• By Dartington SRU
  • Posted on Thursday 11th September, 2014

Want to stop depression from worsening among teens? Target their parents

When parents of at-risk adolescents learned how to improve their family’s communication and problem-solving skills, it helped to prevent their children from becoming increasingly depressed, a US study found – whether or not the young people had any treatment themselves.

Along the way, the Adolescent Transitions Programme (ATP) secured the participation of almost 90% of the families in the universal intervention group – a very high percentage given that mothers and fathers of depressed teens are often notoriously reluctant to participate in parenting interventions.

Targeting parents in order to improve their children’s depression is an approach that runs counter to the mainstream. The majority of psychosocial interventions for depressed youth focus on providing individual or group treatment for children and adolescents.

Focusing on teens themselves can have positive effects, as approaches such as cognitive-behavioural therapy (CBT) and inter-personal psychotherapy for adolescents (IPT-A) show.

However, research suggests that depressive symptoms in youth are related to poor family functioning such as parent-child conflict, parental criticism, and low levels of family support. And when their family doesn’t function well, depressed children and adolescents often don’t respond well to treatment.

To make matters worse, parents of depressed youth are often not very motivated to engage with treatments for depressed youths that have a family-focused component such as parent-training sessions.

So what can break this cycle and make it attractive for parents of at-risk teens to participate?

In a study of ATP, two psychologists examined the programme’s effects on depressive symptoms in youth. Arin M. Connell of Case Western Reserve University, working with ATP’s co-developer Thomas J. Dishion of the University of Oregon, found that this family-focused preventive intervention improved parent management practices and parent-adolescent relationships that in turn helped to reduce depressive symptoms in at-risk adolescents.

ATP is a multilevel, family-centered prevention programme aimed at middle school students (around eleven to fourteen years old) with conduct problems or substance use. The intervention works within a “tiered” strategy (universal, selective, and indicated), where each level builds on the previous level.

The universal level offers a modest programme to all the students, whether or not they are at risk of conduct problems, substance use, or depression. It includes six lessons that are modeled after the Life Skills Training (LST) programme, but reduced in scope.

The universal level also establishes a Family Resource Center. The goal, through collaboration with the school staff, is to engage parents, establish norms for parenting practices, and disseminate information about risks for problem behaviour and substance use.

The selective level of intervention targets high-risk families. Families that are assessed as being at risk are offered the Family Check-Up (FCU), which is based on motivational interviewing techniques and is designed to enhance family engagement and trigger the behaviour change process.

Finally, the indicated level, the Parent Focus curriculum, provides direct professional support to parents for making the changes indicated by the Family Check-Up (FCU). Over 12 sessions, parents learn how to make requests, provide clear rules and consequences, solve problems, and engage in active listening.

ATP was originally created to target adolescent problem behaviours. However, families of depressed youths and families of youths with behaviour problems share many risk factors. These families often experience high levels of stress and conflict, low levels of parental warmth and support, and coercive family processes.

Because of these similarities in family processes, Connell and Dishion tested the impact of ATP on the development of youth depressive symptoms in a sample of 106 high-risk youths. The participants were recruited in grade 6 and randomly assigned to intervention and control groups.

For families like these, it is the FCU that sets ATP apart from other programmes, the authors argue. It can be difficult to get the parents of depressed teens to turn up to family interventions and stick with them. So ATP is designed not only to equip parents with better skills, but to motivate parents to engage with the programme in the first place.

In this study, almost 90% of the parents of high-risk teens in the intervention group received services from the family resource staff, and 60% of the parents also had an FCU and linked intervention services. Parents averaged almost eight hours of services across three years, with some families taking advantage of up to 46 hours of services.

Interestingly, relatively few parents chose to participate in the full 12-session curriculum, preferring to use the Family Resource Center for more immediate questions as and when they chose.

Connell and Dishion speculate that the high level of parental engagement is the result of recruitment and encouragement by helpful school personnel, as well as the unusually long window of time for families to participate. The initial commitment for families is very brief, and then more intervention is made available as families choose.

ATP didn’t reduce the average level of depression among the young people, but it prevented it from getting worse. High-risk youths in the ATP group showed no significant increase in depressive symptoms, whereas the control group became more depressed over the three years. These results were found to hold both in the case of the youth report and the mothers’ report in grades 7, 8, and 9.

These findings provide support for the idea that family interventions can reduce depressive symptoms in high-risk youth. Considering that youths in the intervention group only participated in the universal level of ATP and the selective and indicated levels were solely offered to parents, these findings suggest that family involvement can drive changes in depressive symptoms.

As the authors say, “Changes in the parenting system may lead to reductions in youth depression, independent of youth participation in treatment.”

Connell, A.M., & Dishion, T.J. (2008). Reducing depression among at-risk early adolescents: Three-year effects of a family-centered intervention embedded within schools. Journal of Family Psychology, 22(3), 574-585.

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