Abstract
Adolescent depression is a prevailing international mental health concern as up to 27% of adolescents experience either subsyndromal depression or a major depressive episode by the age of 18. Depression in adolescence has been found to negatively impact current and future academic achievement, functioning, mental health, and quality of life. Accordingly, the authors emphasize the importance of proactively preventing depression (and its negative outcomes) instead of waiting and having to “fix” the problems after they have already developed. The current article begins with a discussion of the various types of prevention, including their respective advantages and disadvantages. Further and more importantly, the article’s primary focus is to provide a summary of the theoretical basis, development of, empirical support for, and content of a universal school-based cognitive-behavioral program to prevent adolescent depression entitled LARS&LISA (Lust An Realistischer Sicht & Leichtigkeit Im Sozialen Alltag). As the program exists within the overlapping realms of universal prevention, school-based programs, and cognitive-behavioral interventions, the content of this article is relevant to all three areas and offers insight into the development of depression prevention in general. Finally, empirical support for the positive effects of the program is presented and some ideas for further research are discussed.
Highlights
Through a systematic review of epidemiological studies on subsyndromal depression in adolescence, Bertha and Balázs (2013) found that rates of subsyndromal depression increase sharply around the mid-teen years and continue to rise through early adulthood
Given that the program exists within the overlapping realms of universal prevention, school-based programs, and cognitive-behavioral interventions, the content of this article is relevant to all three areas and offers insight into the development of depression prevention in general
Based on the last 20 years, what are the steps in the ongoing iterative process between program development, empirical studies, and feeding the empirical evidence back into the program development? As the comparison with the structurally equivalent non-specific prevention program (Pössel et al, 2013) hints that the effects of LARS&LISA are based on specific cognitivebehavioral interventions, it seems logical to further examine the underlying mechanisms of change
Summary
Through a systematic review of epidemiological studies on subsyndromal depression in adolescence, Bertha and Balázs (2013) found that rates of subsyndromal depression increase sharply around the mid-teen years and continue to rise through early adulthood. They had to deliver their program to all students at the participating schools, turning it into a universal prevention program Another drawback associated with targeted prevention is that not all members of a high-risk group develop a problem (e.g., major depression) and most individuals that do develop a problem are not from a high-risk group (Offord, 2000). The costs associated with screening a large number of adolescents, combined with the problems in accurately identifying which individuals would benefit from participation in a targeted prevention program call into question whether this type of program is truly the most efficient and efficacious form of prevention, in school settings. By participating in universal prevention programs, even individuals who are not at risk of developing the targeted problem benefit from the skills trained in these programs (Harrington & Clark, 1998). LISA included four main modules: a) Reversible Spiral (associations among thoughts, feelings, and behavior), b) Think Tank (identification of dysfunctional thoughts, reality check on dysfunctional thoughts, development of functional thoughts, rehearsal of functional thought process), c) Just Do It (assertiveness training) d) Making Contact (social competence training)
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