Depression Prevention Program Research Articles

Key Components and Content of Effective Evidence-Based Digital Prevention Programs for Anxiety and Depression in Children and Adolescents: A Systematic Umbrella Review

AbstractAnxiety and depression are among the most common mental health problems in children and adolescents, and evidence-based digital programs may help in their prevention. However, existing reviews lack a detailed overview of effective program elements, including structural features and supporting content. This umbrella review synthesizes the main elements of effective, evidence-based digital programs which facilitate the prevention of anxiety and depression in children and adolescents. Based on an analysis of 11 existing reviews that describe 45 programs, key components and content contributing to program effectiveness were identified. These included a focus on modular and linear structure, which means organizing the program in a clear and sequential manner. Additionally, approaches based on cognitive behavioral therapy and gamification to engage and motivate users, were identified as effective components. The findings provide a better understanding of what makes digital programs effective, including considerations for sustainability and content, offering valuable insights for the future development of digital programs concerning the prevention of anxiety and depression in children and adolescents. Critically noted is that the differentiation between prevention and intervention in the program description is not always clear and this could lead to an overestimation of prevention effects.

Depression screening outcomes among adolescents, young adults, and adults reporting past 30-day tobacco and cannabis use

BackgroundFew studies examine the relationship between depression and use of specific tobacco and/or cannabis products among adolescents, young adults, and adults. We determined whether the odds of depression are greater among those who used specific tobacco and/or cannabis products and among co-users of tobacco and cannabis. MethodCross-sectional online survey of a national convenience sample of 13–40-year-olds (N = 6,038). The survey included depression screening and past 30-day use of specific tobacco and cannabis products (cigarettes; e-cigarettes, little cigars, cigarillos, cigars, hookah,chewing tobacco, smoked cannabis,edible cannabis, blunts). Analyses correspond to the total sample, 13–17-, 18–24-, and 25–40-year-olds. ResultsAmong 5,281 individuals who responded to the depression screener and nine product use questions, 1,803 (34.1 %) reported co-use of at least one tobacco product and one cannabis product in the past 30 days. Past 30-day co-use was associated with higher likelihood of screening positive for depression compared to past 30-day use of tobacco-only (aOR = 1.32, 1.06–1.65; 0.006) or cannabis-only (aOR = 1.94, 1.28–2.94; <0.001). Screening positive for depression was more likely among those who reported past 30-day use of e-cigarettes (aOR = 1.56; 1.35–1.80; <0.001), cigarettes (aOR = 1.24, 1.04–1.48; 0.016), chewed tobacco (aOR = 1.91, 1.51–2.42; <0.001), and blunts (aOR = 1.22, 1.00–1.48; 0.053) compared to those who did not report past 30-day use of these products. Among the 2,223 individuals who screened positive for depression, the most used two-product combination was nicotine e-cigarettes and smoked cannabis (621 individuals, 27.2 %). ConclusionsScreening positive for depression was more likely among past 30-day co-users versus past 30-day users of tobacco-only or cannabis-only. Findings suggest that prevention programs for depression and substance use address tobacco and cannabis co-use.

Cognitive and interpersonal moderators of two evidence-based depression prevention programs.

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).

Supplemental Material for Cognitive and Interpersonal Moderators of Two Evidence-Based Depression Prevention Programs

Supplemental Material for Cognitive and Interpersonal Moderators of Two Evidence-Based Depression Prevention Programs

The Association of Sexual Minority Status with the Prevalence, Diagnosis, and Treatment of Depression among NYC Adults.

Major depressive disorder (MDD) is a common mental health disorder with a lifetime prevalence of 20.6% among United States (US) adults. Multiple US surveys have shown a consistently higher burden of mental health struggles among lesbian, gay, bisexual, trans, and questioning (LGBTQ+) adults compared to non-LGBTQ+ adults. However, it is not known whether diagnosis and treatment for those adults who do report symptoms of MDD differ based on sexual orientation.We test for differences in prevalence, diagnosis, and treatment of MDD in sexual minorities using appropriate multivariable logistic regression using the New York City Health and Nutrition Examination Survey (NYC HANES).About 10% of NYC adults (≥ 20 years old) self-identify as a sexual minority and 8.5% of adults in NYC have MDD based on the Patient Health Questionnaire (PHQ-9) score. Significantly higher proportion of sexual minorities in NYC have depression compared to non-sexual minorities (17.7% vs. 7.6%, p = 0.01). In the multivariable model, sexual minorities were 2.33 (CI = [1.24-4.39], p = 0.009) times more likely to have depression compared to non-sexual minorities. Additionally, people with multimorbidity were more likely to be diagnosed for depression (OR = 3.78, CI = [1.33, 10.75], p = 0.013).Disparities exist in the prevalence, diagnosis, and treatment of MDD in NYC adults. Targeted outreach toward the LGBTQ + community should be considered by public health officials when designing primary and secondary prevention programs for depression.

Do Self-Processes and Parenting Mediate the Effects of Anxious Parents' Psychopathology on Youth Depression and Suicidality?

To understand how anxious parents' global psychopathology increases children's risks for depression and suicidality, we tested mediational pathways through which parent global psychopathology was associated with youth depression and suicidality over a six-year period. Parents (n = 136) who had an anxiety disorder at baseline reported global psychopathology and youth internalizing problems. Youth did not have any psychiatric disorder at baseline and they reported self-esteem, perceived control, and perceived parental warmth and rejection at baseline and 1-year follow-up. At 6-year follow-up, youth depression and suicidality were assessed via multiple reporters including the self, parent, and/or an independent evaluator. Results showed that parental psychopathology had an indirect but not direct effect on youth depression and suicidality via perceived control. No associations were found for the other hypothesized mediators. Perceived control might be a transdiagnostic intervention target in depression and suicide prevention programs for youth exposed to parental anxiety.

The risk of anxiety disorders in women in the first year postpartum - the results from the postpartum depression prevention program ‟Next Stop: MUM".

The purpose of the study was to examine the severity of anxiety symptoms and the co-occurrence of anxiety disorders and mood disorders in a group of women in the first year after childbirth participating in the program for the prevention of postpartum depression. The study included 1,514 women who were screened by midwives during a patronage visit and were followed up, and 10,454 women who took part in an online screening conducted on the project website. The Edinburgh Postpartum Depression Scale was used for screening, including factor analysis to assess the anxiety subscale, and the GAD-2 questionnaire was used too. The risk of anxiety disorders was observed in 9.5% of women during the patronage visit and, depending on the survey method, 21.2% (ESDP 3 A) or 13.2% (GAD-2) in the follow-up study up to 9 months postpartum. In the online study, 62.8% of women obtained results indicating a high risk of anxiety disorders. For comparison, the result of 12 points and more indicating the risk of depression was obtained by 6.3% in the first month after childbirth and 14.3% in the follow-up study. The results show that anxiety disorders and mood disorders are significantly related (r = 0.631; p < 0.01). The risk of having anxiety disorders after childbirth is higher or similar to that of mood disorders. It is warranted to extend screening to anxiety disorders and to develop a rapid pathway of early psychological/psychiatric intervention for women in need.

Experiences of Postpartum Depression in Men: A Qualitative Meta-synthesis

Purpose: This study aimed to comprehensively review the experiences of postpartum depression in men.Methods: A qualitative meta-synthesis suggested by Noblit and Hare was conducted in this study. Three qualitative studies were chosen and synthesized to describe men's experiences of postpartum depression. Results: Four themes emerged as a result of synthesizing: “Frustration stemming from excessive responsibility as a father”, “Life of mine being tied to child-rearing”, “Suppression of emotions due to gender role stereotypes”, and “Communication interruption with wife due to marital conflict”. Conclusion: The results of this study provided a deeper understanding of the experiences of postpartum depression in men, and can help establish prevention program and arrang social support for postpartum depression in men.

Predictors and outcomes of engagement in an online depression prevention program for final year secondary school students

Although school-based delivery of online interventions can effectively prevent depression and other common mental disorders, little is known about the characteristics of students who engage with these programs. This study aimed to identify predictors of two indicators of adolescent engagement (program usage and skill enactment) with a school-based online depression prevention program. The study also explored the association between skill enactment and mental health outcomes. Participants were 204 final-year secondary school students (M = 16.7 years, SD = 0.51 years; 111 females) from the intervention condition of a cluster randomized controlled trial conducted in 10 selective and partially selective government schools in Australia between 2015 and 2016. Program usage was measured as number of modules completed and skill enactment was assessed using a self-report questionnaire at post-intervention to determine the frequency of implementing program strategies (e.g., cognitive restructuring, activity scheduling). Predictors of engagement included demographics, mental health-related variables, and psychological factors (e.g., mastery). Regressions indicated that possible history of depression predicted fewer modules completed, whereas higher baseline anxiety, mastery, and higher perceived level of learning from the program predicted greater skill enactment. Mixed models did not show a significant effect of skill enactment on symptoms of depression, generalized anxiety, social phobia, or personal stigma. Future work is needed to investigate whether the results apply to students enrolled in non-selective programs and examine the effects of skill enactment and other possible mechanisms on outcomes in order to guide the refinement of future interventions.

Gender, age and depressive symptoms in adolescence

The objective of this study was to analyze the relationship of gender and age with depressive symptomatology in adolescents. The participants were 1,212 adolescents, from 1st (53.9%) and 2nd (46.1%) year in Compulsory Secondary Education, belonging to seven schools in the Region of Murcia (Spain), and 104 parents. The percentage of adolescents with clinically significant depressive symptoms is similar to that found in other studies in Spain. The girls presented greater depressive symptomatology. The gender difference was greater in the group with high depressive symptomatology. Depressive symptomatology increased with age, consistent with previous research. The difference was highlighted in adolescent self-reports but not in parent reports. The main conclusion is that the development of depression prevention programs should take gender and age into consideration.

Implementation and effectiveness of a sustained depression prevention program for high school students in Japan

ABSTRACT In Japan, many high school students have severe depression. Preventive interventions for school-based cognitive-behavioral depression are effective countermeasures against depressive problems among high school students. However, since high school curriculums are time-consuming, such interventions are less common among high school students. Therefore, we conducted a long-term but low-frequency intervention that divides the program content through several grades. We examined the effectiveness of our intervention based on the data obtained by a survey during the two-year intervention period and one-year follow-up period for 225 students who had enrolled in 2014–2019. Three-level hierarchical linear model analysis showed that students who participated in the program had improved depressive symptoms and related factors over these three years. The Welch test and chi-square test showed fewer depressive symptoms and a lower percentage of students with depression than the 608 Japanese students who did not receive the intervention; data were collected through an online survey at the end of the program and one year after the intervention ended. The results suggest that a school-based cognitive-behavioral depression prevention program using a long-term but low-frequency approach may effectively reduce the implementation burden into the school curriculum, promote sustained implementation, and prevent depression among high school students.

Cultural Adaptation and Implementation of Cognitive-Behavioral Psychosocial Interventions for Anxiety and Depression in Japanese Youth.

The present article reviews the current status of cognitive-behavioral therapy (CBT) interventions for anxiety and depression in Japanese youth. First, a literature review of youth CBT programs for anxiety and depression is provided. Through this process, we identify which program/protocol has been most researched within Japan. Second, through a systematic interview to the authors, the development process of four predominant programs is outlined. The programs included were a family CBT program for anxiety disorders (the Japanese Anxiety Children/Adolescents Cognitive Behavior Therapy program), two school-based prevention programs for anxiety and depression (Journey of the Brave and Phoenix Time), and a transdiagnostic protocol for anxiety and depression (Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents). Third, cultural adaptation and modification of the programs are discussed from the scope of user-centered design principles as described by Lyon and Koerner (Sci Pract 23:180-200, 2016). As a result, changes in program content and material, as represented by the use of culture-friendly program names, acronyms, illustrations, and characters were endorsed in all of the programs. Structured but flexible session formats helped increase learnability and efficiency while keeping the cognitive load of providers and consumers low. A careful selection of providers, as well as quality training and consultation are important factors to maximize competency and ensure appropriate implementation. Application of existing time frames and staff who work in each setting were effective ways to increase scalability. Overall, it was shown that many of the modifications adopted overlap among successful programs; these represent the most basic and essential requirements for a program to be applicable to a wide range of contexts. Implications and further directions are explored.

Study protocol for the ROSE Scale-Up Study: Informing a decision about ROSE as universal postpartum depression prevention

PurposeTo examine the effectiveness, cost-outcome, equity, scalability, and mechanisms of the Reach Out, Stay strong, Essentials for mothers of newborns (ROSE) postpartum depression prevention (PPD) program as universal versus selective or indicated prevention. BackgroundThe United States Preventive Services Task Force (USPSTF) currently recommends PPD prevention for pregnant people at risk of PPD (i.e., selective/indicated prevention). However, universal prevention may be more scalable, equitable, and cost-beneficial. DesignEffectiveness of ROSE for preventing PPD among people at risk is known. To assess ROSE as universal prevention, we need to determine the effectiveness of ROSE among all pregnant people, including those screening negative for PPD risk. We will enroll 2320 pregnant people, assess them with commonly available PPD risk prediction tools, randomize everyone to ROSE or enhanced care as usual, and assess ROSE as universal, selective, and indicated prevention in terms of: (1) effectiveness (PPD prevention and functioning), (2) cost-benefit, (3) equity (PPD cases prevented by universal prevention that would not be prevented under selective/indicated for minority vs. non-Hispanic white people), (4) quantitative and qualitative measures of scalability (from 98 agencies previously implementing ROSE), (5) ROSE mechanisms across risk levels. We will integrate results to outline pros and cons of the three prevention approaches (i.e., universal, selective, indicated). ConclusionThis will be the first trial to assess universal vs. selective/indicated PPD prevention. Trial design illustrates a novel, efficient way to make these comparisons. This trial, the largest PPD prevention trial to date, will examine scalability, an understudied area of implementation science.

Implementing a Digital Depression Prevention Program in Australian Secondary Schools: Cross-Sectional Qualitative Study

Background Depression is common during adolescence and is associated with adverse educational, employment, and health outcomes in later life. Digital programs are increasingly being implemented in schools to improve and protect adolescent mental health. Although digital depression prevention programs can be effective, there is limited knowledge about how contextual factors influence real-world delivery at scale in schools. Objective The purpose of this study was to examine the contextual factors that influence the implementation of the Future Proofing Program (FPP) from the perspectives of school staff. The FPP is a 2-arm hybrid type 1 effectiveness-implementation trial evaluating whether depression can be prevented at scale in schools, using an evidence-based smartphone app delivered universally to year 8 students (13-14 years of age). Methods Qualitative interviews were conducted with 23 staff from 20 schools in New South Wales, Australia, who assisted with the implementation of the FPP. The interviews were guided by our theory-driven logic model. Reflexive thematic analysis, using both deductive and inductive coding, was used to analyze responses. Results Staff perceived the FPP as a novel (“innovative approach”) and appropriate way to address an unmet need within schools (“right place at the right time”). Active leadership and counselor involvement were critical for planning and engaging; teamwork, communication, and staff capacity were critical for execution (“ways of working within schools”). Low student engagement and staffing availability were identified as barriers for future adoption and implementation by schools (“reflecting on past experiences”). Conclusions Four superordinate themes pertaining to the program, implementation processes, and implementation barriers were identified from qualitative responses by school staff. On the basis of our findings, we proposed a select set of recommendations for future implementation of digital prevention programs delivered at scale in schools. These recommendations were designed to facilitate an organizational change and help staff to implement digital mental health programs within their schools. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-042133

Problematic use of the internet, smartphones, and social media among medical students and relationship with depression: An exploratory study.

Students in sub-Saharan African countries experienced online classes for the first time during the COVID-19 pandemic. For some individuals, greater online engagement can lead to online dependency, which can be associated with depression. The present study explored the association between problematic use of the internet, social media, and smartphones with depression symptoms among Ugandan medical students. A pilot study was conducted among 269 medical students at a Ugandan public university. Using a survey, data were collected regarding socio-demographic factors, lifestyle, online use behaviors, smartphone addiction, social media addiction, and internet addiction. Hierarchical linear regression models were performed to explore the associations of different forms of online addiction with depression symptom severity. The findings indicated that 16.73% of the medical students had moderate to severe depression symptoms. The prevalence of being at risk of (i) smartphone addiction was 45.72%, (ii) social media addiction was 74.34%, and (iii) internet addiction use was 8.55%. Online use behaviors (e.g., average hours spent online, types of social media platforms used, the purpose for internet use) and online-related addictions (to smartphones, social media, and the internet) predicted approximately 8% and 10% of the severity of depression symptoms, respectively. However, over the past two weeks, life stressors had the highest predictability for depression (35.9%). The final model predicted a total of 51.9% variance for depression symptoms. In the final model, romantic relationship problems (ß = 2.30, S.E = 0.58; p<0.01) and academic performance problems (ß = 1.76, S.E = 0.60; p<0.01) over the past two weeks; and increased internet addiction severity (ß = 0.05, S.E = 0.02; p<0.01) was associated with significantly increased depression symptom severity, whereas Twitter use was associated with reduced depression symptom severity (ß = 1.88, S.E = 0.57; p<0.05). Despite life stressors being the largest predictor of depression symptom score severity, problematic online use also contributed significantly. Therefore, it is recommended that medical students' mental health care services consider digital wellbeing and its relationship with problematic online use as part of a more holistic depression prevention and resilience program.

Personalized Depression Prevention Reduces Dependent Stressors Among Adolescents: Results from a Randomized Controlled Trial

ABSTRACT Objective Depression and stressors both increase during adolescence. The stress generation model posits that depression symptoms and associated impairment contribute to the generation of dependent stressors. Adolescent depression prevention programs have been shown to reduce the risk of depression. Recently, risk-informed personalization approaches have been adopted to enhance the efficacy of depression prevention, and preliminary evidence supports the beneficial effects of personalized prevention on depression symptoms. Given the close association between depression and stress, we examined the hypothesis that personalized depression prevention programs would reduce adolescents’ experience of dependent stressors (interpersonal and non-interpersonal) over longitudinal follow-up. Method The present study included 204 adolescents (56% girls, 29% racial minority) who were randomized to receive either a cognitive-behavioral or an interpersonal prevention program. Youth were categorized as high or low on cognitive and interpersonal risk using a previously established risk classification system. Half of the adolescents received a prevention program that matched their risk profile (e.g., high cognitive risk randomized to cognitive-behavioral prevention); half received a mismatched program (e.g., high interpersonal risk randomized to cognitive-behavioral prevention). Exposure to dependent and independent stressors was assessed repeatedly over an 18-month follow-up period. Results Matched adolescents reported fewer dependent stressors during the post-intervention follow-up period (d = .46, p = .002) and from baseline through 18-months post-intervention (d = .35, p = .02) compared to mismatched youth. As expected, there were no differences between matched and mismatched youth on the experience of independent stressors. Conclusions These findings further highlight the potential of personalized approaches to depression prevention and demonstrate benefits that go beyond depression symptom reduction.

Working conditions, authorizations, mental health, and job satisfaction of physician assistants in Germany.

This study explores associations among the overall and facet-specific job satisfaction, work-related factors, responsibilities, and mental health of physician assistants (PAs) in Germany to identify factors that prolong the lifetime and wellbeing of PAs in practice and to counteract the shortage of healthcare staff. An online survey comprising sociodemographic and work-related items, items from the short questionnaire of general and facet-specific job satisfaction (KAFA), and the Depression, Anxiety, and Stress Scale (DASS-21) were distributed to PAs working in Germany in 2021 (cross-sectional survey design). Descriptive statistics, DASS-21 subscale score analysis, t-test, ANOVA, or Kruskal-Wallis test was used. PAs (n = 169) were working mainly in surgery (23.2%), internal medicine (20.3%), or orthopedics and trauma surgery (17.5%), whereas only a few PAs were working in emergency care, geriatrics, neurology, or oncology. They were responsible for a broad spectrum of medical activities depending on the practice setting. PAs working in emergency care claimed to be the most empowered, followed by PAs in orthopedics and surgery. Almost all PAs carried out documentation, anamnesis, and diagnostic services. Although almost all PAs rated their overall job satisfaction as good, satisfactory, or pleasant (91.6%), single facets of job satisfaction were rated differently. Colleagues and supervisors were assessed very positively, whereas payment and professional activities were rated rather average and development opportunities even worse. PAs working in oncology demonstrated the highest overall job satisfaction, followed by PAs working in geriatrics and emergency care. Overall job satisfaction was significantly negatively associated with depression, anxiety, and stress scores (p ≤ 0.001, p ≤ 0.05, and p ≤ 0.05, respectively). Particularly, female gender, having an urban residence, and PAs working in oncology demonstrated significantly increased anxiety scores. Moreover, depression scores of PAs working in oncology or neurology or with a low net income exceeded critical cutoff values. Interventions aimed at removing the significant negative correlation among job satisfaction, depression, anxiety, and stress scores are needed. To retain PAs in their jobs, salary, autonomy, and development opportunities should be improved and prevention programs for anxiety and depression should be offered. Remarkably, PAs' overall good job satisfaction was mainly determined by good evaluations of supervisors and colleagues.

The Relationship between Working Memory and Depressive Symptoms in Adolescents and Relevant Interventions

Major depressive disorder can have a serious negative impact on the cognitive functioning of adolescents, while most existing research focused on the biological, genetic and social factors of major depressive disorder. Working memory is a system related to the manipulation of short-term memory and is part of what constitutes human cognition. The current study reviewed the recent studies exploring the relationship between working memory and major depressive disorder in adolescents and related applications for treatment. As a result, in general, the ability of working memory was negatively associated with major depression, accompanied by negative correlations between it with various relevant factors and depressive symptoms. Also, intervening the working memory could alleviate major depression in adolescents. This paper only provided a generalized discussion regarding the relationship between working memory and depressive symptoms, while the interactions and specific associations of internal systems of working memory with depressive symptoms are expected to be confirmed in the future research. This review can contribute to future research on the relationship between specific working memory systems and mood disorders from a cognitive psychology perspective. It can also provide some suggestions to the design of prevention and intervention programs for depression at schools.

Determinants of Stress Coping in Young Girls with Major Depression

Based on former empirical studies and theoretical considerations the present study investigated differences in stress load and stress coping between adolescent girls with major depression and controls. In addition a biological indicator of chronic stress (the cortisol awakening response) was measured. 148 girls with a mean age of 15 years were studied and assessed twice with a time interval of six months in between. 74 fulfilled DSM IV criteria for major depression at first assessment. Stress symptoms and stress coping was measured with SSKJ 3-8 and SVFKJ, which are validated German questionnaires. Linear multiple regression was used to identify the variables which influence stress coping. Depressed girls reported a significantly higher stress load and significantly more destructive stress coping. The best prediction was found for a resignative coping strategy with initial degree of depression as best predictor. When using a lack of positive self instruction as dependent variable the cortisol awakening response also contributed significantly to the amount of explained variance. Because initial degree of depression seemed to determine the later inadequate coping strategies prevention programs for depression in adolescents are recommended.

PATH 2 Purpose: Design of a comparative effectiveness study of prevention programs for adolescents at-risk for depression in the primary care setting

The majority of mental, emotional, and behavioral (MEB) disorders have an initial onset before age 24, with 20% annual incidence, and with major depressive disorder (MDD) being the most common MEB. Health systems may be able to reduce costs by transitioning from the current treatment-focused model for MDD to a prevention model. However, evidence is needed for (1) the comparative effectiveness of a “scalable intervention” and (2) an implementation model for such a scalable intervention in the primary care setting. This paper describes a comparative effectiveness trial evaluating the efficacy of two evidence-based cognitive-behavioral prevention (CBP) programs: Teens Achieving Mastery over Stress (TEAMS), the “gold standard,” group therapy model, and Competent Adulthood Transition with Cognitive Behavioral, Humanistic and Interpersonal Training (CATCH-IT), a scalable, self-directed, technology-based model. Eligible adolescents, age 13–19, are offered one of these two depression prevention programs across five health systems (30 clinics) in urban and suburban Chicago, IL, rural Western IL, and Louisville, KY. We are comprehensively evaluating patient-centered outcomes and stakeholder-valued moderators of effect versus baseline at two, six, 12, and 18-month assessment points. Using a hybrid clinical trial design that simultaneously examines the implementation process, the study is also assessing adolescents', parents', and providers' experiences (e.g., efficacy, time commitment, cultural acceptability) within each intervention approach.