Depression Prevention Intervention Research Articles

The expression of perinatal depression in rural Ghana.

In low- and middle-income countries, perinatal depression (PND) has been associated with poor infant health outcomes, including frequency of infant diarrheal episodes, preterm delivery and low birth weight, and discontinuation or problems breastfeeding. Yet little is known about the awareness or expression of PND depression in Ghana. A total of 12 in-depth key-informant interviews were conducted with women who had experienced PND within the previous two-and-a-half years. Three focus-group discussions were conducted with new mothers (n = 11), grandmothers (n = 8), and fathers (n = 9) for contextual and supporting information. 'Thinking too much' was the term most commonly used to describe PND. The women saw their distress as caused largely by poverty, lack of social support, and domestic problems. Women sought help through family and religious organizations, rather than through medical services. Problems producing breast milk or breastfeeding were nearly universal complaints and suggest significant effects on infant health in the study area. These results present evidence to support the increasing consensus that depression presents in similar and disabling ways across cultures and contexts. This formative qualitative data is required to tailor depression prevention or treatment interventions to this particular socio-cultural context.

An internet-based adolescent depression preventive intervention: study protocol for a randomized control trial.

BackgroundThe high prevalence of major depressive disorder in adolescents and the low rate of successful treatment highlight a pressing need for accessible, affordable adolescent depression prevention programs. The Internet offers opportunities to provide adolescents with high quality, evidence-based programs without burdening or creating new care delivery systems. Internet-based interventions hold promise, but further research is needed to explore the efficacy of these approaches and ways of integrating emerging technologies for behavioral health into the primary care system.Methods/DesignWe developed a primary care Internet-based depression prevention intervention, Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training (CATCH-IT), to evaluate a self-guided, online approach to depression prevention and are conducting a randomized clinical trial comparing CATCH-IT to a general health education Internet intervention. This article documents the research framework and randomized clinical trial design used to evaluate CATCH-IT for adolescents, in order to inform future work in Internet-based adolescent prevention programs. The rationale for this trial is introduced, the current status of the study is reviewed, and potential implications and future directions are discussed.DiscussionThe current protocol represents the only current, systematic approach to connecting at-risk youth with self-directed depression prevention programs in a medical setting. This trial undertakes the complex public health task of identifying at-risk individuals through mass screening of the general primary care population, rather than solely relying on volunteers recruited over the Internet, and the trial design provides measures of both symptomatic and diagnostic clinical outcomes. At the present time, we have enrolled N = 234 adolescents/expected 400 and N = 186 parents/expected 400 in this trial, from N = 6 major health systems. The protocol described here provides a model for a new generation of interventions that blend substantial computer-based instruction with human contact to intervene to prevent mental disorders such as depression. Because of the potential for broad generalizability of this model, the results of this study are important, as they will help develop the guidelines for preventive interventions with youth at-risk for the development of depressive and other mental disorders.Trial registrationClinical Trial Registry: NCT01893749 date 6 May 2012.

Where to go from here? An exploratory meta-analysis of the most promising approaches to depression prevention programs for children and adolescents.

Objective: To examine the overall effect of individual depression prevention programs on future likelihood of depressive disorder and reduction in depressive symptoms. In addition, we have investigated whether Cognitive Behavioural Therapy (CBT), Interpersonal Therapy (IPT) and other therapeutic techniques may modify this effectiveness. Methods: This study is based on and includes the trial data from meta-analyses conducted in the Cochrane systematic review of depression prevention programs for children and adolescents by Merry et al. (2011). All trials were published or unpublished English language randomized controlled trials (RCTs) or cluster RCTs of any psychological or educational intervention compared to no intervention to prevent depression in children and adolescents aged 5–19 years. Results: There is some evidence that the therapeutic approach used in prevention programs modifies the overall effect. CBT is the most studied type of intervention for depression prevention, and there is some evidence of its effectiveness in reducing the risk of developing a depressive disorder, particularly in targeted populations. Fewer studies employed IPT, however this approach appears promising. To our knowledge, this is the first study to have explored how differences in the approach taken in the prevention programs modify the overall treatment effects of prevention programs for children and adolescents. Conclusions: More research is needed to identify the specific components of CBT that are most effective or indeed if there are other approaches that are more effective in reducing the risk of future depressive episodes. It is imperative that prevention programs are suitable for large scale roll-out, and that emerging popular modes of delivery, such as online dissemination continue to be rigorously tested.

The influence of cognitive control training on stress reactivity and rumination in response to a lab stressor and naturalistic stress

Cognitive control impairments have been identified as an underlying mechanism for rumination, a key predictor of depression. Literature suggests that cognitive control training (CCT) targeting working memory functioning can increase effectiveness of existing antidepressant treatments to reduce rumination. However, it remains unclear whether CCT can also be implemented as a preventive intervention for depression, increasing resilience. For this purpose, at-risk undergraduate students (high trait ruminators) were allocated to a CCT or active control condition, consisting of 10 online training sessions. Working memory functioning was assessed preceding and following the training and reactivity to a lab stressor was assessed directly following training. Finally, at four weeks follow-up, brooding – the maladaptive form of rumination – was re-assessed in response to a naturalistic stressor (examination period). Although we did not find direct transfer effects of CCT on working memory functioning, increase in working memory functioning following CCT was related to post-training brooding and resilience levels. Moreover, participants receiving CCT demonstrated lower stress reactivity in the lab and a decrease in brooding following a naturalistic stressor at follow-up, indicating temporal stability of our findings. These findings suggest that CCT can be considered a promising preventive intervention to reduce stress reactivity and rumination.

Sensory-Processing Sensitivity predicts treatment response to a school-based depression prevention program: Evidence of Vantage Sensitivity

ObjectiveTreatment effects of preventative mental health interventions for adolescents tend to be relatively small. One reason for the small effects may be individual differences in the response to psychological treatment as a function of inherent characteristics, a notion proposed in the concept of Vantage Sensitivity. The current study investigated whether the personality trait Sensory-Processing Sensitivity moderated the efficacy of a new school-based intervention aimed at the prevention of depression. MethodUsing a two-cohort treatment/control design with one cohort serving as the control group (N=197) and a subsequent cohort as the treatment group (N=166) it was tested whether Sensory-Processing Sensitivity predicted depression trajectories from pre-treatment up to a 12months follow-up assessment in 11-year-old girls from an at-risk population in England. ResultsSensory-Processing Sensitivity emerged as a significant predictor of treatment response. The prevention program successfully reduced depression scores in girls scoring high on Sensory-Processing Sensitivity but was not effective at all in girls scoring low on the same measure. ConclusionsThis study provides first empirical evidence for Vantage Sensitivity as a function of the personality trait Sensory-Processing Sensitivity regarding treatment response to a school-based depression prevention intervention.

Cultural considerations for adaptation of an internet-based intervention for depression prevention in Mainland China

Cultural considerations for adaptation of an internet-based intervention for depression prevention in Mainland China

The Policy Context of Depression and Suicide Prevention in Europe. Results of the Joint Action Situation Analysis

Fight against depression and suicide in Europe: evidence-based tools partly utilised. Results of JA situation analysis Gyorgy Purebl, Tamas Kurimay Semmelweis University of Medicine, Budapest, Hungary Introduction According to the WHO GBD Study depression will be the second most frequent cause of disability by 2020. Although many activities and research have been done against depression, and devidence-based therapies are also available, depression remains a top health concern with increasing significance. Aims Joint Action of Mental Health and Well-being Workpackage 4 aims to develop a framework for action at the level of policies, infrastructures and interventions for prevention and treatment of depression and suicide. The first step is the data collection about the best practices in the participating countries. Method Comprehensive assessment was conducted for evaluating the utilisation of evidence-based tools: 1.) systematic review of scientific publications and policy documents in the field, 2.) assessment of best practices 3.) situation analysis in national frameworks. The evaluation do not focus only to scientific and clinical excellence but also management and activity on policy level. Data collection is conducted with the help of the JA WP4's key stakeholders. Results The preliminary data of the evaluation revealed that although many evidence-based tools are available, there are considerable differences in their utilisation, and many of them are not enacted into a policy context in the different participating countries. The final data will be presented in more details. Conclusion Although combating depression and suicide is a significant need in public health, evidence-based tools are partly exploited in the practice. In the next phase of JA an action framework will be developed, for tackling the obstacles of dissemination of evidence-based practices in Europe, with the invocation of policy context.

Abstract NS18: Prevalence and Predictors of Depression among Elderly Stroke Patients in Korea

Background: Depression after stroke not only affects rehabilitation and recovery, but increases caregiver burden. With rapidly increasing aged population, stroke burden substantially increases in Korea, which makes depression after stroke an important concept to assess. Purpose: The purposes of this study were to (1) assess the prevalence of depression and (2) identify predictors of depression among elderly stroke patients in Korea. Methods: A cross-sectional, descriptive study was conducted in a convenience sample of 233 hospitalized elderly patients with acute ischemic stroke using a self-administered survey. We assessed depression using the Hospital Anxiety and Depression Scale (HADS) and collected demographic data and stroke severity (e.g., hemiparesis, dysphagia, cognitive impairment). Descriptive statistics, chi-square test, and logistic regression analyses were used for data analysis. Results: Of the total participants, 60.5% were men, 76.8% were aged ≥ 61 years, 70% were married, 80.3% lived with family, and 71.7% were depressed (HADS depression scale ≥ 8). Individuals who were women (χ 2 =10.32), lived alone (χ 2 =3.38), had symptoms of dysphagia (χ 2 =6.14), dysphasia (χ 2 =8.14), hemiparesis (χ 2 =5.61), cognitive impairment (χ 2 =4.86), or anxiety (χ 2 =54.53) were more likely to be depressed than those who were men, lived with family, had no symptoms of dysphagia, dysphasia, hemiparesis, cognitive impairment ( p < .05), or anxiety. The likelihood of being depressed was higher in individuals who had anxiety (OR=18.93, 95% CI=[6.88, 52.08]) or lived alone (OR=0.28, 95% CI=[0.06, 0.77]) than individuals who did not have anxiety or lived with family. Conclusions: In conclusion, the study findings suggest that clinicians who handle elderly stroke patients should pay attention to the individuals who have anxiety or live alone as the risk of depression after stroke seems to be higher in these groups. Further research focus should be given to (1) identifying underlying factors of anxiety, (2) developing preventive interventions for depression after stroke, including strategies to decrease anxiety and ensure social support, and (3) exploring the association of depression with other health outcomes, such as quality of life and mortality.

"You need to get them where they feel it": Conflicting Perspectives on How to Maximize the Structure of Text-Message Psychological Interventions for Adolescents.

Mobile psychological interventions are of growing interest, particularly for populations with little access to traditional mental health services. Optimum structural components of these interventions are unknown. In this study, twenty-one adolescents (age 13-17) with past two week depressive symptoms were recruited from the emergency department to participate in a semi-structured interview, to inform development of a text-message-based depression prevention intervention. Teens expressed conflict about intervention structure. Although trust and reliability were essential to sustain engagement, teens disagreed about how to best maintain reliability; whether the program should be "pushed" or "pulled"; and what the ideal degree of human interaction would be. These findings highlight the challenges in automating psychological interventions that are normally delivered face-to-face. Data indicate a broad desire for developing tailoring methods for system design (duration, frequency, and level of interactivity). The paper closes with thoughts about potential solutions to these structural issues for mobile psychological interventions.

4. Decreased delta sleep ratio and elevated alpha power predict vulnerability to depression during interferon-alpha treatment

Poor sleep often precedes depression. This is also true for depression occurring during interferon-a (IFN-a) therapy, where approximately one-quarter of non-depressed subjects develop depression by the second month. Those who sleep well remain relatively resilient. To implement potential depression prevention interventions, the specific sleep parameters that might influence depression resilience require determination. Therefore, two nights of polysomnography with quantitative EEG were obtained in 24 adult, euthymic subjects who subsequently were treated with IFN-a. Sleep parameters included the delta sleep ratio (DSR) (early-night restorative delta power) and alpha power (8–12 Hz; indexing hyperarousal). Every two weeks after starting IFN-a, a Beck Depression Inventory-II (BDI-II) score was obtained. The maximal increase in BDI-II from pre-treatment baseline – excluding the sleep question – was determined. As hypothesized, DSR was inversely associated with increases in BDI-II scores ( p p p p

A qualitative investigation of adolescents' perceived mechanisms of change from a universal school-based depression prevention program.

A recent meta-analysis provides evidence supporting the universal application of school-based prevention programs for adolescent depression. The mechanisms underlying such successful interventions, however, are largely unknown. We report on a qualitative analysis of 109 Grade 9 students’ beliefs about what they gained from an evidence-based depression prevention intervention, the Resourceful Adolescent Program (RAP-A). Fifty-four percent of interviewees articulated at least one specific example of program benefit. A thematic analysis of responses revealed two major themes, improved interpersonal relationships and improved self-regulation, both stronger than originally assumed. A more minor theme also emerged—more helpful cognitions. It is postulated that both improved interpersonal relationships and improved self-regulation are likely to enhance one another, and more helpful cognitions may express its contribution through enhanced self-regulation. These findings broaden our understanding of the impact of depression prevention programs, beginning to illuminate how such programs benefit participants.

Cognitive-behavioral group depression prevention compared to bibliotherapy and brochure control: Nonsignificant effects in pilot effectiveness trial with college students

ObjectiveConduct a pilot trial testing whether a brief cognitive-behavioral (CB) group reduced depressive symptoms and secondary outcomes relative to bibliotherapy and brochure controls in college students with elevated depressive symptoms. Method82 college students (M age = 19.0, SD = 0.9; 70% female, 80% White) with elevated self-assessed depressive symptoms were randomized to a 6-session CB group, bibliotherapy, or educational brochure control condition, completing assessments at pretest, posttest, and at 6- and 12-month follow-up. ResultsPlanned contrasts found no significant effects for CB group on depressive symptoms compared to either bibliotherapy or brochure controls at posttest (d = −.08 and .06, respectively) or over follow-up (d = −.04 and −.10, respectively). There were no intervention effects for social adjustment and substance use, though CB group participants had improved knowledge of CB concepts at posttest, versus brochure controls. Condition differences in major depression onset were nonsignificant but suggested support for CB interventions (CB group = 7.4%, bibliotherapy = 4.5%, brochure control = 15.2%). ConclusionsUnexpectedly modest support was found for a brief CB group depression prevention intervention, compared to bibliotherapy or brochure control, when provided to self-selected college students, suggesting that alternative screening or interventions approaches are needed for this population.

Observed parental responsiveness/warmth and children's coping: cross-sectional and prospective relations in a family depression preventive intervention.

The current study examined concurrent and prospective relations between observed parenting behaviors and children's coping strategies in the context of a preventive intervention designed to change both parenting and children's use of secondary control coping. Questionnaires and direct observations were obtained from parents with a history of depression (N = 180) and their children (ages 9-15 years) at baseline, 6-month (after completion of the intervention), and 18-month follow-up assessments. Cross-sectional analyses indicate that baseline observed parental responsiveness/warmth was significantly associated with composite parent/child reports of children's baseline primary control, secondary control, and disengagement coping. Using a mixed effects model, prospective mediational analyses indicate that intervention-driven improvements in observed parental responsiveness/warmth from baseline to 6 months significantly accounted for increases in children's use of secondary control coping strategies from baseline to the 18-month follow-up assessment. No significant mediation effects emerged for primary control coping or disengagement coping. The present findings suggest that it may be possible to improve children's coping strategies not only through targeted interventions, but also indirectly by improving responsive and warm parenting behaviors. Limitations and strengths are noted and implications for future research are outlined.

A brief problem-solving indicated-prevention intervention for prevention of depression in nonprofessional caregivers.

Despite depression being a common problem among nonprofessional caregivers, no studies of prevention of depression targeting this population exist in the literature. The studies of indicated prevention of depression aim of this study was to assess the efficacy of a problem-solving intervention in preventing clinical depression in a sample of female caregivers. A controlled randomized trial was conducted among 173 participants (mean age 53.9 years), 89 of whom were randomized to the intervention group and 84 (controls) to usual care. The intervention comprised five weekly 90-minute group sessions. At post-treatment, depression symptoms in the intervention group had remitted significantly more than in the control group, with a large effect size ( d = 1.54). The proportion of participants showing clinically significant improvement was significantly larger in the intervention group (80.9% vs. 11.9% among controls), and fewer intervention-group participants had progressed to clinical depression during the study period (4.5% vs. 13.1% among controls). The intervention group also exhibited a significantly greater reduction in emotional distress and caregiver burden than the control group. These findings attest to the short-term efficacy of the intervention.

Pilot Study of Implementation of an Internet-Based Depression Prevention Intervention (CATCH-IT) for Adolescents in 12 US Primary Care Practices: Clinical and Management/Organizational Behavioral Perspectives.

To explore the implementation of CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral Humanistic and Interpersonal Training), an Internet-based depression intervention program in 12 primary care sites, occurring as part of a randomized clinical trial comparing 2 versions of the intervention (motivational interview + Internet program versus brief advice + Internet program) in 83 adolescents aged 14 to 21 years recruited from February 1, 2007, to November 31, 2007. The CATCH-IT intervention model consists of primary care screening to assess risk, a primary care physician interview to encourage participation, and 14 online modules of Internet training to teach adolescents how to reduce behaviors that increase vulnerability to depressive disorders. Specifically, we evaluated this program from both a management/organizational behavioral perspective (provider attitudes and demonstrated competence) and a clinical outcomes perspective (depressed mood scores) using the RE-AIM model (Reach, Efficacy, Adoption, Implementation, and Maintenance of the intervention). While results varied by clinic, overall, clinics demonstrated satisfactory reach, efficacy, adoption, implementation, and maintenance of the CATCH-IT depression prevention program. Measures of program implementation and management predicted clinical outcomes at practices in exploratory analyses. Multidisciplinary approaches may be essential to evaluating the impact of complex interventions to prevent depression in community settings. Primary care physicians and nurses can use Internet-based programs to create a feasible and cost-effective model for the prevention of mental disorders in adolescents in primary care settings. ClinicalTrials.gov identifiers: NCT00152529 and NCT00145912.

Culturally Tailored Depression/Suicide Prevention in Latino Youth: Community Perspectives

Latino adolescents are at elevated risk for depression and suicide compared to other ethnic groups. Project goals were to gain insight from community leaders about depression risk factors particular to Latino adolescents and generate innovative suggestions to improve cultural relevance of prevention interventions. This project utilized a CBPR approach to enhance cultural relevance, acceptability, and utility of the findings and subsequent program development. Two focus groups of youth and youth-involved Latino community leaders (n = 18) yielded three overarching themes crucial to a culturally tailored depression prevention intervention: (1) utilize a multipronged and sustainable intervention approach, (2) raise awareness about depression in culturally meaningful ways, and (3) promote Latino youth's social connection and cultural enrichment activities. Findings suggest that both adaptation of existing prevention programs and development of hybrid approaches may be necessary to reduce depression/suicide disparities for Latino youth. One such hybrid program informed by community stakeholders is described.

Translating Research Into Practice: Targeting Negative Thinking as a Modifiable Risk Factor for Depression Prevention in the College Student Population

This article describes the effects of an evidence-based depression prevention intervention on the depressive symptomatology, negative thinking, and self-esteem in college students. A feasibility study was conducted using pre-test post-test design sampling a total of 12 college students. Participants underwent 4-weeks of psychological treatment using Peden's cognitive behavioral group intervention. The Beck Depression Inventory, Crandell Cognitions Inventory, and Rosenberg Self-Esteem Scale were administered at two time points: prior to the intervention (T1) and 4weeks later (T2). Paired t-test analysis found participants had significantly decreased depressive symptoms and negative thinking, and significantly increased self-esteem from T1 to T2.

Adaptation of an internet-based depression prevention intervention for Chinese adolescents: from “CATCH-IT” to “grasp the opportunity”

There is a dearth of information on the compatibility of Western-developed, internet-based interventions that prevent onset and precipitation of depression in global settings. Recently, Project CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral, Humanistic and Interpersonal Training), an information technology-based intervention, was adapted to prevent depression in Hong Kong Chinese adolescents. This paper evaluates qualitative data from consultations to develop a revised intervention of CATCH-IT for Hong Kong youth. A theoretical thematic analysis approach was used to analyze data. Materials from three consultation trips which included focus groups (2007), an expert panel (2007), a public health campaign (2009), and a joint primary care physician-social worker review group (2010) were compiled. Authors (KS and AZ) independently reviewed the data and applied the theoretical framework of behavioral vaccines to code the data. These data were subsequently consolidated to provide a coherent narrative analysis. The cognitive behavioral therapy (CBT), behavioral activation (BA), and resiliency modules were maintained, while the interpersonal therapy (IPT) modules of CATCH-IT were excluded in the Hong Kong adaptation. Concurrent self-reports of drinking, smoking, illicit drug use and gambling behavior were added. Rather than primary care consultations, social worker consultations may be the best point of entry for intervention. Socio-cultural relevance of psychotherapeutics and delivery context of internet-based interventions will require significant adaptation for the Hong Kong setting. However, because of community engagement throughout the process of adaptation, we believe the CATCH-IT intervention can be adapted for Chinese adolescents in Hong Kong with retained fidelity. The revised intervention is called "Grasp the Opportunity".

Impact of a preventive intervention for perinatal depression on mood regulation, social support, and coping.

Perinatal depression prevention trials have rarely examined proximal outcomes that may be relevant for understanding long-term risk for depression. The Mothers and Babies (MB) Course is a cognitive-behavioral depression prevention intervention, which has been shown to prevent depressive symptoms among at-risk perinatal women of color. This study examined intervention impact on three proximal outcomes that are theoretically linked with the intervention's model of change and have been empirically linked with risk for depression: mood regulation expectancies, perceived social support, and coping. The study used data from a randomized intervention trial of the MB Course with 78 low-income, predominantly African-American perinatal women enrolled at one of four home visitation programs in Baltimore City. Mood regulation expectancies, perceived social support, and coping were assessed with self-report instruments at baseline, post-intervention, and 3- and 6-month follow-ups. The intervention group experienced 16 % greater growth in mood regulation from baseline to 6-month follow-up compared to the usual care group, suggesting a prevention effect. The pattern of findings was similar, although not statistically significant, for social support. Contrary to prediction, the control group experienced less growth in avoidant coping than the intervention group. Findings indicate the MB Course enhances mood regulation, which may facilitate prevention of depression over time. Assessment of intervention effects on proximal outcomes is beneficial for understanding how interventions may enhance protective factors relevant to successful long-term outcomes.

Depression prevention and mental health promotion interventions: is stigma taken into account? An overview of the Italian initiatives

Depressive disorders represent a major public health concern in European countries and Italian epidemiological studies confirm that despite being highly prevalent in the general population and in clinical settings, their recognition and treatment are often inadequate (Balestrieri et al. 2004). Research suggested that the public stigma of mental disorders (defined as the general public's negative attitudes towards individuals with mental disorders) increases self-stigma (e.g. internalized attitudes held by people suffering from a mental disorder) with the consequences that individuals avoid seeking treatment and increase their social isolation (Kanter et al. 2008). In a survey on the Australian general population (Griffiths et al. 2008), personal stigma was associated with greater current psychological distress and lower depression literacy.