3 - (SYM40) Prevention of Adolescent Depression in Primary Care Settings: What Do We Know? What Do We Need?

In this symposium we discuss preliminary results from the P2P project and their implications. As many have noted, clinical depression among youth is an important clinical and public health concern. Rates of depression among children and adolescents have been rising, and only a minority of depressed youth have access to, or receive, high-quality evidence-based care. With this in mind, prevention of depression becomes a public health priority. Evidence suggests that Primary prevention efforts tend to yield, at best, a small effect size. A more fruitful (and efficient) approach may be to identify at-risk youth (secondary prevention) and to offer them accessible, convenient, and simple evidence-based tools to prevent the onset of an initial depressive episode. This can be done in primary care settings, with pediatricians they know and trust. P2P results indicate that both person-to-person and online CBT-based strategies can be helpful in preventing the onset of major depression, and improving global functioning. Results indicate that designing interventions that youth find engaging and appealing is key. Participation levels tend to be low, and active support from clinical staff (i.e., MI calls) can be quite helpful. The role of social support in facilitating engagement with treatment and use of CBT strategies is worthy of exploration. We did not observe a robust dose-response relationship. This may have stemmed from the organization of our treatments, with psychoeducation and behavioral activation strategies presented first. Studies designed to determine the most effective components of our interventions, and factors associated with early or rapid assimilation of materials, will be helpful in refining prevention strategies. We were heartened to learn that at-risk youth will engage with evidence-based treatment strategies and that alternative approaches appear to be beneficial. Maintenance of gains and factors that support the consolidation of interventions are worthy of study. At the same time, a small percentage of at-risk youth experienced a depressive episode during the study period—Our interventions were not fully effective. It will be important to identify factors that discriminate this high-vulnerability group and strategies to aid them.