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Gregory N. Clarke, PhD; Mark Hornbrook, PhD; Frances Lynch, PhD; Michael Polen, MS; John Gale, MD; William Beardslee, MD; Elizabeth O'Connor, PhD; John Seeley, MS

Arch Gen Psychiatry. 2001;58:1127-1134.

Background  Adolescent offspring of depressed parents are at high risk for development of depression. Cognitive restructuring therapy holds promise for preventing progression to depressive episodes.

Methods  A randomized, controlled trial was conducted to prevent depressive episodes in at-risk offspring (aged 13-18 years) of adults treated for depression in a health maintenance organization (HMO). Potential adult cases were found by reviewing the HMO pharmacy records for dispensation of antidepressant medication and the mental health appointment system. Medical charts were reviewed for a depression diagnosis. Recruitment letters signed by treating physicians were mailed to adults. Eligible offspring had subdiagnostic depressive symptoms insufficient to meet full DSM-III-R criteria for affective disorder and/or a past mood disorder. These youth were randomized to usual HMO care (n = 49) or usual care plus a 15-session group cognitive therapy prevention program (n = 45).

Results  We detected significant treatment-by-time (program) effects for the Center for Epidemiological Studies Depression Scale (P = .005) and the Global Assessment of Functioning scores (P = .04). Survival analysis of incident major depressive episodes during a median 15-month follow-up found a significant advantage (P = .003) for the experimental condition (9.3% cumulative major depression incidence) compared with the usual-care control condition (28.8%).

Conclusion  A brief, group cognitive therapy prevention program can reduce the risk for depression in the adolescent offspring of parents with a history of depression.

From the Kaiser Permanente Center for Health Research, Portland, Ore (Drs Clarke, Hornbrook, Lynch, Gale, and O'Connor and Mr Polen); the Judge Baker Children's Center, Children's Hospital Boston, Boston, Mass (Dr Beardslee); and the Oregon Research Institute, Eugene, Ore (Mr Seeley).

Corresponding author and reprints: Gregory N. Clarke, PhD, Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland OR 97227-1098 (e-mail: greg.clarke{at}kp.org).

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