Randomized, School-based Effectiveness Trial of the Adolescent Depression Awareness Program
Condition: Adolescent - Emotional Problem; Depression; Prevention Harmful Effects
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      The primary goal of the proposed research is to assess the effectiveness of the Adolescent
      Depression Awareness Program (ADAP), a school-based depression education program, in
      increasing depression literacy and treatment seeking in high school students. The ADAP
      intervention will be carried out in approximately 60 schools with over 15,000 students. The
      following are ADAP Implementation Sites: Baltimore Archdiocese High Schools; New Castle
      County, Delaware; Washtenaw County, Michigan; and York County, Pennsylvania.
    

Detailed description: 
      The primary goal of the proposed research is to assess the effectiveness of the Adolescent
      Depression Awareness Program (ADAP), a school-based depression education program, in
      increasing depression literacy and treatment seeking. This proposal will have broad reach as
      the intervention will be carried out in 66 schools with over 15,000 students.

      The lifetime prevalence of Major Depressive Disorder (MDD) in the United States is high,
      ranging from 15% to 17%. Its usual symptom onset occurs early in life, during teen or young
      adult years. It has been estimated that 8.5% of youth ages 12 to 17 (over 2 million
      adolescents) experienced at least one Major Depressive Episode in the past year (SAMHSA
      Office of Applied Studies, 2008). Nearly half (48.3%) of these youth reported severe
      impairment in at least one of four major role domains (home, school/work, family
      relationships, or social life). The onset of depression during adolescence is associated with
      increased risks for educational underachievement, unemployment, early parenthood, substance
      dependence, anxiety disorders, and recurrent major depression during early adulthood
      (Fergusson & Woodward, 2002). The most severe consequence of untreated depression is suicide.
      Psychological autopsy studies of adolescent suicides have reported that upwards of 90% had at
      least one psychiatric disorder at the time of their death, most notably depression (Marttunen
      et al., 1990; Brent et al., 1993; Shaffer et al., 1996). From a developmental perspective,
      the prevention and treatment of depression during adolescence can provide lifelong benefits.
      Effective treatments for adolescent depression are available (TADS, 2007); however,
      adolescents in need of treatment are often not recognized by parents, teachers, or peers. The
      National Comorbidity Study-Replication estimated a median delay of 8 years between the onset
      of depressive symptoms and receiving treatment (Wang et al., 2006). The early identification
      of depression leading to effective treatment can help address the morbidity and mortality
      associated with adolescent depression.

      Despite the importance of adolescent depression, there have been few large-scale randomized
      trials investigating the effectiveness of universal interventions targeting depression among
      adolescents. ADAP is a 3-hour high school-based curriculum, proposed herein to be delivered
      as part of the standard high school health education curriculum, aimed at improving
      depression literacy. The mission of ADAP is to educate high school students, teachers, and
      parents about teenage unipolar and bipolar depression (Hess et al., 2004). The core message
      of ADAP is that "depression is a treatable medical illness." ADAP was developed in 1999 by a
      team of psychiatrists and psychiatric nurses from the Johns Hopkins University School of
      Medicine. In the past decade, ADAP has been implemented in over 85 schools with over 20,000
      students throughout the United States. Previously published research evaluating ADAP
      described a significant improvement in adolescents' knowledge about depression after
      receiving the curriculum using a one group pretest/posttest design (Swartz et al., 2008).
      Recently, in Tulsa, Oklahoma, comparison schools were included, and it was found that the
      proportion of students achieving "depression literacy" (scoring 80% or higher on our
      knowledge assessment) more than tripled from pretest to posttest (Leon et al., in review) in
      the ADAP group. To date, a randomized design has not been employed and the impact of ADAP on
      treatment seeking behaviors has not been studied. Both of these issues are important to
      address before ADAP can be routinely integrated into high school health education curricula.
      The specific aims of this proposal are as follows:

      Specific Aim 1: To assess the effectiveness of ADAP, a school-based depression education
      program, in increasing depression literacy.

      1.1 To assess depression literacy changes following the intervention, as compared to the
      standard health education curriculum, with a post-test at 6 weeks post intervention.

      1.2 To assess the sustainability of depression literacy changes with a post-test at 4 months
      post ADAP.

      Specific Aim 2: To assess whether the ADAP intervention, as compared to the standard health
      curriculum, has an influence on treatment seeking behaviors in high school students, as
      measured by an increase in visits to school counselors and self-reported treatment seeking.

      2.1 To track mental health help-seeking and the receipt of mental health services pre and
      post ADAP in a subset of schools (28 schools in York County Pennsylvania and St. Francis
      Indian School on the Rosebud Indian Reservation served by the Indian Health Service).

      2.2 To track mental health visits to school counselors in aggregate pre and post ADAP in all
      66 participating schools.

      Specific Aim 3: To identify possible mediators (e.g., fidelity) and moderators of
      intervention impact (e.g., access to community mental health services, teacher
      characteristics, school characteristics, parental participation in the community forum;
      stigma).
    

Intervention name(s): Adolescent Depression Awareness Program (ADAP)
Intervention type(s): Other
Intervention description(s): Depression education curriculum delivered by trained school health education teachers or other school personnel
Other intervention name(s): ADAP
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Adolescent; Depression; Early intervention (education); Randomized Controlled Trial; Primary Prevention; schools; Health Literacy; Discrimination (Psychology); Mental Health Services