Preventing depression in adolescents

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6720 (Published 8 October 2012)
Cite this as: BMJ 2012;345:e6720

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  1. Sally N Merry, associate professor, child and adolescent psychiatry ,
  2. Karolina Stasiak, research fellow
  1. 1Werry Centre for Child and Adolescent Mental Health, Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
  1. s.merry{at}auckland.ac.nz

Requires a broad public health approach and refinement of interventions

The individual and societal costs of depressive disorder have been well documented, and the arguments for depression prevention programmes are compelling.1 The prevalence of depression rises steeply in mid-adolescence, so schools are a logical place to deliver prevention programmes. Several studies have investigated the efficacy of interventions aimed at preventing depression in adolescents, and meta-analyses have provided encouraging results.2 However, many studies have had methodological difficulties, including lack of attention controls.

In a linked paper (doi:10.1136/bmj.e6058), Stallard and colleagues have reported the results of a large well conducted pragmatic randomised trial.3 They compared the resourceful adolescent programme—a group programme delivered in schools and based on cognitive behavioural therapy that has shown evidence of effect in universal samples of school students—with an attention control or usual classes.4 5 Facilitators were well trained, and the study was also appropriately powered and had excellent retention and follow-up rates. However, no demonstrable effect was seen, and the findings suggest that the intervention programme may actually have led to an increase in depressive symptoms. These findings are worrying, especially when meta-analyses have shown that …

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