Category: Child / Adolescent - Depression

Symposium

Prevention of Initial Depressive Disorders Among "At-Risk" Portuguese Adolescents

Friday, November 17
3:45 PM - 5:15 PM
Location: Indigo Ballroom B, Level 2, Indigo Level

Keywords: Depression | Prevention | Adolescents
Presentation Type: Symposium

Background: Although a first episode of Major Depressive Disorder (MDD) may occur during early childhood, initial episodes of MDD rapidly increase during adolescence with 2% of the population experiencing an episode of MDD by age 14 to approximately 15% by age 18. Therefore, it is important to prevent initial episodes so individuals “at risk” for MDD can continue normal development and avoid personal and social consequences of the disorder.


 


Methods: In an attempt to replicate the positive effects of our depression prevention program in Iceland, 1,392 14-15-year-old participants in Portugal were screened for being “at risk” for MDD. 168 “at risk” but never depressed subjects participated in either a 5-session assessment-only condition for two years or alternatively in a weekly group depression prevention group program for 14 weeks plus the 5-session assessment sessions. The program teacher manual and student workbook were translated from Icelandic to English to Portuguese with back translation at each phase, and the supplemental materials were adapted to be culturally sensitive. Assessments, conducted by “masked” interviewers, included clinical interviews (e.g., K-SADS, A-LIFE) and self-report measures. All assessments and the prevention program took place in school settings.


 


Results: Participants who participated in the prevention program experienced significantly fewer initial episodes of MDD/Dysthymia. During the 2-year follow up period, 12 assessment only participants (12.24%) were diagnosed with MDD/Dysthmia while only 2 (2.86%) of the prevention program participants received such diagnoses. Survival curves and new episode rates were estimated using the Cox proportional hazards model and indicated that the program significantly reduced the risk of developing a first episode of MDD(X2(1)=5.218, p=.022). The hazard ratio for this comparison was .207, which indicates that within 24 months following completion of the program the intervention decreased the likelihood of having a first or initial episode of depression/dysthymia by 79%; a student who participated in the prevention program was only 20.7%% as likely to develop an initial episode of the depression/dysthymia as a student who was in the assessment-only group.


 


Discussion:Data from this study and prior research utilizing this prevention protocol indicate that the probability of an initial episode of MDD can be reduced by ~80%. Implications of these findings and their use in other countries and cultures will be discussed.

Ed Craighead

J. Rex Fuqua Professor, Department of Psychiatry and Behavioral Sciences and Department of Psychology
Emory University

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