The harmful impact of depression extends far beyond the individual sufferer to caregivers, friends and family members. Children of people with depression are more likely to suffer from depression themselves. This may be due to both inherited and environmental factors.
This new randomised controlled trial (RCT), published earlier this week in JAMA Psychiatry, set out to establish whether cognitive-behavioural prevention (CBP) can reduce the incidence of depression in children whose parents are (or have been) depressed.
The RCT was carried out at four different treatment centres in the US.
Children (aged 13-17 years old) were recruited who:
- had at least one parent or carer with depressive disorder
- were not currently being treated for depression
- had subsyndromal depressive symptoms, scoring ≥ 20 on CES-D (Center for Epidemiologic Studies Depression Scale), or a history of depressive disorder, in remission for at least 2 months
33 sets of siblings were randomised, a total of 316 participants. 159 children were allocated to the CBP intervention, with 157 allocated to UC.
- Emphasised cognitive restructuring and problem solving
- 90-minute sessions of mixed-sex, 3-10-participant
- 8-weekly acute sessions and 6-monthly continuation sessions
It’s not clear what the Usual Care regimen was.
Outcomes were measured at baseline, after the acute intervention (2 months), after the continuation (9 mo), 1 year after (21 mo) and 2 years later (33 mo).
- Depression onset rate
- CES-D, CDRS-R
- Sibling correlations were investigated
- NNTs were calculated
Over the 33-month follow-up, 36.8% of adolescents receiving CBP had a depression onset vs 47.7% of youth in the UC group, corresponding to an NNT of 10 (95% CI, 5 to 2,624)
- There was some evidence that children whose parents were not depressed at the time of intake were more likely to benefit. 128 (45.4%) of parents had active depression at enrolment
- Differences in CES-D and CDRS-R were not statistically significant
The researchers concluded:
The CBP program showed significant sustained effects compared with UC in preventing the onset of depressive episodes in at-risk youth over a nearly 3-year period.
Important next steps will be to strengthen the CBP intervention to further enhance its preventive effects, improve intervention outcomes when parents are currently depressed, and conduct larger implementation trials to test the broader public health impact of the CBP program for preventing depression in youth.
- It’s not clear whether treatment allocation was concealed prior to recruitment
- It’s not clear how experienced the therapists were
- There was a lot of variation in attendance between centres in retaining participants and in the outcomes experienced by those participants
- Outcomes assessors were blinded to treatment group
- The confidence interval around the benefit was very wide, and close to the “line of no difference” (hence the large upper limit on the NNT)
- It should be noted that children of parents who were currently suffering a depressive episode did not appear to benefit from the intervention
- Although there is a risk of selection bias and some evidence of performance bias, it seems that this study shows promise for preventive interventions, particularly amongst children whose parents are not currently experiencing an active depressive episode
Beardslee,, WR et al Prevention of Depression in At-Risk Adolescents: Longer-term Effects. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2013.295
@YoungMindsUK Please read our blog about cognitive-behavioural prevention of depression in children & young people http://t.co/F7leFpZcPr
CBT may prevent depression in at-risk children whose parents have a history of depression but… http://t.co/wMqvQTXLNW
Children of people with depression are more likely to suffer from depression themselves http://t.co/F7leFpZcPr
@Mental_Elf Yes, mental health issues seems to have some genetic background & being with someone who is depressed can make you depressed.
@Mental_Elf Parents teaching children their behaviour? Genetics versus lifestyle and circumstances?
CBT to reduce the incidence of depression in children http://t.co/F7leFpZcPr Another superb blog from @DBadenoch @JAMAPsych #RCT
Cognitive-behavioural prevention can stop the onset of depressive episodes in at-risk young people, says new RCT http://t.co/F7leFpZcPr
Compelling new research shows that CBT prevents #depression in at-risk teens. Universal implementation, please! http://t.co/aEAqd9GWco
In case you missed it: CBT may prevent depression in at-risk children whose parents have a history of depression http://t.co/F7leFpZcPr
RT@YoungMindsUK Blog about cognitive-behavioural prevention of depression in children & young people http://t.co/Fe6wRd5l2U
Mental Elf: CBT may prevent depression in at-risk children whose parents have a history of depression http://t.co/jvhaCpt5IP
[…] Les omtalen i The Mental Elf her […]
From @Mental_Elf #CBT may prevent #depression in at-risk children whose parents have a history of depression http://t.co/8d5jOYV1rE
right, family history of depression may also pass on this to further children. As per a study risk of depression in children may be as mild as that in adults or as severe as that in adults. see this link Causes of depression