Steven M. Brunwasser

A meta-analytic review of the Penn Resiliency Program's effect on depressive symptoms.

The purpose of this review was to evaluate whether the Penn Resiliency Program (PRP), a group cognitive-behavioral intervention, is effective in targeting depressive symptoms in youths. We identified 17 controlled evaluations of PRP (N = 2,498) in which depressive symptoms had been measured via an online search of PsycINFO, Medline, ERIC, and ProQuest Dissertations and Theses and by requesting data from PRP researchers. We combined effect sizes (ESs; Glasss d), using random effects models at postintervention and two follow-up assessments (6-8 and 12 months postintervention). PRP participants reported fewer depressive symptoms at postintervention and both follow-up assessments compared with youths receiving no intervention, with ESs ranging from 0.11 to 0.21. Subgroup analyses showed that PRPs effects were significant at 1 or more follow-up assessments among studies with both targeted and universal approaches, when group leaders were research team members and community providers, among participants with both low and elevated baseline symptoms, and among boys and girls. Limited data showed no evidence that PRP is superior to active control conditions. Preliminary analyses suggested that PRPs effects on depressive disorders may be smaller than those reported in a larger meta-analysis of depression prevention programs for older adolescents and adults. We found evidence that PRP significantly reduces depressive symptoms through at least 1-year postintervention. Future PRP research should examine whether PRPs effects on depressive symptoms lead to clinically meaningful benefits for its participants, whether the program is cost-effective, whether CB skills mediate program effects, and whether PRP is effective when delivered under real-world conditions.

Evaluation of a group cognitive-behavioral depression prevention program for young adolescents: a randomized effectiveness trial.

Depression is a common psychological problem in adolescence. Recent research suggests that group cognitive-behavioral interventions can reduce and prevent symptoms of depression in youth. Few studies have tested the effectiveness of such interventions when delivered by school teachers and counselors (as opposed to research team staff). We evaluated the effectiveness of the Penn Resiliency Program for adolescents (PRP-A), a school-based group intervention that targets cognitive behavioral risk factors for depression. We randomly assigned 408 middle school students (ages 10–15) to one of three conditions: PRP-A, PRP-AP (in which adolescents participated in PRP-A and parents were invited to attend a parent intervention component), or a school-as-usual control. Adolescents completed measures of depression and anxiety symptoms, cognitive style, and coping at baseline, immediately after the intervention, and at 6-month follow-up. PRP-A reduced depression symptoms relative to the school as usual control. Baseline levels of hopelessness moderated intervention effects. Among participants with average and high levels of hopelessness, PRP (A and AP) significantly improved depression symptoms, anxiety symptoms, hopelessness, and active coping relative to control. Among participants with low baseline hopelessness, we found no intervention effects. PRP-AP was not more effective than PRP-A alone. We found no intervention effects on clinical levels of depression or anxiety. These findings suggest that cognitive-behavioral interventions can be beneficial when delivered by school teachers and counselors. These interventions may be most helpful to students with elevated hopelessness.

Depressive and Anxiety Symptom Trajectories From School Age Through Young Adulthood in Samples With Autism Spectrum Disorder and Developmental Delay

OBJECTIVE The objectives of this study were to model growth in anxiety and depressive symptoms from late school age through young adulthood in individuals with autism spectrum disorder (ASD) and controls with developmental delay (DD), and to assess relationships among internalizing growth patterns, participant characteristics, baseline predictors, and distal outcomes. METHOD Data were collected between ages 6 and 24 years in 165 participants (n = 109 with ASD; n = 56 with nonspectrum DD), most of whom received diagnostic evaluations in both childhood and early adulthood. Questionnaires were collected approximately every 3 to 6 months between ages 9 and 24 years. Parent-rated Child Behavior Checklist (CBCL), Adult Behavior Checklist (ABCL), and Developmental Behaviour Checklist anxiety- and depression-related subscale distributions were modeled with mixed-effects Poisson models, covarying diagnosis, age, verbal IQ (VIQ), gender, and significant 2- and 3-way interactions. RESULTS Anxiety was positively associated with VIQ, and controlling for VIQ, both anxiety and depressive symptoms were greater in ASD than nonspectrum participants. Female gender predicted greater increases over time in anxiety and depressive symptoms for both diagnostic groups. Lower maternal education was associated with increasing internalizing symptoms in a subset of less verbal individuals with ASD. In exploratory post hoc analyses, internalizing symptoms were associated with poorer emotional regulation in school age, and with lower life satisfaction and greater social difficulties in early adulthood. CONCLUSION Findings support previous claims that individuals with ASD are at particular risk for affect- and anxiety-specific problems. Although symptom levels in females increase at a faster rate throughout adolescence, males with ASD appear to have elevated levels of depressive symptoms in school age that are maintained into young adulthood.

Rumination and Perceived Impairment Associated with Depressive Symptoms in a Verbal Adolescent-Adult ASD Sample

The aim of this study was to examine the association between depressive symptoms and several psychosocial constructs (insight into autism symptoms, rumination, desire for social interaction, and satisfaction with social support) that may play a role in the development or maintenance of depression in verbally fluent adolescents and adults with ASD. Participants included 50 individuals with ASD and verbal IQ ≥ 70, aged 16–35 (sample size varied by measure). Elevated depressive symptoms on the Beck Depression Inventory, 2nd edition (BDI‐II), were associated with greater self‐perceived, autism‐related impairments (n = 48), greater rumination (n = 21), and lower perceived social support (n = 37). Rumination tended to moderate the association between self‐perceived autism symptoms and BDI‐II scores (n = 21), and was significantly associated with ASD‐related insistence on sameness behaviors (n = 18). An unexpected relationship between depressive features and social participation and motivation will need to be clarified by longitudinal research. These and similar findings contribute to our understanding of the phenomenology of depression in ASD, which is critical to the development of practical prevention and treatment. Autism Res 2014, 7: 381–391.

Effect of a Cognitive-Behavioral Prevention Program on Depression 6 Years After Implementation Among At-Risk Adolescents: A Randomized Clinical Trial

IMPORTANCE Adolescents whose parents have a history of depression are at risk for developing depression and functional impairment. The long-term effects of prevention programs on adolescent depression and functioning are not known. OBJECTIVE To determine whether a cognitive-behavioral prevention (CBP) program reduced the incidence of depressive episodes, increased depression-free days, and improved developmental competence 6 years after implementation. DESIGN, SETTING, AND PARTICIPANTS A 4-site randomized clinical trial compared the effect of CBP plus usual care vs usual care, through follow-up 75 months after the intervention (88% retention), with recruitment from August 2003 through February 2006 at a health maintenance organization, university medical centers, and a community mental health center. A total of 316 participants were 13 to 17 years of age at enrollment and had at least 1 parent with current or prior depressive episodes. Participants could not be in a current depressive episode but had to have subsyndromal depressive symptoms or a prior depressive episode currently in remission. Analysis was conducted between August 2014 and June 2015. INTERVENTIONS The CBP program consisted of 8 weekly 90-minute group sessions followed by 6 monthly continuation sessions. Usual care consisted of any family-initiated mental health treatment. MAIN OUTCOMES AND MEASURES The Depression Symptoms Rating scale was used to assess the primary outcome, new onsets of depressive episodes, and to calculate depression-free days. A modified Status Questionnaire assessed developmental competence (eg, academic or interpersonal) in young adulthood. RESULTS Over the 75-month follow-up, youths assigned to CBP had a lower incidence of depression, adjusting for current parental depression at enrollment, site, and all interactions (hazard ratio, 0.71 [95% CI, 0.53-0.96]). The CBP programs overall significant effect was driven by a lower incidence of depressive episodes during the first 9 months after enrollment. The CBP programs benefit was seen in youths whose index parent was not depressed at enrollment, on depression incidence (hazard ratio, 0.54 [95% CI, 0.36-0.81]), depression-free days (d = 0.34, P = .01), and developmental competence (d = 0.36, P = .04); these effects on developmental competence were mediated via the CBP programs effect on depression-free days. CONCLUSIONS AND RELEVANCE The effect of CBP on new onsets of depression was strongest early and was maintained throughout the follow-up period; developmental competence was positively affected 6 years later. The effectiveness of CBP may be enhanced by additional booster sessions and concomitant treatment of parental depression. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT00073671.

Programs for the Prevention of Youth Depression: Evaluation of Efficacy, Effectiveness, and Readiness for Dissemination

The objective of this study was to evaluate the current state of evidence of the effectiveness of depression prevention programs for youth, assess the degree to which current evidence supports broad implementation, and outline additional steps needed to close the gap between effectiveness and dissemination. We used the Society for Prevention Researchs Standards of Evidence (Flay et al., 2005) to evaluate the degree to which existing depression prevention programs have established intervention efficacy, effectiveness, and readiness for dissemination. We reviewed all depression prevention programs for youth that have been evaluated in at least two published, randomized controlled trials in which the intervention was compared to a no-intervention control group. A total of 37 studies evaluating 11 different programs were reviewed with regard to depressive symptoms and diagnoses at postintervention and follow-up (at least 6 months). Eight programs demonstrated significant main effects on depressive symptoms relative to controls in multiple randomized controlled trials; 5 programs had at least 1 trial with significant main effects present at least 1 year postintervention. Two programs demonstrated efficacy for both depressive symptoms and depressive episodes across multiple independent trials. Regarding effectiveness, 6 programs had at least 1 study showing significant effects when delivered by endogenous service providers; 4 programs had significant effects in studies conducted independently of the program developers. Several programs have demonstrated promise in terms of efficacy, but no depression prevention program for children or adolescents as yet has garnered sufficient evidence of effectiveness under real-world conditions to warrant widespread dissemination at this time.

In memory of Chris Peterson: Introduction to special issue

Special Editors: Jane Gillham, Steven Brunwasser, Acacia Parks, and Robert Emmons When Chris Peterson died on 9 October 2012, Positive Psychology lost a leading visionary, researcher and spokesperson; the field of Psychology lost one of its most influential scholars; the University of Michigan lost one of its most beloved educators; and those of us who had the great fortune to know him well lost a dear friend. Chris’ contributions to the field of Positive Psychology, particularly in the classification and study of character strengths, have inspired a wealth of scholarship. Although character strengths have been discussed and explored for millennia, Chris revolutionized this field by examining a wide variety of strengths that have been valued across culture and time, by developing methods for measuring character strengths, and by scientifically documenting the link between strengths and well-being. Chris believed an important path to well-being lies in identifying and using our strengths. He helped to develop positive psychology interventions to cultivate strengths in young people. In addition to his many journal articles, his books, Character Strengths and Virtues: A Handbook and Classification and A Primer in Positive Psychology, are essential resources for anyone interested in Positive Psychology. He leaves behind an enduring and growing legacy to which the articles in this special issue are a testament. There are several prominent themes among the articles, all of which were of great importance to Chris. The first three articles highlight (some of) Chris’ contributions to the study of both psychopathology and wellbeing. In the opening article, Seligman shares Chris’ compelling but uncompleted theory of psychopathology which extends from their groundbreaking work into the classification of character strengths and virtues (Peterson & Seligman, 2003). Seligman highlights the theory’s potential to provide an understanding of psychopathology that is richer and more useful than current symptombased (e.g. DSM) approaches. Lester and colleagues describe Chris’ role in the development of the Global Assessment Tool, a multi-dimensional questionnaire that is the centerpiece of the US Army’s efforts to monitor and improve social and emotional fitness among its soldiers. Young and colleagues question the common practice of focusing exclusively on the value of ‘signature strengths’; they examine whether a balanced strength profile (i.e. use of both signature and lower strengths) is related to well-being independently of the frequency of signature strength use. The next two articles explore the degree to which strengths might be universal (vs. contextual) and stable (vs. influenced by life circumstances and events). Both articles attempt to replicate and extend studies conducted by Chris and his colleagues. Using the method of Park, Peterson, and Seligman (2006), McGrath demonstrates a remarkable degree of concordance across 75 nations in the rank ordering of character strength endorsement. Similarly, Schueller and colleagues adapted an existing method (Peterson & Seligman, 2003), to examine differences in character strength endorsement before and after tragic events. The last four articles explore the potential role of Positive Psychology interventions (especially those based on Chris’ work) to alleviate psychological distress and to promote well-being in individuals and in communities. Rashid describes how Chris’ work helped lay the foundation for Positive Psychotherapy. He provides illustrations of Positive Psychotherapy in practice and reviews the growing evidence for this therapeutic approach. Three articles examine the potential of using Chris’ model of character strengths to enhance youth education. Linkins and colleagues make the case for an approach to character education focused on identifying and fostering children’s existing character strengths, as opposed to more traditional approaches that attempt to mold behavior to be consistent with institutionally valued behaviors. White and colleagues describe an initiative to transform a private school into a positive institution by incorporating character strength development into all aspects of education. Finally, Quinlan and colleagues evaluate a classroom-based strengths intervention on student perceptions of the quality of classroom relationships and functioning. Though often lost on outsiders, Chris’ scholarship was a reflection of his personality. People would commonly point out the apparent incompatibility between the content of his work and his outward appearance: ‘For a positive psychologist, you don’t look very happy.’ To which Chris would quip in his gruff baritone: ‘But I’m happy on the inside!’ In truth, Chris embodied his work more than anyone we have known. Like all great scholars, he loved the process of scientific discovery in its own right. But Chris’ research was not esoteric. He

Treatment and Prevention of Depression and Anxiety in Youth: Test of Cross‐Over Effects

Anxiety and depression are highly comorbid and share several common etiological processes. Therefore, it may be more efficient to develop interventions that treat or prevent these problems together rather than as separate entities. The present meta‐analytic review examined whether interventions for children and adolescents that explicitly targeted either anxiety or depression showed treatment specificity or also impacted the other outcome (i.e. cross‐over effects). We addressed this question both within the same type of study (i.e. treatment, prevention) and across study types. Only randomized controlled trials (RCTs) that assessed both constructs with dimensional measures were included in this review. For treatment studies, RCTs targeting anxiety (n = 18) showed significant effects on both anxious and depressive symptoms, although more strongly on anxiety than depression; similarly, RCTs treating depression (n = 9) yielded significant effects on both depressive and anxious symptoms, but stronger effects on depression than anxiety. Thus, there were cross‐over effects in treatments purportedly targeting either anxiety or depression, and also treatment specificity, such that larger effects were seen for the target problem at which the treatment was aimed. Anxiety prevention studies (n = 14) significantly affected anxious, but not depressive symptoms, indicating no cross‐over effect of anxiety prevention trials on depression. For depression prevention studies (n = 15), the effects were not significant for either depressive or anxiety symptoms, although the effect was significantly larger for depressive than for anxious symptoms. Post‐hoc analyses revealed that the effect on depressive symptoms was significant in depression preventions trials of targeted but not universal samples. Implications for transdiagnostic interventions are discussed.

Social Support Seeking and Early Adolescent Depression and Anxiety Symptoms: The Moderating Role of Rumination

This study examined how social support seeking and rumination interacted to predict depression and anxiety symptoms 6 months later in early adolescents (N = 118; 11-14 years at baseline). We expected social support seeking would be more helpful for adolescents engaging in low rather than high levels of rumination. Adolescents self-reported on all measures at baseline, and on depression and anxiety symptoms 6 months later. Social support seeking predicted fewer symptoms of depression and anxiety at low rumination levels but was not associated with benefits as rumination increased. For depression symptoms, social support seeking predicted more symptoms at high rumination levels. Results were stronger for emotion-focused than problem-focused support seeking and for depression compared with anxiety symptoms. These findings suggest that cognitive risk factors like rumination may explain some inconsistencies in previous social support literature, and highlight the importance of a nuanced approach to studying social support seeking.

The Prospective Associations between Self-Efficacy and Depressive Symptoms from Early to Middle Adolescence: A Cross-Lagged Model

Over the course of adolescence, an increasing number of adolescents experience depression. In order to effectively target depression, identifying risk factors for depressive symptoms is pivotal. Since low levels of self-efficacy were associated with higher levels of depressive symptoms in previous studies, the current study investigated the bidirectional and prospective associations between depressive symptoms and academic, social and emotional self-efficacy from early to mid adolescence in a cross-lagged path model. The sample consisted of 1,341 adolescents (47 % girls) with a mean age of 14 years, SD = 0.56. Depressive symptoms and self-efficacy levels were assessed every 6 months over a period of 2.5 years. Depressive symptoms predicted subsequent levels of academic and emotional self-efficacy on all time points, and social self-efficacy on one time point. Self-efficacy did not predict subsequent levels of depressive symptoms. There was no evidence of sex differences in the cross-lagged associations between depressive symptoms and self-efficacy levels. Implications of the findings are discussed.