Clarke Cognitive-Behavioral Prevention Intervention Program: A Promising Indicated Intervention to Prevent Depression
The Clarke Cognitive-Behavioral Prevention Intervention, a 15-session group cognitive-behavioral intervention focused on coping with stress, is modeled after an effective cognitive-behavioral treatment for depression. The first randomized trial targeted adolescents with elevated depressive symptoms and was delivered in schools. At one-year follow-up, intervention participants had a much lower incidence of major depressive disorder or dysthymia (14.5 percent) than participants in the usual care control group (25.7 percent) (Clarke, Hawkins, et al., 1995). A second trial broadened the definition of high-risk adolescents to include parental depression and subsyndromal symptoms and recruited 95 adolescents from a health maintenance organization rather than from classrooms (Clarke, Hornbrook, et al., 2001). At 15-month follow-up, participants in the experimental condition showed a much lower rate of major depressive episodes (9.3 percent) than those in the usual care condition (28.8 percent) (p = .003). These results were recently replicated in a four-site randomized trial involving 316 at-risk youths (Garber, Clarke, et al., 2007, in press). Parental depression at the beginning of the intervention significantly moderated the effect, however; thus adolescents who had a parent with current depression did not experience a significant reduction in rates of incident depression versus those receiving usual care. Further follow-up of this sample is under way.