Abstract
The purpose of this study was to identify subgroups of university students with the highest likelihood of remaining at elevated levels of depressive symptoms six months following the receipt of a depressive prevention intervention on the basis of known risk factors and participation in one of two depression prevention programs. Data from a randomized controlled trial evaluating depression prevention among 133 college students with elevated depressive symptoms were analyzed. Participants were randomized to a cognitive-behavioral or relaxation training group preventive intervention. Classification tree analysis showed that older age was the strongest risk factor for persistently elevated depression. Additional risk factors were: (1) for younger students, fewer daily pleasant activities; (2) for those with higher level of pleasant activities, higher level of stressful events; and (3) for those with higher level of stressful events, lower assertiveness. Results offer directions for prevention foci, identify specific subgroups of college students to target for depression prevention efforts, and suggest that research aim to help older, non-traditional students or graduating students manage the transition from college to the work force.
Highlights
Depression is a highly prevalent mental disorder in university students, with rates of major depressive disorder (MDD) in this population ranging from 8% to 20% (e.g., [1,2,3])
A further look at the present results shows that age was significantly correlated to academic year, anxiety symptoms, and life change units, suggesting that increased stress and anxiety could be related to the high risk for depression in the older age group
The present results found that: (1) being over 23 years of age while attending university confers the highest discriminative risk for failing to benefit from an indicated depression prevention intervention; (2) for younger students, the risk for persistently elevated depression levels increases if they are not engaged in an adequate number of pleasant activities; (3) among students who are engaging in pleasant activities, in the present of stressful life circumstances, almost half will remain persistently depressed; and (4) for those exposed to high stress, low assertiveness predicts a higher risk for remaining depression, while high assertiveness appears to act as a protective factor
Summary
Depression is a highly prevalent mental disorder in university students, with rates of major depressive disorder (MDD) in this population ranging from 8% to 20% (e.g., [1,2,3]). One of the main predictors of future MDD is the occurrence of subsyndromal depressive symptoms [9], which are highly prevalent across the age span [10], with rates reaching 33% in university students [11]. These clinically significant depressive symptoms are associated with increased risk of suicidal behavior [12] and with psychosocial dysfunction and distress levels comparable to those caused by MDD [13]. Selective preventive interventions target individuals at elevated risk for depression as a function of family, environmental or personal factors; indicated prevention interventions are conducted with individuals who already show subclinical signs and symptoms of depression [18]
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