CBT may prevent depression in at-risk children whose parents have a history of depression but are not currently depressed

The harmful impact of depression extends far beyond the individual sufferer to caregivers, friends and family members. Children of people with depression are more likely to suffer from depression themselves. This may be due to both inherited and environmental factors.

This new randomised controlled trial (RCT), published earlier this week in JAMA Psychiatry, set out to establish whether cognitive-behavioural prevention (CBP) can reduce the incidence of depression in children whose parents are (or have been) depressed.

Methods

The RCT was carried out at four different treatment centres in the US.

Participants

It’s unlikely that the study participants felt good enough to do a Glee-style synchronised jump during the trial, but you get the idea

Children (aged 13-17 years old) were recruited who:

had at least one parent or carer with depressive disorder
were not currently being treated for depression
had subsyndromal depressive symptoms, scoring ≥ 20 on CES-D (Center for Epidemiologic Studies Depression Scale), or a history of depressive disorder, in remission for at least 2 months

Regimens

33 sets of siblings were randomised, a total of 316 participants. 159 children were allocated to the CBP intervention, with 157 allocated to UC.

Cognitive-Behavioural Prevention:

Emphasised cognitive restructuring and problem solving
90-minute sessions of mixed-sex, 3-10-participant
8-weekly acute sessions and 6-monthly continuation sessions

It’s not clear what the Usual Care regimen was.

Outcomes

Outcomes were measured at baseline, after the acute intervention (2 months), after the continuation (9 mo), 1 year after (21 mo) and 2 years later (33 mo).

Depression onset rate
CES-D, CDRS-R
Sibling correlations were investigated
NNTs were calculated

Results

According to this study, you have to treat 10 children with CBP rather than usual care, to prevent one case of depression

Over the 33-month follow-up, 36.8% of adolescents receiving CBP had a depression onset vs 47.7% of youth in the UC group, corresponding to an NNT of 10 (95% CI, 5 to 2,624)
There was some evidence that children whose parents were not depressed at the time of intake were more likely to benefit. 128 (45.4%) of parents had active depression at enrolment
Differences in CES-D and CDRS-R were not statistically significant

Conclusions

The researchers concluded:

The CBP program showed significant sustained effects compared with UC in preventing the onset of depressive episodes in at-risk youth over a nearly 3-year period.

Important next steps will be to strengthen the CBP intervention to further enhance its preventive effects, improve intervention outcomes when parents are currently depressed, and conduct larger implementation trials to test the broader public health impact of the CBP program for preventing depression in youth.

Comments

It’s not clear whether treatment allocation was concealed prior to recruitment
It’s not clear how experienced the therapists were
There was a lot of variation in attendance between centres in retaining participants and in the outcomes experienced by those participants
Outcomes assessors were blinded to treatment group
The confidence interval around the benefit was very wide, and close to the “line of no difference” (hence the large upper limit on the NNT)
It should be noted that children of parents who were currently suffering a depressive episode did not appear to benefit from the intervention
Although there is a risk of selection bias and some evidence of performance bias, it seems that this study shows promise for preventive interventions, particularly amongst children whose parents are not currently experiencing an active depressive episode