Abstract
Effectiveness research on depression prevention usually compares pre- to post-intervention outcomes across groups, but this aggregation across individuals may mask heterogeneity in symptom change trajectories. Hence, this study aimed to identify subgroups of adolescents with unique trajectories of change in a school-based depression prevention trial. It was also examined how trajectory membership was associated with the intervention conditions, depressive symptoms at 12-month follow-up, and baseline predictors. Hundred-ninety adolescent girls (Mage = 13.34; range = 11–16 years) with subclinical depression at screening (M = 57 days before pre-test) were allocated to four conditions: a face-to-face, group-based program (OVK), a computerized, individual program (SPARX), OVK and SPARX combined, and a monitoring control condition. Growth Mixture Modeling was used to identify the distinct trajectories during the intervention period using weekly depressive symptom assessments from pre-test to post-test. Analyses revealed three trajectories of change in the full sample: Moderate-Declining (62.1% of the sample), High-Persistent (31.1%), and Deteriorating-Declining (6.8%) trajectories. Trajectories were unrelated to the intervention conditions and the High-Persistent trajectory had worse outcomes at follow-up. Several baseline factors (depression severity, age, acceptance, rumination, catastrophizing, and self-efficacy) enabled discrimination between trajectories. It is concluded that information about likely trajectory membership may enable (school) clinicians to predict an individual’s intervention response and timely adjust and tailor intervention strategies as needed.
Highlights
Cognitive-behavioral (CB) interventions are generally found to be mildly effective in preventing the onset of depression among high-risk youth. informative, the establishment of the effectiveness of psychological interventions is primarily concerned with comparing aggregated pre- to post-intervention outcomes across groups
The current study aimed to address this gap by studying profiles of change in a school-based depression prevention trial for adolescent girls with elevated depressive symptoms
Despite the proliferation of research on school-based depression prevention programs, uncertainty remains regarding how adolescents change during these preventive efforts
Summary
Cognitive-behavioral (CB) interventions are generally found to be mildly effective in preventing the onset of depression among high-risk youth (see the meta-analyses by Rasing et al, 2017 & Werner-Seidler et al, 2017). informative, the establishment of the effectiveness of psychological interventions is primarily concerned with comparing aggregated pre- to post-intervention outcomes across groups (i.e., intervention versus control). Effectiveness research implicitly assumes that change is linear and steady across time (Hayes et al, 2007) and that group-derived estimates can be generalized back down to the individual participant (Fisher et al, 2018). Those assumptions and research practices, are worrisome because the aggregation of data across individuals may obscure heterogeneity in symptom change trajectories. Individual time course data are increasingly recognized for their ability
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