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Preventing Depression Among Early Adolescents in the Primary Care Setting: A Randomized Controlled Study of the Penn Resiliency Program

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An Erratum to this article was published on 10 January 2008

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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References

  • Achenbach, T. M. (1991). Manual for the child behavior checklist/4–18 and 1991 child behavior profile. Burlington: University of Vermont, Department of Psychiatry.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Cunningham, E. G. (2003). Psychometric properties of the Children's Attributional Style Questionnaire. Psychological Reports, 93, 481–485.

    Article  PubMed  Google Scholar 

  • Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Kovacs, M. (2001). Children's Depression Inventory Manual. North Tonawanda, NY: Multi-Health Systems.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • Petersen, A. C., Sarigiani, P. A., & Kennedy, R. E. (1991). Adolescent depression: Why more girls? Journal of Youth and Adolescence, 20, 247–271.

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Reich, W. (2000). Diagnostic Interview for Children and Adolescents (DICA). Journal of the American Academy of Child and Adolescent Psychiatry, 39: 59–66.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Shapiro, S. S., & Wilk, M. B. (1965). An analysis of variance test for normality. Biometrika, 52, 591–611.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Psychiatric Services, 52, 1190–1197.

    Article  PubMed  Google Scholar 

  • Seligman, M. E. P. (1991). Learned optimism. New York: Knopf.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Thomspon, M., Kaslow, N. J., Weiss, B., & Nolen-Hoeksema, S. (1998). Children's Attributional Style Questionnaire-revised: Psychometric examination. Psychological Assessment, 10, 166–170.

    Article  Google Scholar 

  • 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.

    Google Scholar 

  • Weisz, J. R. (2004). Psychotherapy for children and adolescents: Evidence-based treatments and case examples. New York: Cambridge University Press.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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).

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Yu, D. L., & Seligman, M. E. P. (2002). Preventing depressive symptoms in Chinese children. Prevention and Treatment, 5, np.

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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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Correspondence to Jane E. Gillham.

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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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