Major depressive disorder (MDD) is a syndrome characterized by symptoms of sadness and anhedonia that last for at least two weeks (APA, 2013). Many people with depression are quite distressed by their symptoms but are nonetheless able to function in daily activities. Others may be impaired to the extent that they are unable to carry out even the simplest tasks of daily living. In some cases, depression is so severe that those afflicted by it kill themselves. Depression is one of the most disabling mental health problems (Eaton, Alexandre, Bienvenu, Clarke, Martins, Nestadt, & Zablotsky, 2012). Based on data from the Epidemiologic Catchment Area study (Eaton, Anthony, Tepper, & Dryman, 1992), depression can occur at any time throughout the life course, starting around age 5 for both males and females. There is a sharp rise in incidence during the adolescent years and throughout young adulthood (Klerman & Weissman, 1989; Rutter, 1986). Thirty-three is the median age of onset (Eaton, Alexandre, Kessler, Martins, Mortensen et al., 2012). In 2014, it was estimated that almost three million adolescents ages 12-17 in the United States had at least one major depressive episode in the past twelve months. Affecting nearly one in every ten people in this age group, depression represents a major burden on the adolescent health in the United States. (Hedden, Kennet, Lipari, Medley, Tice et al., 2014). Given the high prevalence of depression in this population as well as in adult populations, there is a high cost burden for failing to prevent the disorder. Estimates from 2005 indicate that depression costs approximately 97 billion dollars per year in direct and indirect costs (Manderscheid, Alexandre, Everett, Leaf, & Zablotsky, 2012). The many people affected by depression and the large economic burden it costs to the healthcare system provide strong justification for preventive interventions. Yet there is another compelling reason to try to prevent depression in adolescents. Studies of mental health prevention programs have showed convincing results about the effectiveness of depression prevention (Jané-Llopis, Hosman, Jenkins, & Anderson, 2003). A meta-analysis of nearly three dozen studies by Horowitz and Garber (2006) found that
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Indicated interventions target individuals who are identified (i.e., individually screened) as at high-risk, meaning they have minimal but detectable signs or symptoms of a diagnosable disorder (Munoz et al., 1996). Based on the prevention literature, indicated (and selective) interventions that focus on both cognitive-behavioral and problem-solving skills appear to be effective at preventing depressive symptoms in both the short and long-term (Gladstone, 2011). The cognitive component emphasizes that people are depressed because of problematic thoughts, whereas the behavioral component is useful for addressing problematic individual and social behaviors that lead to or sustain depression (Ingram, Williams, Sharp, & Harfmann, 2015). In particular, an intensive indicated intervention program using cognitive-behavioral and problem-solving skills training would involve teaching students about: (1) the interrelatedness of thoughts, feelings, and behaviors; (2) cognitive explanatory styles, such as pessimistic; (3) cognitive reframing skills, including how to evaluate inaccurate beliefs and generate alternative interpretations and predictions about negative life events; (4) coping styles; (5) assertiveness; (5) decision-making; and (6) relaxation (Gillham, Reivich, Freres, Chaplin, Shatté et al., 2007). An exemplar of an indicated intervention covering similar topics is the Penn Resiliency Program, a widely evaluated preventive intervention for depression prevention in middle- and high-school-aged youth (Gillham, Reivich, Jaycox et al.,
Indicated interventions target individuals who are identified (i.e., individually screened) as at high-risk, meaning they have minimal but detectable signs or symptoms of a diagnosable disorder (Munoz et al., 1996). Based on the prevention literature, indicated (and selective) interventions that focus on both cognitive-behavioral and problem-solving skills appear to be effective at preventing depressive symptoms in both the short and long-term (Gladstone, 2011). The cognitive component emphasizes that people are depressed because of problematic thoughts, whereas the behavioral component is useful for addressing problematic individual and social behaviors that lead to or sustain depression (Ingram, Williams, Sharp, & Harfmann, 2015). In particular, an intensive indicated intervention program using cognitive-behavioral and problem-solving skills training would involve teaching students about: (1) the interrelatedness of thoughts, feelings, and behaviors; (2) cognitive explanatory styles, such as pessimistic; (3) cognitive reframing skills, including how to evaluate inaccurate beliefs and generate alternative interpretations and predictions about negative life events; (4) coping styles; (5) assertiveness; (5) decision-making; and (6) relaxation (Gillham, Reivich, Freres, Chaplin, Shatté et al., 2007). An exemplar of an indicated intervention covering similar topics is the Penn Resiliency Program, a widely evaluated preventive intervention for depression prevention in middle- and high-school-aged youth (Gillham, Reivich, Jaycox et al.,