and adolescents, Merry and Spence (2007) highlight several promising approaches. However, they also describe failed attempts to repeat results in real-world school and primary care settings, limited follow-up periods, and methodological flaws, and they conclude that there is not yet sufficient evidence of effectiveness for preventive interventions for depression. In an analysis of the high-quality studies reviewed by Horowitz and Garber (2006), Gladstone and Beardslee (in press) demonstrate that although symptom reduction, a powerful goal in itself, is possible, very few studies of adolescents have examined actual reduction in new episodes of major depression, the work of Clarke and colleagues cited above being the notable exception. They emphasize that future studies should examine prevention of episodes as well as reductions in symptomatology.
In the committee’s judgment, the balance of evidence suggests that some interventions can significantly reduce the symptomatology and incidence of depression. The potential to increase the sample sizes and reach of interventions has been highlighted by work done to adapt behavioral interventions to a range of settings and cultural groups, including conducting worldwide randomized controlled trials via the Internet (Muñoz, Lenart, et al., 2006).
The Clarke Cognitive-Behavioral Prevention Intervention (see Box 7-1), an indicated program targeting adolescents at risk for future depression, has successfully prevented episodes of major depression in several randomized trials. A recent replication indicated that it is not as effective for adolescents with a depressed parent (Garber, Clarke, et al., 2007). The Penn Resiliency Program (PRP) (see Box 7-2), a school-based group intervention that teaches cognitive-behavioral and social problem-solving skills to prevent the onset of clinical depression, has also had promising results.
Children of parents with depression and related difficulties have a substantially higher rate of depression than their counterparts in homes with no mental illness (Beardslee and Podorefsky, 1988; Hammen and Brennan, 2003; Lewinsohn and Esau, 2002; Beardslee, Versage, and Gladstone, 1998; Weissman, Wickramaratne, et al., 2006). They are also at risk for a variety of other difficulties in such areas as school performance and interpersonal relationships (Goodman and Gotlib, 1999). Beardslee and colleagues developed two public health preventive interventions (see Box 7-3) specifically aimed at providing information and assistance in parenting to children of depressed parents, both of which have shown positive results in multiple randomized trials.