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Mechanisms of Change in the Prevention of Depression: An Indicated School-Based Prevention Trial at the Transition to High School.

Abstract：

OBJECTIVE:Depression represents a major public health concern, and prevalence increases significantly during adolescence. The high school transition may exacerbate the risk of depression for youth with pre-existing vulnerability. The High School Transition Program (HSTP) is a brief, skills-based intervention that has demonstrated efficacy in preventing depression in adolescents. The current study aimed to evaluate the theorized mechanisms of change of the HSTP intervention by testing a multiple mediation model including school attachment (SA) and self-esteem (SE) as two mediators of treatment outcomes. METHOD:Students (N= 497; 61.5% girls) with elevated depressive symptoms, identified for the intervention program via an eighth-grade screening, were randomized to a brief intervention (n = 247) or the HSTP (n = 233) from 2003 to 2008. Participants completed measures at five time points. The first assessment occurred at the start of the second semester of eighth grade and the last assessment occurred at the end of ninth grade. A multiple mediation model tested whether SA and SE contributed to changes in depression for youth in the HSTP. RESULTS:The mediation model, including contemporaneously assessed SE and SA, was not supported. There was evidence of sequential mediation, such that students who participated in the HSTP intervention reported higher SA, which in turn predicted improved SE, and in turn contributed to amelioration of depressive symptoms. CONCLUSION:The HSTP intervention ameliorated depressive symptoms by targeting factors specific to the school transition (ie, SA). Results suggest youth at risk for depression may benefit from prevention efforts that enhance students' capacity to effectively manage identified environmental stressors, such as school transitions. CLINICAL TRIAL REGISTRATION INFORMATION:Middle School to High School Transition Project: Depression and Substance Abuse Prevention; https://clinicaltrials.gov/; NCT00071513.

journal_name

J Am Acad Child Adolesc Psychiatry

journal_title

Journal of the American Academy of Child and Adolescent Psychiatry

authors

Blossom JB,Adrian MC,Stoep AV,McCauley E

doi

10.1016/j.jaac.2019.05.031

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

541-551

issue

eissn

0890-8567

issn

1527-5418

pii

S0890-8567(19)30408-3

journal_volume

pub_type

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Mechanisms of Change in the Prevention of Depression: An Indicated School-Based Prevention Trial at the Transition to High School.