Major depression prevention effects for a cognitive-behavioral adolescent indicated prevention group intervention across four trials

Mindfulness-based intervention for depression and insulin resistance in adolescents: Protocol for BREATHE, a multisite, pilot and feasibility randomized controlled trial

BACKGROUND

Elevated depression symptoms have been associated with higher insulin resistance in adolescents, and consequently, greater risk for type 2 diabetes (T2D). Mindfulness-based intervention (MBI) may be suited for adolescents at risk for T2D given its potential to decrease depression and improve stress-related behavior/physiology underpinning insulin resistance. To prepare for a future multisite efficacy randomized controlled trial, a rigorous, multisite, pilot and feasibility study is needed to test this approach. The current paper describes the design and protocol for a multisite, pilot and feasibility randomized controlled trial of six-week MBI, cognitive-behavioral therapy (CBT), and health education (HealthEd) group interventions, to assess multisite fidelity, feasibility, and acceptability.

METHODS

Participants are N = 120 adolescents ages 12-17, with body mass index (BMI) ≥85th percentile, elevated depression symptoms (20-item Center for Epidemiologic Studies-Depression Scale total score > 20), and family history of diabetes. Enrollment occurs across four United States (US) sites, two in Colorado, one in Washington, D·C., and one in Maryland. Group interventions are delivered virtually by trained psychologists and co-facilitators. Assessments occur at baseline, six-week follow-up, and one-year follow-up.

RESULTS

Primary outcomes are intervention implementation fidelity, based upon expert ratings of audio-recorded sessions (≥80% adherence/competence), and recruitment feasibility, based upon percentage enrollment of eligible youth (≥80%). Secondary outcomes are intervention training fidelity/feasibility/acceptability, recruitment timeframe, and retention/assessment feasibility.

CONCLUSION

Findings will inform optimization of training, recruitment, intervention delivery, retention, and assessment protocols for a multisite, efficacy randomized controlled trial evaluating MBI for decreasing depression and improving insulin resistance in adolescents at risk for developing T2D.

An experimental test of increasing implementation support for college peer educators delivering an evidence-based prevention program

OBJECTIVE

College students are at particularly high risk for mental health problems, such as eating disorders, which are associated with functional impairment, distress, and morbidity, but barriers limit implementation of evidence-based interventions at colleges. We evaluated the effectiveness and implementation quality of a peer educator (PE) delivered eating disorder prevention program (the Body Project [BP]), which has a broad evidence-based using a train-the-trainer (TTT) approach and experimentally evaluated three levels of implementation support.

METHOD

We recruited 63 colleges with peer educator programs and randomly assigned them to (a) receive a 2-day TTT training in which peer educators were trained to implement the Body Project and supervisors were taught how to train future peer educators (TTT), (b) TTT training plus a technical assistance (TA) workshop (TTT + TA), or (c) TTT plus the TA workshop and quality assurance (QA) consultations over 1-year (TTT + TA + QA). Colleges recruited undergraduates (N = 1,387, 98% female, 55% White) to complete Body Project groups.

RESULTS

There were no significant differences across condition for attendance, adherence, competence, and reach, though nonsignificant trends suggested some benefit of TTT + TA + QA relative to TTT for adherence and competence (ds = .40 and .30). Adding TA and QA to TTT was associated with significantly larger reductions in risk factors and eating disorder symptoms.

CONCLUSIONS

Results suggest that the Body Project can be effectively implemented at colleges using peer educators and a TTT approach and that adding TA and QA resulted in significantly larger improvements in outcomes for group participants, and marginally higher adherence and competence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Nature-Based Meditation, Rumination and Mental Wellbeing

Novel approaches for children and young people (CYP) in the prevention and intervention of mental illness are needed and nature-based interventions (NBI) may be clinically useful. This proof-of-principle study tested the effects of a novel brief nature-based meditation on rumination, depressive symptoms and wellbeing in young people. Sixty-eight university students were randomised to one of three conditions: active control (n = 23), indoor meditation (n = 22) or nature-based meditation (n = 23). Participants completed self-report measures on state and trait rumination post intervention and depression and wellbeing at a 2-week follow-up. Depressive rumination significantly decreased post intervention in the nature condition and depressive symptoms improved for both intervention groups. Wellbeing only significantly improved at follow-up in the nature condition. Nature condition participants demonstrated one minimal clinically important difference (MCID) for wellbeing at follow-up. Depressive symptoms for this condition were below the clinically significant threshold for depression. The number needed to treat (NNT) analysis suggested that two to five young people would need to complete the intervention. Preliminary evidence suggests NBIs, such as the one in the present study, can reduce depressive rumination and symptoms and improve wellbeing. Replication with larger clinical samples is required to substantiate findings.

Effects of Group and Individual Culturally Adapted Cognitive Behavioral Therapy on Depression and Sexual Satisfaction among Perimenopausal Women

Aims: Previous research has shown the efficacy of culturally adapted Cognitive Behavioral Therapy (CA-CBT) in reducing depression, yet its effect on increasing sexual satisfaction is not well documented. In this study, an embedded randomized controlled trial design was used to examine the effect of group and individual CA-CBT on depression and sexual satisfaction among perimenopausal women. Method: A total of 64 depressed Iranian perimenopausal women were randomly assigned to two formats of treatments; sixteen sessions of group CA-CBT and eight sessions of individual CA-CBT, as well as a waitlist control group. Depression and sexual satisfaction were measured using BDI-II and ENRICH, respectively, at T1 (pre-treatment), T2 (post-treatment) and T3 (follow-up). Results: Repeated measures ANOVA indicated that the women who underwent both group and individual CA-CBT had effectively reduced depression and increased sexual satisfaction between pre-treatment and post-treatment, and it was sustained after six months of follow-ups with large effect sizes of significant differences (p < 0.001), but the control group did not. Conclusion: The results showed promising evidence for the efficacy of both treatment groups of CA-CBT for depression and sexual satisfaction among perimenopausal women. The population mental health burden among perimenopausal women may likely be reduced by propagating this effective treatment.

Problem-solving intervention to prevent depression in non-professional caregivers: a randomized controlled trial with 8 years of follow-up

BACKGROUND

Studies of psychological interventions for the prevention of depression have found significant effects in the short-term, but the long-term efficacy has yet to be determined. This study evaluated the 8-year effect of a randomized controlled trial for indicated prevention of depression in female caregivers.

METHODS

A total of 173 non-professional female caregivers with subclinical depressive symptoms not meeting criteria for a major depressive episode (MDE) were randomized to either a brief problem-solving intervention (n = 89) or usual-care control group (n = 84). Blinded evaluators conducted an assessment at the 8-year follow-up. The primary outcome was Depression Status, defined by diagnoses of MDE since the 1-year follow-up using the Structured Clinical Interview for the Disorders of the DSM-5. The secondary outcome was current Depressive Symptom Severity. Regression analyses were conducted to evaluate the effect of the intervention on the outcomes.

RESULTS

There were no significant differences in the Depression Status between the problem-solving (30.3%) and control groups (26.2%) (adjusted OR 1.25, 95% CI -0.58 to 2.69). Depressive Symptom Severity, however, was significantly lower in the problem-solving group compared to the control group at this follow-up, amounting to a small effect size of Cohen's d = 0.39 (adjusted B = -3.32, p = 0.018).

CONCLUSIONS

This is the first study to assess such a long-term follow-up of intervention of indicated prevention of depression. Results seem to indicate that the protective effect of the intervention became smaller over time during follow-up. Future research should replicate these results.

Using baseline target moderation to guide decisions on adapting prevention programs

Tom Dishion, a pioneer in prevention science, was one of the first to recognize the importance of adapting interventions to the needs of individual families. Building towards this goal, we suggest that prevention trials be used to assess baseline target moderated mediation (BTMM), where preventive intervention effects are mediated through change in specific targets, and the resulting effect varies across baseline levels of the target. Four forms of BTMM found in recent trials are discussed including compensatory, rich-get-richer, crossover, and differential iatrogenic effects. A strategy for evaluating meaningful preventive effects is presented based on preventive thresholds for diagnostic conditions, midpoint targets and proximal risk or protective mechanisms. Methods are described for using the results from BTMM analyses of these thresholds to estimate indices of intervention risk reduction or increase as they vary over baseline target levels, and potential cut points are presented for identifying subgroups that would benefit from program adaptation because of weak or potentially iatrogenic program effects. Simulated data are used to illustrate curves for the four forms of BTMM effects and how implications for adaptation change when untreated control group outcomes also vary over baseline target levels.

Evaluating construct equivalence of youth depression measures across multiple measures and multiple studies

Construct equivalence of measures across studies is necessary for synthesizing results when combining data in meta-analysis or integrative data analysis. We discuss several assumptions required for construct equivalence, and review methods using individual-level data and item response theory (IRT) analysis for detecting or adjusting for violations of these assumptions. We apply IRT to data from 7 measures of depressive symptoms for 4,283 youth from 16 randomized prevention trials. Findings indicate that these data violate assumptions of conditional independence. Bifactor IRT models find that depression measures contain substantial reporter variance, and indicate that a single common factor model would be substantially biased. Separate analyses of ratings by youth find stronger evidence for construct equivalence, but factor invariance across sex and age does not hold. We conclude that data synthesis studies employing measures of youth depression should analyze results separately by reporter, explore more complex approaches to integrate these different perspectives, and explore methods that adjust for sex and age differences in item functioning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Intrinsic Functional Brain Connectivity Predicts Onset of Major Depression Disorder in Adolescence: A Pilot Study

Children with familial risk for major depressive disorder (MDD) have elevated risk for developing depression as adolescents. Here, we investigated longitudinally whether resting-state functional connectivity (RSFC) could predict the onset of MDD. In this pilot study, we followed a group of never-depressed children with familial risk for MDD and a group of age-matched controls without familial risk who had undergone an MRI study at 8-14 years of age. Participants were reassessed 3-4 years later with diagnostic interviews. We first investigated group differences in RSFC from regions in the emotion regulation, cognitive control, and default mode networks in the children who later developed MDD (converted), the children who did not develop MDD (nonconverted), and the control group. We then built a prediction model based on baseline RSFC that was independent of the group differences to classify the individuals who later developed MDD. Compared with the nonconverted group, the converted group exhibited hypoconnectivity between subgenual anterior cingulate cortex (sgACC) and inferior parietal lobule (IPL) and between left and right dorsolateral prefrontal cortices. The nonconverted group exhibited higher sgACC-IPL connectivity than did both the converted and control groups, suggesting a possible resilience factor to MDD. Classification between converted and nonconverted individuals based on baseline RSFC yielded high predictive accuracy with high sensitivity and specificity that was superior to classification based on baseline clinical rating scales. Intrinsic brain connectivity measured in healthy children with familial risk for depression has the potential to predict MDD onset, and it can be a useful neuromarker in early identification of children for preventive treatment.