Journal of Abnormal Psychology, 93, 235–238.
Seligman, M. E. P., Schulman, P., DeRubeis, R. J., & Hollon, S. D. (1999). The prevention of depression and anxiety. Prevention and Treatment, 2, np.
Spence, S. H., Sheffield, J. K., & Donovan, C. L. (2003). Preventing adolescent depression: An evaluation of the problem solving for life program. Journal of Consulting and Clinical Psychology, 71, 3–13.
Strunk, D. R., & DeRubeis, R. J. (2001). Cognitive therapy for depression: A review of its efficacy. Journal of Cognitive Psychotherapy. Special Review of Cognitive Behavioral Therapy, 15, 289–297.
Thomspon, M., Kaslow, N. J., Weiss, B., & Nolen-Hoeksema, S. (1998). Children's Attributional Style Questionnaire-revised: Psychometric examination. Psychological Assessment, 10, 166–170.
Treatment for Adolescents with Depression Study Team. (2004). Flouxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for adolescents with depression study (TADS) randomized controlled study. Journal of the American Medical Association, 292, 807–820.
Weisz, J. R. (2004). Psychotherapy for children and adolescents: Evidence-based treatments and case examples. New York: Cambridge University Press.
Weisz, J. R., Donenberg, G. R., Han, S. S., & Weiss, B. (1995). Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63, 688–701.
Weisz, J. R., & Hawley, K. M. (1998). Finding, evaluating, refining, and applying empirically supported treatments for children and adolescents. Journal of Clinical Child Psychology, 27, 206–216.
Weisz, J. R., & Jensen, A. L. (2001). Child and adolescent psychotherapy in research and practice contexts: Review of the evidence and suggestions for improving the field. European Child and Adolescent Psychiatry, 10, 112–118.
Weisz, J. R., & Kazdin, A. E. (2003). Concluding thoughts: Present and future of evidence-based psychotherapies for children and adolescents. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents. New York: Guilford Press (439–451).
Winter, L. B., Steer, R. A., Jones-Hicks, L., & Beck, A. T. (1999). Screening for major depression disorders in adolescent medical outpatients with the Beck Depression Inventory for primary care. Journal of Adolescent Health, 24, 389–394.
Yu, D. L., & Seligman, M. E. P. (2002). Preventing depressive symptoms in Chinese children. Prevention and Treatment, 5, np.
ACKNOWLEDGMENTS
The first two authors contributed equally to this project. The authors are grateful to the children and parents who participated in the project, to Ms. Jane Mardison for her help in gathering the data, to Dr. Jerrold DiRegolo and Mr. Conrad Gonzalez for their group work, to Mr. Tom Ray at the Division of Research for supplying and organizing data from central servers, and to the Kaiser Foundation Research Institute for funding this research. We offer a special thanks to Samantha Gaiber, Rachel Moser, Ivy Pete, and Steve Brunwasser for putting in the many hours of detail work that made this project possible.
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An erratum to this article is available at http://dx.doi.org/10.1007/s10802-007-9212-6.
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Gillham, J.E., Hamilton, J., Freres, D.R. et al. Preventing Depression Among Early Adolescents in the Primary Care Setting: A Randomized Controlled Study of the Penn Resiliency Program. J Abnorm Child Psychol 34, 195–211 (2006). https://doi.org/10.1007/s10802-005-9014-7
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DOI: https://doi.org/10.1007/s10802-005-9014-7