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November 2013

Preventing Depression in AdolescentsTime for a New Approach?

Author Affiliations
  • 1Werry Centre of Child and Adolescent Mental Health, Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
JAMA Pediatr. 2013;167(11):994-995. doi:10.1001/jamapediatrics.2013.2862

Trying to prevent the onset of depression in adolescence is alluring. Depressive disorders are costly to individuals and to society1 and there is a steep rise in prevalence in adolescence,2 which sets the scene for a serious and relapsing disorder.3 This has led to many studies of universal and targeted programs for preventing depression in children and adolescents. Recent meta-analyses4,5 of these studies have indicated that there is evidence suggesting that this approach may be effective, although shortcomings with the studies were identified. Many were underpowered to show difference, often had no active condition for the control groups and unclear fidelity of implementation, and some of the most effective studies would likely be difficult to deliver outside of a research setting.46 Among the studies in the meta-analyses were many school-based programs, mostly based on cognitive-behavioral therapy strategies, with more evidence for targeted interventions, as would be expected because of the higher baseline mean depression scores. However, there are issues over the scalability of targeted interventions including their feasibility, cost, and potential stigmatization of screening. In addition, it is a well-known maxim that an intervention delivered to a targeted group may miss a far larger group in the nonscoring individuals and thus be less effective than a universal approach.7

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