A new study published in JAMA Psychiatry in September 2013 shows that children at “double-risk” for depression experience positive results from cognitive behavioral therapy (CBT.) The study followed 316 teenagers with a history of depressive symptoms, who also have at least one parent with current or past depression. The results of the study show that those teenagers who underwent a series of group CBT sessions known as cognitive behavioral prevention (CBP) were less likely to experience depressive symptoms or depressive episodes later on. The lead researcher for this study was Dr. William R. Beardslee, a professor of child psychiatry at Harvard Medical School who also serves as the director of Baer Prevention Initiatives at Boston Children’s Hospital. The 316 teenagers in the study, all between the ages of 13 and 17, came from one of four sites in Massachusetts, Oregon, Tennessee and Pennsylvania. Of the teenagers, 159 were randomly assigned to the CBP treatment, while 157 were randomly assigned to receive their usual care. The 159 individuals in the CBP group underwent weekly group sessions over the course of eight weeks, and then monthly continuation sessions over the course of six months. Following completion of the program, participants in the CBP sessions were evaluated for a further two years along with the patients who did not undergo CBP. The study published two sets of results; the first at the end of the sessions (nine months into the study,) and the second at the end of the full 33 weeks of evaluation. At the nine-month point, 21.4 percent of the patients in the CBP group had experienced the onset of a depressive episode, compared to 32.7 percent of the standard care group. At 33 months, 36.8 percent of the CBP had suffered a depressive episode, compared to 47.7 percent of the standard care group. In order to evaluate the study participants for depressive symptoms and episodes, Dr. Beardslee and his research team administered two separate tests periodically: the Center for Epidemiologic Studies Depression Scale (CES-D) and the Children’s Depression Rating Scale-Revised (CDRS-R.) A score of 20 or more on the CES-D scale met the criteria for a depressive episode.
A Global Problem
Depression is a large and expensive problem around the world. The Global Health Organization has named depression the third-largest cause of global disease. Due to their limited numbers, past studies on the effectiveness of depression prevention methods have not produced significant results. If CBP and other prevention methods prove to be effective and gain wider use, they could greatly reduce the number of people who suffer from this painful illness, and eliminate some of the more significant costs of treating active depressive episodes.
The Effects of Parental Depression
Although the study results showed significant improvement in the abatement of depressive symptoms for the CBP group, the improvements were negated when the parents of the “double-risk” teenagers were depressed at the study baseline (the start of the CBP sessions). Of the participants in the study, 128 had at least one parent in an active depressive episode at the onset of the study. For these individuals, there was no difference in the onset of depressive episodes between those in the CBP group and those in the standard treatment group. However, the CES-D scores did improve for individuals in the CBP group with one or more parents depressed at the baseline.
The Need for Future Research
In the conclusion of their study findings, Dr. Beardslee and his research group note that further research is needed to continue developing cognitive behavioral prevention so that it produces results for an even larger percentage of the population. They also note the importance of understanding the influence that parental depression has on the incidence of depressive episodes in children. Although the current study shows that parental depression does have a strong influence on the effectiveness of CBP, it does not provide many clues as to why parental depression is so influential on intervention effectiveness.
