Journal of consulting and clinical psychology最新文献

Objective: Despite the prevalence of depressive disorders among youth, there is no health system model to address the prevention of these disorders.

Method: With the goal of creating effective, tolerable, and scalable interventions for the prevention of adolescent depression, we have fielded three randomized clinical trials, centered in health care delivery organizations that use a whole-of-society approach: (a) Path 2 Purpose (N = 664), comparing the Competent Adulthood Transition with Cognitive Behavioral, Humanistic, and Interpersonal Training (CATCH-IT; B. W. Van Voorhees et al., 2015), guided digital health intervention to a synchronous mental health specialist-led group cognitive behavioral intervention, Coping with Depression Course-Adolescent; (b) PATHway (N = 400), examining the efficacy of the CATCH-IT components; and (c) Behavioral Health Stratified Treatment (N = 780), which examines the feasibility and potential benefit of a coordinated care, risk stratification, and intervention matching approach for adolescents with intellectual and developmental disabilities using both CATCH-IT (lower risk) and the Coping with Depression Course-Adolescent (higher risk).

Results: The study samples for all three trials include youth from traditionally underrepresented groups (71.8%) with some economic distress (47.6%). Intervention utilization was moderate across trials. Feedback from study teams reveals general barriers to implementation and challenges specific to the pandemic.

Conclusions: We review these trials, report preliminary data on demographics and intervention utilization, and provide feedback from study teams on implementation challenges encountered. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: The purpose of this randomized controlled trial was to test the effects of an online, coached mindfulness intervention on momentary negative affect (mNA) for youth with high levels of trait negative affectivity.

Method: Participants were 111 youth ages 12 to 17 years old (M = 14.17, SD = 1.60). Youth self-identified as 68% female, 29% male, and 4.5% gender diverse; 54.55% identified as White; 31.82 reported being Hispanic/Latinx. Participants were selected for having high levels of trait negative affect and were randomized to receive either the mindfulness program or no intervention. We used ecological momentary assessment to measure stress and emotions and to derive measures of mNA comprised of stressor-independent and stressor-reactive negative affect. The ecological momentary assessment protocol involved participants completing a short survey/diary entry on Qualtrics four times per day for 5 days. Internalizing symptoms were assessed with the Patient Health Questionnaire-8, Generalized Anxiety Disorder-7, and the Screen for Child Anxiety Related Disorders.

Results: The mindfulness intervention resulted in a significant reduction in stressor-reactive negative affect (t = 2.001, df = 96, p = .048; Cohen's d = .40), but not stressor-independent mNA or overall mNA. Additionally, reductions in stressor-reactive negative affect significantly correlated with changes in internalizing symptomatology (standardized β = .26, p = .032).

Conclusions: These results indicate that among youth with high levels of trait negative affectivity, a relatively affordable and accessible digital mindfulness program significantly reduced stressor-reactive negative affect. The absence of an effect on stressor-independent or overall average mNA suggests some specificity of the effects of mindfulness to stressor-reactive negative affect in an at-risk sample of adolescents. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: This overview aims to summarize systematic reviews with meta-analyses estimating the effects of school-based depression prevention interventions on depression outcomes.

Method: We conducted electronic searches (Australian Education Index, Google Scholar, ProQuest Dissertations and Theses A&I, Pubmed, Social Science Premium Collection), hand-searched key journals, and conducted backward and forward citation chasing to identify eligible reviews. Two reviewers independently screened records, assessed full texts for eligibility, and collected data. We narratively summarized review findings and quantified the overlap of primary studies across systematic reviews using Corrected Covered Area.

Results: We identified 29 eligible systematic reviews with 472 included primary studies overall (Mdn = 35, range = 4-137). Only 177 primary studies (37%) were included in more than one review (Corrected Covered Area = 6%). We rated all reviews as low (10%) or critically low (90%) quality on A MeaSurement Tool to Assess systematic Reviews-2, and most reviews (86%) at high risk of bias on Risk Of Bias In Systematic reviews. Reviews mostly suggest school-based depression prevention interventions may have modest average positive impacts on depression-related outcomes-both overall and for specific stages of prevention, school levels and student ages, and specific program manuals and intervention types. However, some reviews did not detect effects, and most reviews noted concerns about primary study quality, heterogeneity, and publication bias in this body of evidence.

Conclusions: School-based depression prevention interventions may be beneficial on average, though existing reviews have important methodological limitations. A living systematic review conducted according to methodological best practice could provide timely, relevant, and rigorous evidence for educational decision making. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Specific modifiable factors (e.g., screen time [ST], sleep duration, physical activity, or social connections) are targets for reducing depression risk in adults. However, research in adolescents lacks causal inference implementations, as prevention trials are costly and often prohibitive. Emulating randomized trials with observational data enables inference regarding hypothetical interventions on modifiable factors that reduce depression risk, in general and at-risk populations.

Method: Data from the Adolescent Brain Cognitive Development (N = 8,699) and the Generation R (N = 3,739) studies were leveraged for modifiable factors (age 10) and internalizing symptoms (age 12-14). We (a) tested prospective associations of each modifiable factor with internalizing symptoms under target trial emulation (TTE) and (b) used G-formula to estimate the potential effects on internalizing symptoms if hypothetical interventions were implemented. Analyses were conducted in the full sample (universal prevention setting) and at-risk youth (selective and indicated prevention setting).

Results: First, under TTE, only ST associated with internalizing symptoms. Second, in the universal prevention setting, adhering to more stringent ST guidelines (0-1 hr) decreased internalizing symptoms by 0.10-0.16 SDs while following more lenient guidelines (3-4 hr) increased them by 0.07-0.09 SDs, compared to existing guidelines (2 hr). Such changes were greater in the indicated (subclinical symptom) prevention settings and robust to residual confounding. Restricting physical activity reduced internalizing risk in the indicated setting, but findings were not robust.

Conclusions: With a causally informed strategy, we demonstrated the potential effects of numerous hypothetical interventions on modifiable factors for depression risk reduction, across multiple preventive settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Rising rates of mental illness in young people over recent decades are a trend that represents a wake-up call across the globe. The causes of this increase are not known. We also know little about effective interventions or implementation strategies to prevent depression in either youth or adults. The need for the prevention of mental ill health represents an outstanding research opportunity for our field.

Method: This conceptual article identifies current challenges in our field, provides potential solutions, and suggests the most promising avenues for future solutions and how we might investigate them.

Results: Key challenges include the following: poor implementation with low fidelity; methodological challenges related to appropriate sampling, time frames, interventions, and active controls; and lack of fit between interventions and their context. Potential solutions include the following: supplementing trials with evidence from large-scale epidemiological studies, establishing prevention models that work at scale including those that address social determinants and show effectiveness in low- and middle-income countries, building capacity in methods, and strengthening geographically dispersed networks of prevention researchers and practitioners.

Conclusions: There are major challenges in conducting prevention research and demonstrating effects. New perspectives and collaborations are needed to overcome existing barriers. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: To examine short-term (i.e., postintervention) outcomes from a randomized controlled trial comparing a school-based telehealth-delivered depression prevention program, Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), to services as usual (SAU). We expected IPT-AST would be acceptable and feasible and that IPT-AST adolescents would experience greater reductions in depression symptoms, anxiety symptoms, and impairment compared with SAU.

Method: Adolescents (N = 242; M_age = 14.80 years, SD = 0.70; 65% female; 21% Black; 13% Hispanic/Latinx) with elevated scores on the Center for Epidemiologic Studies Depression Scale (Radloff, 1977) at screening provided data at baseline, 2-month (midpoint of IPT-AST), and 3-month (postintervention) assessments. They reported depression symptoms on the Center for Epidemiologic Studies Depression Scale, anxiety symptoms on the Screen for Child Anxiety Related Emotional Disorders (Birmaher et al., 1997), and impairment on the Columbia Impairment Scale (Bird et al., 1993). Baseline depression diagnosis was examined as a moderator.

Results: Hierarchical linear models showed that adolescents reported significant reductions in depression symptoms and impairment across conditions. IPT-AST adolescents reported significantly greater reductions in anxiety symptoms than SAU adolescents, d = .39, 95% CI [.05, .72], p = .003. Depression diagnosis moderated outcomes (ds = .33-.34, ps ≤ .05), such that IPT-AST adolescents without a diagnosis at baseline showed greater improvements in depression and anxiety symptoms than SAU adolescents. Adolescents in SAU with a depression diagnosis at baseline showed greater improvements in impairment compared with IPT-AST. Attendance and satisfaction data demonstrated the feasibility and acceptability of telehealth-delivered IPT-AST.

Conclusions: Results support telehealth-delivered IPT-AST as a promising intervention for improving short-term outcomes among adolescents with depression symptoms but without a depression diagnosis. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: This study sought to evaluate the feasibility, acceptability, and preliminary efficacy of the Happy Older Latinos are Active (HOLA) health promotion intervention in a group of older Latinos who were at risk for developing major depressive disorder or generalized anxiety disorder.

Method: Sixty older Latinos age 60+ with subthreshold depression or anxiety were randomized to receive either HOLA (n = 30) or enhanced psychoeducation through fotonovela control (n = 30). The primary outcomes of interest were feasibility, acceptability, and reduction in depression and anxiety symptom severity. Outcome measures were administered at baseline and at the end of the intervention.

Results: Within a year, the enrollment target was met with < 5% of eligible participants refusing randomization. The randomization scheme produced equal numbers of participants randomized to each condition. Four participants (6.7%; HOLA = 1; control = 3) were lost to follow-up, 69% of the HOLA sessions were attended, and participants reported high satisfaction with the intervention. Finally, compared with control, a significant proportion of participants in HOLA experienced a clinically significant reduction in their anxiety symptoms (60% vs. 26.7%).

Conclusions: Findings highlight the feasibility, acceptability, and significant impact the HOLA intervention can have in reducing psychological distress because it is responsive, respectful, and specific to the needs of older Latinos. Furthermore, using a community health worker to deliver a health promotion intervention to prevent common mental disorders in older Latinos is an innovative approach for reducing disease burden in a population living with high disparities in accessing and engaging in mental health services. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Children of parents with severe mental illness are at increased risk of mental illness throughout their lifespan due to complex gene-environment interactions. Preventive interventions supporting parents and children are warranted. Compared with usual treatment, we tested the effectiveness of a multidisciplinary family-based preventive intervention, VIA Family.

Method: We did a parallel randomized controlled superiority trial in Copenhagen, Denmark. A total of 95 families, of 95 parents with either schizophrenia spectrum disorder (n = 12 [12.6%]), bipolar disorder (n = 25 [26.3%]), or recurrent major depressive disorder (n = 58 [61.1%]), participated. A total of 179 coparents and 113 children (6-12 years) participated. Assessments took place at baseline and after 18 months of intervention. We estimated the effects on family functioning with the McMaster Family Assessment Device and on levels of stimulation and support in the home environment with the Home Observation Measurement of the Environment.

Results: Effects on family functioning did not differ between the two groups: parents with severe mental illness (0.11; 95% CI [-0.10, 0.31]), p = .296, and coparents (-0.07; 95% CI [-0.27, 0.13]), p = .482. Assessor-rated levels of stimulation and support in the home environment improved in VIA Family, but not significantly compared with usual treatment (M_diff: 1.79; 95% CI [-0.37, 3.95], p = .104). Sensitivity analyses confirmed our main findings.

Conclusions: Effects on family functioning and the home environment did not differ between VIA Family and usual treatment. We cannot rule out a clinically relevant effect of VIA Family on levels of stimulation and support in the home environment. Long-term follow-up will investigate potential preventive effects. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Young adults in college engage in risky drinking that results in alcohol-related harms. Most evidence-based prevention interventions recommended for this population rely on correcting exaggerated drinking norms via personalized normative feedback (PNF). Informed by an extensive literature linking alcohol attitudes and drinking behavior, we adapted a brief counter-attitudinal advocacy (CAA) task to the alcohol prevention context. The goal of this study is to evaluate the ability of CAA in changing drinking and related consequences and to explore the comparative efficacy of CAA versus PNF.

Method: This two-site randomized controlled trial had two experimental conditions (CAA and PNF) and an assessment-only control condition. Participants were 585 students who reported heavy episodic drinking and ≥ 2 alcohol-related negative consequences. Alcohol outcomes were assessed at 1-, 3-, and 6-month follow-ups to test hypotheses that the CAA and PNF manipulations will decrease drinks per week, typical drinks per day, peak blood alcohol concentration, and alcohol consequences, relative to control.

Results: Participants reported reductions in drinks per week, typical drinks, and alcohol consequences. Those who received PNF reported significantly fewer drinks per week than controls, whereas those who received CAA reported significantly fewer consequences than controls. The CAA and PNF conditions did not differ from one another.

Conclusions: This study demonstrates an application of attitude change theory and CAA methods to the alcohol prevention context, across demographically different settings. The novel CAA task had a harm reduction effect on consequences but not consumption. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Several researchers who have evaluated Interpersonal Psychotherapy (IPT) wrote a commentary arguing that the group-delivered IPT treatment for eating disorders that we adapted and used in a recent trial (Stice, Rohde, et al., 2023) was less effective than the new dissonance-based eating disorder treatment (Body Project Treatment) because the group-delivered IPT did not contain all core elements, was not developmentally appropriate, was not tailored for people with eating disorders, and because our team lacked sufficient IPT expertise. In response, we note that the group-delivered IPT that we evaluated produced higher abstinence from binge eating and compensatory weight control behaviors (40%) than did individually delivered IPT in the only trial that also evaluated this treatment with a broad range of eating disorders (33%; Fairburn et al., 2015). The fact that the group-delivered IPT produced a higher abstinence rate than individually delivered IPT for a similar spectrum of patients appears to refute the stated concerns regarding the group-delivered version of IPT because it was not less effective than individually delivered IPT. We argue it is critical to establish that a treatment significantly outperforms alternative treatments with a distinct intervention target because only an active comparator controls for the potential confounds that can drive improvement in trials, including expectancies, demand characteristics, and nonspecific therapeutic effects. We also note that IPT for the treatment of eating disorders has not significantly outperformed three alternative treatments and that the evidence base for IPT may thus be driven by expectancies, demand characteristics, and nonspecific effects. (PsycInfo Database Record (c) 2025 APA, all rights reserved).