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A Randomized Placebo-Controlled Trial of a School-Based Depression Prevention Program
Abstract
Objective To conduct a placebo-controlled study of the effectiveness of a universal school-based depression prevention program.Method Three hundred ninety-two students age 13 to 15 from two schools were randomized to intervention (RAP-Kiwi) and placebo programs run by teachers. RAP-Kiwi was an 11-session manual-based program derived from cognitive-behavioral therapy. The placebo was similar but with cognitive components removed. Outcomes were self-rated depression scales, the Reynolds Adolescent Depression Scale (RADS), and the Beck Depression Inventory II (BDI-II). Follow-up was to 18 months. Analysis was done on an intent-to-treat basis.Results Immediately after the intervention, depression scores were reduced significantly more by RAP-Kiwi than by placebo, with a mean difference in change from baseline between groups of 1.5 on BDI-II (CI > 0.38, p =.01) and 2.24 on RADS (CI > 0.22, p =.04). Categorical analysis confirmed significant clinical benefit with an absolute risk reduction of 3% (95% CI, 1-11%, McNemar chi, p =.03), with the "number needed to treat" for short-term benefit of 33. Group differences in depression scores averaged across time to 18 months were significant on RADS but not on BDI-II. Retention rates were 91% at 6 months and 72% at 18 months.Conclusions The RAP-Kiwi program is a potentially effective public health measure. Confirmation of effectiveness measuring episodes of depressive illness and broader measures of adjustment is warranted.
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“Furthermore, programs that have been successful in reducing psychopathology in adolescents have incurred high financial costs and relied on scarce resources, such as teachers’ classroom time or researchers for program delivery [15].”
From Feasibility and effectiveness of a web-based positive psychology program for youth mental health: Randomized controlled trial (2014) · cites this paper as [15]
In the citing paper
“Reported means in some trials, even those that reported statistical significance, suggest no clear advantage for the early intervention condition (e.g. Horowitz, Garber, Ciesla, Young, & Mufson, 2007; Merry, McDowell, Wild, Bir, & Cunliffe, 2004; Quayle, Dziurawiec, Roberts, Kane, & Ebsworthy, 2001).”
From A randomized controlled trial of strong minds: A school-based mental health program combining acceptance and commitment therapy and positive psychology (2016) · cites this paper as Merry et al., 2004
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“These programs show benefits particularly for youth with current symptoms or for those with a risk for depression.([4]) Their benefits when applied universally are less certain.”
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“Targeted interventions may be difficult to apply at a large scale due to the tremendous amount of screening efforts required (Merry et al., 2004).”
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“Evaluation of such programmes show they are effective [2, 20].”
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“These programs are generally effective in reducing and preventing depression (Clarke, Hawkins, et al., 1995; Clarke, Hornbrook, et al., 2001; Merry, McDowell, Wild, Bir, & Cunliffe, 2004; Spence, Sheffield, & Donovan, 2003).”
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“In depression prevention studies that include more than one self-report measure, this kind of discrepancy is common (e.g., Horowitz, Garber, Ciesla, Young, & Mufson, 2007; Merry et al., 2004; Muñoz et al., 1995).”
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“…this stage seems to favor indicated programs and many authors have agreed that the cost savings found with indicated programs makes these the most cost-effective methods of program delivery for the prevention of adolescent depression (Andrews et al., 2002; Clarke et al., 1995; Merry et al., 2004).”
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“It should be noted that the depression scores in both arms of the study dropped on all measures, and that the magnitude of effect was similar to the intervention arm of a previous study done by our group (Merry et al., 2004).”
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“It is salutary that its effectiveness was not shown in a real world trial [64].”
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“The purpose of this review was to update the information on prevention and early intervention programmes for depression in adolescents, building on the Cochrane report and meta-analysis reported by Merry et al. (2004).13”
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Rose, T., Shields, J. J., Tueller, S., & Larson, S. L. (2014) · Journal of Religion and Health · doi:10.1007/s10943-014-9828-0 · Cited by 57
Brunwasser, S. M., & Garber, J. (2015) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2015.1020541 · Cited by 64
“RAP also has been evaluated in two nonrandomized controlled trials (Harnett & Dadds, 2004; Shochet et al., 2001) and an RCT with only a placebo comparison condition (Merry et al., 2004).”
MethodMackay, B., Shochet, I. M., & Orr, J. A. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3263-5 · Cited by 64
“RAP-A is based on integral elements of CBT and Interpersonal Psychotherapy (IPT), both of which have developed a solid evidence base for the treatment of depression in young people (Clarke et al. 2001; Garber 2006; Garber et al. 2009a; Horowitz et al. 2007; Merry et al. 2004; RivetDuval et al. 2011).”
MethodCheek, C., Bridgman, H., Fleming, T., Cummings, E., Ellis, L., Lucassen, M. F., Shepherd, M., & Skinner, T. (2014) · JMIR Serious Games · doi:10.2196/games.3183 · Cited by 51
“Early intervention with cognitive behavior therapy (CBT) for young people with depression has been shown to be effective in reducing mental health symptoms [6-9].”
A survey of adolescents’ knowledge about depression
Hess, S. G., Cox, T. S., Gonzales, L. C., Kastelic, E. A., Mink, S. P., Rose, L. E., & Swartz, K. (2004) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2004.09.005 · Cited by 54
“With regards to depression, however, we have ound no publication to date, describing a schoolased depression education program, although here are several reports of school based depression revention programs (Burns & Hickie, 2002; erry et al., 2004; Shochet et al., 2001; Oria, ureton, & Canham, 2001).”
BackgroundMethodMa, L., Zhang, Y., Huang, C. X., & Cui, Z. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.03.051 · Cited by 63
Wolitzky-Taylor, K. B., Ruggiero, K., McCart, M., Smith, D. W., Hanson, R. F., Resnick, H. S., de Arellano, M. D., Saunders, B. E., & Kilpatrick, D. (2009) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374410903401146 · Cited by 49
Stallard, P. N., & Buck, R. (2013) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.112.119172 · Cited by 53
Feuerborn, L. L., & Gueldner, B. A. (2019) · Mindfulness · doi:10.1007/s12671-019-01101-1 · Cited by 64
The Positive Impact of Social and Emotional Learning for Kindergarten to Eighth-Grade Students
Payton, J. W., Weissberg, R. P., Durlak, J. A., Dymnicki, A. B., Taylor, R. D., Schellinger, K. B., & Pachan, M. K. (2008) · Cited by 51
Randomized controlled trial of a friendship skills intervention on adolescent depressive symptoms.
Rose, K., Hawes, D. J., & Hunt, C. J. (2014) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0035827 · Cited by 56
Salazar de Pablo, G., De Micheli, A., Solmi, M., Oliver, D., Catalan, A., Verdino, V., Di Maggio, L., Bonoldi, I., Radua, J., Baccaredda Boy, O., et al. (2021) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000294 · Cited by 51
Tak, Y. R., Lichtwarck‐Aschoff, A., Gillham, J. E., Zundert, R. M. P. V., & Engels, R. C. M. E. (2015) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-015-0080-1 · Cited by 49
“In contrast to these results, some universal prevention programs showed long-term benefits from 4 months up to 18 months follow-up (Lock and Barrett 2003; Merry et al. 2004; Pössel et al. 2004; Pössel et al. 2013; Pössel et al. 2008; Shochet et al. 2001).”
BackgroundMethodResultPerceived stigma and depression among black adolescents in outpatient treatment
Rose, T., Joe, S., & Lindsey, M. A. (2010) · Children and Youth Services Review · doi:10.1016/j.childyouth.2010.08.029 · Cited by 48
Impact of comorbidity in prevention of adolescent depressive symptoms.
Pössel, P., Seemann, S., & Hautzinger, M. (2008) · Journal of Counseling Psychology · doi:10.1037/0022-0167.55.1.106 · Cited by 47
“Although in some studies, no gender effect was found (Chaplin et al., 2006; Clarke et al., 1993, second study; Merry et al., 2004; Shochet et al., 2001), in other studies, boys (Clarke et al.”
BackgroundResultInfluentialShochet, I. M., & Ham, D. (2004) · International Journal of Mental Health Promotion · doi:10.1080/14623730.2004.9721935 · Cited by 47
“Merry et al (2004) concluded that, when delivered by teachers, RAP-Kiwi was effective in reducing depressive symptoms and was a potentially effective public health intervention.”
BackgroundMethodBramesfeld, A., Platt, L., & Schwartz, F. W. (2006) · Health Policy · doi:10.1016/j.healthpol.2005.11.012 · Cited by 43
Sinclair, R., Millar, L., Allender, S. E., Snowdon, W., Waqa, G., Jacka, F. N., Moodie, M., Petersen, S., & Swinburn, B. A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0161709 · Cited by 46
Pössel, P., Adelson, J. L., & Hautzinger, M. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.09.010 · Cited by 41
“Although some of these studies reported no sex effects (Chaplin et al., 2006; Clarke et al., 1993 [second study reported]; Merry et al., 2004; Shochet et al., 2001), other studies differed as to whether boys (Clarke et al., 1993 [first study reported]; Shatté, 1996) or girls (Gillham, Hamilton,…”
BackgroundResultRice, F. J., Rawal, A., Riglin, L., Lewis, G., Lewis, G., & Dunsmuir, S. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.07.019 · Cited by 40
Shochet, I. M., Saggers, B. R., Carrington, S. B., Orr, J. A., Wurfl, A. M., Duncan, B. M., & Smith, C. L. (2016) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-016-0203-4 · Cited by 48
“RAP-A is based on integral elements of CBT and interpersonal psychotherapy (IPT), both of which are supported as effective, evidence-based interventions for treating depression in young people (e.g. Clarke et al. 2001; Merry et al. 2004; Rivet-Duval et al. 2011).”
BackgroundInfluentialWhat are the active ingredients in preventative interventions for depression?
Collins, K., & Dozois, D. J. A. (2008) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2008.00143.x · Cited by 37
Beaudry, M. B., Swartz, K., Miller, L., Schweizer, B., Glazer, K., & Wilcox, H. (2019) · Journal of School Health · doi:10.1111/josh.12725 · Cited by 33
Study protocol RapMusicTherapy for emotion regulation in a school setting
Uhlig, S., Jansen, E., & Scherder, E. (2015) · Psychology of Music · doi:10.1177/0305735615608696 · Cited by 41
Metadata
- Authors
- Merry, S., McDOWELL, H., Wild, C. J., Bir, J., & Cunliffe, R.
- Affiliations
- University of Auckland (NZ)
- Corresponding author
- Merry, Sally
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2004-05
- Volume
- 43
- Issue
- 5
- Pages
- 538-547
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2088454316
- Cited by
- 249
- References
- 40
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 2 · 2023: 19 · 2022: 7 · 2021: 8 · 2020: 8 · 2019: 11 · 2018: 7 · 2017: 13 · 2016: 14 · 2015: 11 · 2014: 18 · 2013: 9 · 2012: 20
- FWCI
- 16.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- the Health Research Council (99/039)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › School Health and Nursing Education
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression prevention, school-based intervention, adolescent depression, cognitive behavioral therapy, universal prevention programs, program retention, public health prevention
- MeSH terms
- Adolescent, Depression, Female, Humans, Male, Preventive Health Services, School Health Services, United States, Single-Blind Method
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