Abstract
The present study proposes and demonstrates a comprehensive framework for evaluation of a universal school-based depression prevention program. Efficacy was evaluated by considering the impact of continuous versus categorical approaches to operationalizing outcome, the effect of the intervention on key change agent variables, and moderation of intervention effects by student symptom severity at baseline. Participants 252 adolescent boys and girls (60 % male), aged 13 to 17 years (M = 13.62 years, SD = 0.60 years) from four schools in the state of Victoria, Australia, who were allocated by school into a waitlist = control (n = 88) or a CBT-based intervention (n = 164) group. The intervention involved six 45-min weekly sessions run during wellbeing classes. While the intervention and control groups did not differ in average improvement in symptoms by post-intervention, further analyses showed that responsiveness was highly variable within the intervention, and those with elevated depressive symptoms benefitted most. The proposed change agents of self-esteem, resilience, body image satisfaction, and perceived social support did not uniquely predict change in depressive symptoms but collectively accounted for substantial variance in this change process. Collectively, this framework provided insights into aspects of the intervention that worked and highlighted areas for improvement, thus providing clear direction for future research.
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Angold, A., Costello, E. J., Messer, S. C., Pickles, A., Winder, F., & Silver, D. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–249.
Araya, R., Fritsch, R., Spears, M., Rojas, G., Martinez, V., Barroilet, S., … Montgomery, A.A. (2013). School intervention to improve mental health of students in Santiago, Chile: A randomized clinical trial. JAMA Pediatrics, 167, 1004–1010.
Australian Bureau of Statistics (ABS). (2010). Is life in Australia getting any better? Canberra: ABS. Measures of Australia’s progress, Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1370.0~2010~Main%20Features~Home%20page%20(1).
Australian Institute of Health and Welfare. (2013). Mental health services – In brief 2013 Cat. no. HSE 141. Canberra: AIHW. Retrieved from http://www.aihw.gov.au/publication-detail/?id=60129544726.
Bagley, C., & Mallick, K. (2001). Normative data and mental health construct validity for the Rosenberg self-esteem scale in British adolescents. International Journal of Adolescence and Youth, 9, 117–126.
Barrett, P. M., & Turner, C. M. (2004). Prevention of childhood anxiety and depression. In P. Barrett & T. H. Ollendick (Eds.), Handbook of Interventions that Work with Children and Adolescents. Prevention and Treatment (pp. 429–474). West Sussex: Wiley.
Berry, K., & Hunt, C. J. (2009). Evaluation of an intervention program for anxious adolescent boys who are bullied at school. Journal of Adolescent Health, 45, 376–382.
Brooks, S. J., & Kutcher, S. (2001). Diagnosis and measurement of adolescent depression: a review of commonly utilized instruments. Journal of Child and Adolescent Psychopharmacology, 11, 341–376.
Byrne, B. B. (2012). Structural Equation Modelling with MPlus. Basic Concepts, Application and Programming. New York: Routledge.
Calear, A., & Christensen, H. (2010). Systematic review of school-based prevention and early intervention. Journal of Adolescence, 33, 429–438.
Canty-Mitchell, J., & Zimet, G. (2000). Psychometric properties of the multidimensional scale of perceived social support in urban adolescents. American Journal of Community Psychology, 28, 391–400.
Cardemil, E. V., Reivich, K. J., & Seligman, M. (2002). The prevention of depressive symptoms in low-income minority middle school students. Prevention & Treatment, 5(1), 8a.
Fuller-Tyszkiewicz, M., Skouteris, H., McCabe, M., Mussap, A., Mellor, D., & Ricciardelli, L. (2012). An evaluation of equivalence in body dissatisfaction measurement across cultures. Journal of Personality Assessment, 94, 410–417.
Gillham, J.E., Reivich, K.J., Freres, D.R., Chaplin, T.M., Shatté, A.J., Samuels, B., … Seligman, M.E. (2007). School-based prevention of depressive symptoms: A randomized controlled study of the effectiveness and specificity of the Penn Resiliency Program. Journal of Consulting and Clinical Psychology, 75, 9–19.
Gladstone, T. R., & Beardslee, W. R. (2009). The prevention of depression in children and adolescents: a review. Canadian Journal of Psychiatry, 54, 212–221.
Gregorich, S. E. (2006). Do self-report instruments allow meaningful comparisons across diverse population groups? Testing measurement invariance using the confirmatory factor analysis framework. Medical Care, 44, S78–S94.
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people. BMC Psychiatry, 10(1), 113.
Harnett, P. H., & Dadds, M. R. (2004). Training school personnel to implement a universal school-based prevention of depression program under real world conditions. Journal of School Psychology, 42, 343–357.
Hetrick, S. E., Cox, G. R., & Merry, S. N. (2015). Where to go from here? An exploratory meta-analysis of the most promising approaches to depression prevention programs for children and adolescents. International Journal of Environmental Research and Public Health, 12, 4758–4795.
Horowitz, J., Garber, J., Ciesla, J., Young, J., & Mufson, L. (2007). Prevention of depressive symptoms in adolescents: a randomized trial of cognitive-behavioral and interpersonal prevention programs. Journal of Consulting & Clinical Psychology, 75, 693–706.
Kessler, R. C., Amminger, G. P., Aguilar‐Gaxiola, S., Alonso, J., Lee, S., & Ustun, T. B. (2007). Age of onset of mental disorders: a review of recent literature. Current Opinion in Psychiatry, 20, 359–364.
Masia-Warner, C., Klein, R. G., Dent, H. C., Fisher, P. H., Alvir, J., Albano, A. M., & Guardino, M. (2005). School-based intervention for adolescents with social anxiety disorder: results of a controlled study. Journal of Abnormal Child Psychology, 33, 707–722.
McArdle, J. J. (2001). A latent difference score approach to longitudinal dynamic structural analyses. In R. Cudeck, S. du Toit, & D. Sorbom (Eds.), Structural Equation Modeling: Present and Future (pp. 342–380). Lincolnwood: Scientific Software International.
McLaughlin. (2009). Universal prevention for adolescent depression. In S. Nolen-Hoeksema & L. M. Hilt (Eds.), Handbook of Depression in Adolescents (pp. 661–684). New York: Routledge.
Merry, S. N., Hetrick, S. E., Cox, G. R., Brudevold-Iversen, T., Bir, J. R., & McDowell, J. J. (2011). Cochrane review: psychological and educational interventions for preventing depression in children and adolescents. Evidence-based Child Health: A Cochrane Review Journal, 7, 1409–1685.
Nehmy, T. (2010). School-based prevention of depression and anxiety in Australia: current state and future directions. Clinical Psychologist, 14, 74–83.
Neil, A. L., & Christensen, H. (2007). Australian school-based prevention and early intervention programs for anxiety and depression: a systematic review. The Medical Journal of Australia, 186, 305–308.
Poppelaars, M., Yuli, R. T., Lichtwarck-Aschoff, A., Engels, R. C. M. E., Lobel, A., Merry, S. N., Lacassen, M. F. G., & Granic, I. (2014). Autonomous and controlled motivation in a randomized controlled trial comparing school-based and computerized depression prevention programs. In B. Shouten, S. Fedtke, M. V. Schijven, & A. Gekker (Eds.), Games for Health (pp. 125–134). Amsterdam: Springer Fachmedien Wiesbaden.
Possel, P., Horn, A. B., & Hautzinger, M. (2003). Preliminary results of a school-based depression prevention program for adolescents. Journal of Health Psychology, 11, 10–20.
Pössel, P., Horn, A. B., Groen, G., & Hautzinger, M. (2004). School-based prevention of depressive symptoms in adolescents: a 6-month follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1003–1010.
Pössel, P., Martin, N. C., Garber, J., & Hautzinger, M. (2013). A randomized controlled trial of a cognitive-behavioral program for the prevention of depression in adolescents compared with nonspecific and no-intervention control conditions. Journal of Counseling Psychology, 60, 432–438.
Quayle, D., Dziuraweic, S., Roberts, C., Kane, R., & Ebsworthy, G. (2001). The effect of an optimism and lifeskills program on depressive symptoms in preadolescence. Behaviour Change, 18, 194–203.
Raes, F., Griffith, J., Van der Gucht, K., & Williams, J. M. G. (2014). School-based prevention and reduction of depression in adolescents: a cluster-randomised controlled trial of a mindfulness group program. Mindfulness, 5, 477–486.
Reinwand, D. A., Schulz, D. N., Crutzen, R., Kremers, S. P. J., & de Vries, H. (2015). Who follows eHealth interventions as recommended? A study of participants’ personal characteristics from the experimental arm of a randomized controlled trial. Journal of Medicine Internet Research, 17, e115.
Ricciardelli, L. A., & McCabe, M. P. (2000). Psychometric Evaluation of the Body Image and Body Change Inventory: An Assessment Instrument for Adolescent Boys and Girls. Melbourne: Deakin University. Unpublished manuscript.
Rohde, P., Stice, E., Shaw, H., & Briére, F. (2014). Indicated cognitive-behavioral depression prevention compared to bibliotherapy and brochure control: acute effects of an effectiveness trial with adolescents. Journal of Consulting and Clinical Psychology, 82, 65–74.
Rosenberg, M. (1965). Society and the Adolescent Self-Image. Princeton: Princeton University Press.
Salazar-Pousada, D., Arroyo, D., Hidalgo, L., Perez-Lopez, F.R., & Chedraui, P. (2010). Depressive Symptoms and Resilience among Pregnant Adolescents: A Case–control Study. Obstetrics and Gynecology International, 2010.
Sawyer, M. G., Pfeiffer, S., Spence, S. H., Bond, L., Graetz, B., Kay, D., Patton, G., & Sheffield, J. (2010). School-based prevention of depression: a randomised controlled study of the beyond blue schools research initiative. Journal of Child Psychology and Psychiatry, 51, 199–209.
Selig, J. P., & Preacher, K. J. (2009). Mediation models for longitudinal data in developmental research. Research in Human Development, 6, 144–164.
Sheffield, J. K., Spence, S. H., Rapee, R. M., Kowalenko, N., Wignall, A., Davis, A., & McLoone, J. (2006). Evaluation of universal, indicated and combined cognitive behavioral approaches to the prevention of depression among adolescents. Journal of Consulting and Clinical Psychology, 74, 66–79.
Shochet, I. M., Dadds, M. R., Holland, D., Whitefield, K., Harnett, P. H., & Osgarby, S. M. (2001). The efficacy of a universal school-based program to prevent adolescent depression. Journal of Clinical Child & Adolescent Psychology, 30, 303–315.
Sinclair, S. J., Blais, M. A., Gansler, D. A., Sandberg, E., Bistis, K., & LoCicero, A. (2010). Psychometric properties of the Rosenberg Self-Esteem Scale: overall and across demographic groups living within the United States. Evaluations & the Health Professions, 33(1), 56–80.
Spence, S., Sheffield, J., & Donovan, C. (2003). Preventing adolescent depression: an evaluation of the problem solving for life program. Journal of Consulting and Clinical Psychology, 71, 3–13.
Stallard, P., Sayal, K., Phillips, R., Taylor, J.A., Spears, M., Anderson, R., Araya, R., … Montgomery, A.A. (2012). Classroom based cognitive behavioural therapy in reducing symptoms of depression in high risk adolescents: Pragmatic cluster randomized controlled trial. British Medical Journal, 345, e6058.
Timmons, A. C., & Preacher, K. J. (2015). The importance of temporal design: how do measurement intervals affect the accuracy and efficiency of parameter estimates in longitudinal research? Multivariate Behavioral Research, 50, 41–55.
Wagnild, G. (2009). A review of the resilience scale. Journal of Nursing Measurement, 17, 105–113.
Wagnild, G., & Young, H. (1993). Development and psychometric evaluation of the resilience scale. Journal of Nursing Measurement, 1, 165–178.
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52, 30–41.
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Tomyn, J.D., Fuller-Tyszkiewicz, M., Richardson, B. et al. A Comprehensive Evaluation of a Universal School-Based Depression Prevention Program for Adolescents. J Abnorm Child Psychol 44, 1621–1633 (2016). https://doi.org/10.1007/s10802-016-0136-x
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DOI: https://doi.org/10.1007/s10802-016-0136-x