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theses

Adolescent depression is a prevalent and debilitating mental health concern associated with impairment in functioning in school, family, and peer relationships (Birmaher et al., 1996; Williams, O’Connor, Eder, & Whitlock, 2009). Adolescents who suffer from subthreshold depressive symptoms, despite not qualifying for a formal depression diagnosis, also experience impairment and decreased quality of life, including a heightened risk of Major Depressive Disorder and suicide (Bertha & Balázs, 2013). Young and Hankin (2018) developed the Personalized Depression Prevention Project to examine whether certain programs have a greater impact on preventing depression in adolescence by matching or mismatching adolescents to evidence-based prevention groups based on their risk profile. Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST; Young, Mufson, & Schueler, 2016) and Coping with Stress (CWS; Clarke & Lewinsohn, 1995) are evidence-based prevention programs for adolescents at-risk for the development of depression. IPT-AST focuses on interpersonal risk factors and CWS addresses cognitive risk factors of depression. The present study used a mixed-methods approach to examine the issue of whether personalized programs are more effective than generalized programs in preventing adolescent depression. Drawing from the Personalized Depression Prevention Project, two systemic individual case studies were conducted with participants in the same IPT-AST group: one mismatched to IPT-AST, given the name “Madison”; and one matched to IPT-AST, given the name “Riley.” Qualitative data from audio recordings and progress notes of the group intervention and clinical evaluations were examined in conjunction with quantitative data from self-report and clinician-assessed measures to capture the clinical process and outcomes of the two adolescents during the intervention and in the 30 months following. The case studies found that Madison, the mismatched participant, fared better than Riley, the matched participant. A detailed analysis of the case study data reveals (a) several factors that appeared to contribute to the deviation in the results from the risk-profile theory, and (b) other important possible factors for the different outcomes between Madison and Riley. These factors occurred at different systems levels, including individual-level variables such as social anxiety, interpersonal history, and level of functioning; intervention-level factors such as the setting of certain treatment goals; and group-level factors such as the degree of participation and trust in the group. Limitations of the study are also described. Overall, the study findings highlight factors to be considered for future prevention programs.

ETD_10320

Psy.D.

Includes bibliographical references

doi:10.7282/t3-t65e-h590

ETD doctoral

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