Addressing Rural Youth Mental Health Disparities by Task-Shifting an Evidence-Based Depression Prevention Program to Mentors

Several adolescent depression prevention programs have demonstrated effects on depressive symptoms and overall functioning. Yet, despite an increasing emphasis on elucidating mechanisms of change in interventions, few studies have identified mediators of these preventive interventions. In this study, we examined interpersonal mediators of Interpersonal Psychotherapy–Adolescent Skills Training (IPT-AST), an evidence-based depression prevention program. The Depression Prevention Initiative is a school-based randomized controlled trial in which 186 adolescents (M age = 14.01, SD = 1.22; 66.7% female; 32.2% racial minority) were assigned to receive either IPT-AST (n = 95) or Group Counseling (GC) (n = 91). We examined whether change in interpersonal conflict, social support, or social functioning from baseline to midintervention mediated the effects of IPT-AST on depressive symptoms and overall functioning at postintervention. At postintervention, youth in IPT-AST had lower depressive symptoms (d = −.31) and higher overall functioning scores (d = .32) than youth in GC. Improvements in adolescent romantic functioning, reductions in peer conflict, and improvements in a factor score reflecting mother–adolescent conflict and difficulties in family functioning emerged as significant mediators. However, the effects of the intervention on change in the mediators were not statistically significant. These findings add to the sparse literature on mediators of psychosocial interventions, provide partial support for the theoretical mechanisms underlying change in IPT-AST, and highlight important directions for future prevention and intervention research.

Patterns of Symptom Improvement among Depressed Adolescents treated with Interpersonal Psychotherapy Adolescent Skills Training (IPT-AST) in School Based Clinics Vijayeta Kumari Sinh Subthreshold symptoms of depression (defined as symptoms that do not meet full criteria for the disorder) are a significant concern, associated with a range of behavioral and emotional problems, raising the risk of adolescents developing more severe depression later. Yet research on subthreshold depression is lacking, and the relationship between affective and somatic symptom improvement has not been adequately studied. Prior research with adult samples lend credence to the hypothesis that symptoms of mood/motivation respond faster to psychotherapy (Rush, Beck, Kovacs, Weissenburger, & Hollon, 1982) than pharmacotherapy with the opposite response for vegetative symptoms such as sleep and appetite (DiMascio, Weissman, Prusoff, & Neu 1979). The current study was built upon prior research that found Interpersonal Psychotherapy Adolescent Skills Training (IPT-AST) to be an efficacious prevention intervention for adolescents with subthreshold depression, as compared to school counseling (Young, Mufson & Gallop, 2010). In this investigation, we sought to compare the trends in symptomatic improvement among 32 participants treated with IPT-AST over eight weeks. Clusters of mood/ motivation and vegetative symptoms were followed from baseline to the end of treatment. The results suggest that mood symptoms improved significantly before vegetative symptoms, within the first four weeks of preventive treatment. Significant improvement in vegetative symptoms was found to occur later between weeks 6 and 8. Thus adolescents receiving IPT-AST preventive treatment demonstrated faster reduction in mood/motivation symptoms than vegetative symptoms. Analyses revealed that fewer participants were identified as having not improved on the mood/motivation cluster than on the vegetative cluster indicating a better response for adolescents with mood symptoms than vegetative symptoms. Although, no relationships in improvements in mood/motivation and vegetative clusters were found controlling for baseline mood/motivation and vegetative symptoms; positive associations were found between cluster variables (mood, vegetative and total depression) over time. Gender was also not found to moderate the relationship between improvement on mood and vegetative symptoms over time indicating no significant differences in the improvement between males and females. Overall, findings from the current investigation strengthen the results from previous studies regarding the timeline of symptom improvement with IPT-AST.

Case Studies Within Psychotherapy Trials: Integrating Qualitative and Quantitative Methods presents a specific, mixed-methods approach, called the “Cases Within Trials” (CWT) model, to psychotherapy research combining the results from a randomized clinical trial (RCT); the results of richly and qualitatively detailed systematic case studies involving contrasting outcomes drawn from the experimental condition of the RCT; and a synthesis of the two types of knowledge. Chapter 4 of the book applies this model to a study of the application of a group-based, interpersonal therapy treatment—called “Interpersonal Psychotherapy—Adolescent Skills Training” (IPT-AST)—in preventing depression in adolescents. Finding a substantial statistical advantage of the interpersonal treatment over a “school counseling as usual” condition, the authors then analyze and compare the positive-outcome case of Menorka with the negative-outcome case of Shelly, both drawn from the IPT-AST condition.

Adapting an Adolescent Depression Prevention Program for Pediatric Primary Care.

This randomized controlled trial examined the longitudinal effects of two school-based indicated depression prevention programs on adolescents’ internalizing and externalizing symptoms, as measured by adolescents, their parents, and their teachers. One hundred eighty-six adolescents participated in this study. The average age was 14.01 (SD = 1.22) years, and the sample was 66.7% female. One third of the sample belonged to a racial minority. Youth received either Interpersonal Psychotherapy–Adolescent Skills Training or group counseling. Symptoms were assessed using adolescent, parent, and teacher reports on the Achenbach System of Empirically Based Assessment at baseline, postintervention, and 6-month follow-up. Adolescents reported the most robust effects in favor of Interpersonal Psychotherapy–Adolescent Skills Training. Adolescents in Interpersonal Psychotherapy–Adolescent Skills Training reported significantly greater reductions in internalizing symptoms through the 6-month follow-up and significantly greater reductions in externalizing symptoms during the intervention as compared to group counseling. Less robust effects were found when examining parent and teacher reports, although there was evidence of significant within-group change in parent- and teacher-reported internalizing symptoms for both interventions and significant between-group differences in teacher-reported externalizing symptoms. This study provides additional evidence supporting the efficacy of Interpersonal Psychotherapy–Adolescent Skills Training as a depression prevention program for adolescents. Interpersonal Psychotherapy–Adolescent Skills Training appears to have fast-acting effects on broadband internalizing and externalizing symptoms as reported by adolescents. This suggests that Interpersonal Psychotherapy–Adolescent Skills Training may serve as a transdiagnostic preventive intervention. Moreover, given the disparate reports of adolescents, parents, and teachers, this study demonstrates the significance of collecting information from multiple sources when possible.

Trajectories of change in maternal and adolescent depressive symptoms in the depression prevention initiative

Given the rise in depression disorders in adolescence, it is important to develop and study depression prevention programs for this age group. The current study examined the efficacy of Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), a group prevention program for adolescent depression, in comparison to group programs that are typically delivered in school settings. In this indicated prevention trial, 186 adolescents with elevated depression symptoms were randomized to receive IPT-AST delivered by research staff or group counseling (GC) delivered by school counselors. Hierarchical linear modeling examined differences in rates of change in depressive symptoms and overall functioning from baseline to the 6-month follow-up assessment. Cox regression compared rates of depression diagnoses. Adolescents in IPT-AST showed significantly greater improvements in self-reported depressive symptoms and evaluator-rated overall functioning than GC adolescents from baseline to the 6-month follow-up. However, there were no significant differences between the two conditions in onset of depression diagnoses. Although both intervention conditions demonstrated significant improvements in depressive symptoms and overall functioning, results indicate that IPT-AST has modest benefits over groups run by school counselors which were matched on frequency and duration of sessions. In particular, IPT-AST outperformed GC in reduction of depressive symptoms and improvements in overall functioning. These findings point to the clinical utility of this depression prevention program, at least in the short-term. Additional follow-up is needed to determine the long-term effects of IPT-AST, relative to GC, particularly in preventing depression onset.

This chapter provides an overview of the past decade of research on Interpersonal Psychotherapy–Adolescent Skills Training (IPT-AST). Studies on the efficacy of IPT-AST for the prevention of depression in adolescents are discussed to provide a summary of the empirical evidence for IPT-AST available to date. Current and future directions for research on IPT-AST are outlined. Adaptations of IPT-AST for other populations are briefly described. Research to date suggests that IPT-AST may be effective for these populations.

This chapter discusses the development of an interpersonally oriented depression prevention program for adolescents, Interpersonal Psychotherapy–Adolescent Skills Training (IPT-AST). Depression is a common and debilitating illness that rises in prevalence during the teenage years. Adolescence is therefore an opportune time to provide preventive interventions to reduce the burden of depression. IPT-AST is an adaptation of interpersonal psychotherapy, an empirically supported treatment for adult and adolescent depression. The program targets interpersonal risk and protective factors that have been linked to depression in adolescence. IPT-AST is an appropriate program for adolescents with different levels of risk for depression and can be implemented in diverse settings, such as schools, primary care offices, afterschool programs, and community organizations.

Personalized Depression Prevention: A Randomized Controlled Trial to Optimize Effects Through Risk-Informed Personalization

To test potential cognitive and interpersonal moderators of two evidence-based youth depression prevention programs. Two hundred four adolescents (Mage = 14.62 years, SD = 1.65; 56% female; 71% White, 11% Black, 11% multiracial, 5% Asian, 2% other races, 18% Hispanic/Latinx) were randomized to either a cognitive-behavioral (Coping With Stress [CWS]) or interpersonal (Interpersonal Psychotherapy-Adolescent Skills Training [IPT-AST]) prevention program. Potential moderators, selected based on theory and research, included rumination, negative cognitive style, dysfunctional attitudes, hopelessness, parent-adolescent conflict, negative interactions with parents and friends, and social support from parents and friends. Depression symptoms were assessed repeatedly through 18 months postintervention. After adjusting for multiple comparisons, rumination (B = -2.02, SE = .61, p = .001, d = .47), hopelessness (B = -2.03, SE = .72, p = .005, d = .41), and conflict with father (B = 1.68, SE = .74, p = .02, d = .32) moderated intervention effects on change in depression symptoms from postintervention through 18-month follow-up. For example, at high levels of conflict with father, youth in IPT-AST reported a significant decrease in symptoms during follow-up, whereas youth in CWS reported a nonsignificant change in symptoms. At low levels of conflict with father, youth in IPT-AST reported a significant increase in symptoms during follow-up, whereas youth in CWS reported a nonsignificant change in symptoms. These exploratory secondary analyses of Personalized Depression Prevention study data highlight specific cognitive and interpersonal risk factors that could be considered when determining which prevention program may be most effective for a given adolescent. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This chapter discusses the delivery of Interpersonal Psychotherapy–Adolescent Skills Training (IPT-AST) in school settings. The literature on school-based mental health programs is reviewed. Advantages of delivering preventive interventions in schools and challenges to implementation are outlined. These challenges include obtaining agreement from school personnel and boards of education; identifying personnel who will take the lead in implementing IPT-AST; identifying adolescents who will be appropriate for these services; explaining IPT-AST to adolescents and parents to engage them in the program; and managing logistical and scheduling issues within the schools. The authors discuss strategies to address the challenges of implementing this depression prevention program in a school setting.

This book describes Interpersonal Psychotherapy–Adolescent Skills Training (IPT-AST), an interpersonally oriented depression prevention program for adolescents. The program developed from an interest in developing and studying a depression prevention program for youth who are experiencing depressive symptoms but do not yet qualify for a diagnosis of depression. The IPT-AST program is a predominantly group-based intervention that teaches communication and interpersonal problem-solving skills to improve relationships and prevent the development of depression. The book provides a detailed description of the IPT-AST program so readers can implement groups in different settings. In addition, there are chapters that outline key issues related to implementation of IPT-AST, including selecting adolescents to participate in group, conducting IPT-AST in schools and other diverse settings, working with adolescents at varying levels of risk for depression, and dealing with common clinical issues. Finally, the book outlines the research that has been conducted on this depression prevention program.

Prevention bends adolescent internalizing trajectories: Within-person changes from pre- to post-prevention.

Interpersonal Psychotherapy—Adolescent Skills Training With Youth From Asian American and Immigrant Families: Cultural Considerations and Intervention Process