Finally, there is some evidence that adolescents who maintain their routines have less posttraumatic stress (Pat-Horenczyk, Schiff, and Doppelt, 2006), a finding consistent with other findings that catastrophizing puts individuals at risk for developing PTSD (Bryant and Guthrie, 2005).

Prevention of Depression

In 1994, when the Institute of Medicine (IOM) report Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research was released, available trials of interventions targeting depression were able to demonstrate only a reduction in symptoms (Muñoz and Ying, 1993). Since that time, methods have been developed for consistently identifying individuals at significant risk of experiencing depression within the next year, and some trials have demonstrated a reduction in the incidence of major depressive episodes, particularly among those at high risk (Muñoz, Le, et al., 2008). Of the trials that have shown a significant reduction in new episodes, all have focused either on high-risk adolescents (Clarke, Hawkins, et al., 1995; Clarke, Hornbrook, et al., 2001; Young, Mufson, and Davies, 2006) or pregnant women (Elliott, Leverton, et al., 2000; Zlotnick, Johnson, et al., 2001; Zlotnick, Miller, et al., 2006), and at least one intervention prevented episodes among those who had prior episodes (Clarke, Hornbrook, et al., 2001). On the basis of these advances, Barrera, Torres, and Muñoz (2007) assert that prevention of depression is a feasible goal for the 21st century, with the promise of being able to reduce incidence by as much as half.

Preventive Interventions for Children and Adolescents

Recent meta-analyses have concluded that interventions to prevent depression can reduce both the number of new cases in adolescents (Cuijpers, van Straten, et al., 2008) and depressive symptomatology among children and youth (Horowitz and Garber, 2006). In a review that included seven trials targeting adolescents, Cuijpers and colleagues (2008) report that preventive interventions for adolescents can reduce the incidence of depressive disorders by 23 percent. They caution, however, that since the follow-up period in most studies did not exceed two years, the projects may have delayed onset rather than incidence. Both meta-analyses showed slightly higher effect sizes for selective and indicated interventions, although the number of universal interventions was very small.

Significant benefit has been reported for preventive interventions for reducing depressive symptoms in children and adolescents, with small to modest effect sizes (Horowitz and Garber, 2006; Jané-Llopis, Hosman, et al., 2003). In a systematic review of preventive interventions with children



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