Title: Prevention of major depression in at-risk adolescents: a pilot randomised trial of a screen-and-intervene program
Funder: Department of Health (England)

Abstract: Background Depression is common among adolescents, and associated with academic and social impairment, family burden, and high rates of attempted and completed suicide2. Few adolescents with depression have any contact with mental health services3, 4. Many cases of adolescent-onset depressions continue into adulthood, typically with a remitting and relapsing course5. Each episode of depression substantially raises the risk of a subsequent episode, and repeated episodes of depression are increasingly hard to treat2. In this context, recent efforts have been made to prevent the onset of depression in adolescence6-11. Large scale, high-quality, universal prevention programs have failed to demonstrate effectiveness6, 7. In contrast, targeted approaches, in which only youth at high risk of developing the disorder are offered an intervention, have been shown to be effective in several RCTs8, 9. However, no study of targeted depression prevention programs has yet been completed in the UK. Further development of targeted prevention programs in a UK NHS setting has potential to benefit patients, improve NHS provision, and to markedly reduce the burden of depression in youth and adults. Aims The proposal addresses two main questions : is it feasible and acceptable to identify youth who are at-risk of developing depression; and is it possible to reduce incidence of depression in this at-risk group? Adolescents whose parents have a history of depression, and who themselves have a history of depression or currently show elevated but sub-syndromal symptoms of depression, are at substantially higher risk of developing major depressive disorder than community samples. The proposal therefore has two main aims : among offspring of parents who have a history of depression, to investigate the feasibility and acceptability of a screening program to identify youth at-risk of depression; and to determine acceptability, feasibility, and preliminary clinical-effectiveness of a group CBT program to prevent onset of depression in youth identified as being at high risk of developing the disorder. Plan of investigation A 2-stage investigation is proposed. In Stage 1 , offspring (10-17 years) of 190 adult patients with a history of depression will complete a depression screening questionnaire. Based on responses, they will be divided into three groups (Low-Risk, High-Risk, In-episode). A randomly selected sample of parents and youth from each group will be interviewed about the acceptability of screening and service provision. Data will be analysed using qualitative methods. In Stage 2 , High-Risk young people will be offered further detailed clinical assessment. Those with elevated but sub-syndromal symptoms of depression, or a history of >=1 previous episode of depression, will be randomly allocated to CBT (8x 90 minute group sessions) or to usual care. Depressive symptoms and episodes of depression will be assessed at post intervention and at 6 month follow up. Clinical data will be analysed using survival regression models and hazard ratios. Young people will be interviewed to elicit their views on the intervention. Potential impact Expected outcomes include: data on the feasibility of screening at-risk youth within existing NHS structures; patient views about the value and shape of targeted “screen-and-intervene” prevention programs; and preliminary findings on feasibility and effectiveness of a novel prevention program. Potential benefits for young patients and their families include a reduced likelihood of developing a depressive disorder. Potential benefits to the NHS include the development of cost-effective and clinically-effective services for vulnerable young people, with consequent reduced burden on NHS services in the medium to long term. If this intervention is evaluated positively, data from the current study will be used to inform a future definitive trial, for which funding would be sought.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH