Lewinsohn, P. M., Clarke, G. N., Hops, H., & Andrews, J. (1990). Cognitive-behavioral treatment for depressed adolescents. Behavior Therapy, 21(4), 385–401. https://doi.org/10.1016/S0005-7894(05)80353-3

Type of Study: Randomized controlled trial
Number of Participants: 59

Population:

• Age — 14–18 years
• Race/Ethnicity — Not specified
• Gender — 61% Female
• Status — Participants were adolescents meeting criteria for depression.

Location/Institution: Eugene and Portland, Oregon

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the efficacy of two versions of Coping with Depression Course for Adolescents (CWD-A) [now called Adolescent Coping with Depression Course (CWD-A)]. Participants were randomly assigned to one of three conditions: Adolescent-and-Parent, Adolescent-Only (CWD-A), and Waitlist. At the conclusion of the 7-8 week waiting period subjects in the waitlist control group completed the postassessment measures and subsequently participated in a CWD-A group. Measures utilized include the Schedule for Affective Disorder and Schizophrenia for School Age Children–Epidemiologic Version (K-SADS-E,) the Beck Depression Inventory (BDI), the Center for Epidemiological Studies-Depression Scale (CES-D), the Child Behavior Checklist (CBCL), and the Development of Abbreviated Measures for Adolescent Target Behaviors. Results indicate that both treatment groups significantly improved at posttreatment, with substantial reductions in diagnosis and depression scores and improvement in behaviors targeted by the CWD-A, whereas the waitlist control group improved very little. The proportion of adolescents still meeting diagnosis criteria was significantly reduced at posttreatment and continued to decline over the 24-month follow-up period. Contrary to expectation, there was no difference on the depression measures between treatment groups. Additionally at the 6-month follow-up parents of the Adolescent-Only group continued to become more positive in their CBCL ratings, matching the level of the Adolescent-and-Parent group. Paralleling these reports was a significant reduction in parent-reported parent –adolescent conflict, from the posttreatment to the 6-month follow-up for both groups. Limitations include small sample size; no control group at postintervention follow-up time points listed below, as the waitlist group was offered enrollment in a CWD-A group immediately following the postintervention interview; lack of generalizability due to gender of participants; and subjects were actively recruited and did not constitute a representative clinical sample.

Length of controlled postintervention follow-up: 1, 6, 12, and 24 months.

Clarke, G. N., Rohde, P., Lewinsohn, P. M., Hops, H., & Seeley, J. R. (1999). Cognitive-behavioral treatment of adolescent depression: Efficacy of acute group treatment and booster sessions. Journal of the American Academy of Child and Adolescent Psychiatry, 38(3), 272–279. https://doi.org/10.1097/00004583-199903000-00014

Type of Study: Randomized controlled trial
Number of Participants: 123

Population:

• Age — 14–18 years
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were adolescents with major depression or dysthymia.

Location/Institution: Eugene and Portland, Oregon

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effects of both acute and maintenance cognitive-therapy (CBT) for depressed adolescents. Participants were randomly assigned to either Adolescent Coping With Depression Course (CWD-A), CWD-A with a separate parent group, or waitlist control. Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic (K-SADS-E), the Longitudinal Interval Follow-up Evaluation (LIFE), the Beck Depression Inventory (BDI), the Child Behavior Checklist (CBCL) and the Hamilton Depression Rating Scale (HAM-D). Results indicate that acute CBT groups (CWD-A) yielded higher depression recovery rates than the waitlist and greater reduction in self-reported depression. Outcomes for adolescent-only and adolescent + parent conditions were not significantly different. The booster sessions did not reduce the rate of recurrence in the follow-up period but appeared to accelerate recovery among participants who were still depressed at the end of the acute phase. Limitations include small sample size, high dropout rate for follow-up sessions, and low attendance for booster sessions.

Length of controlled postintervention follow-up: 12 and 24 months.

Clarke, G. N., Hornbrook, M., Lynch, F., Polen, M., Gale, J., Beardslee, W., O’Connor, E., & Seeley, J. (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry, 58(12), 1127–1134. https://doi.org/10.1001/archpsyc.58.12.1127

Type of Study: Randomized controlled trial
Number of Participants: 94

Population:

• Age — 13–18 years
• Race/Ethnicity — Control Group: 9% Minority; Treatment Group: 10% Minority.
• Gender — Not specified
• Status — Participants were depressed children of depressed parents recruited through the family's health maintenance organization (HMO) physician.

Location/Institution: Oregon

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Clarke et al. (2002). The purpose of the study was to present the results from a prevention trial conducted with the subsyndromal adolescent offspring of parents treated for depression. Participants were randomly assigned to receive a 15-session version of the Coping With Depression for Adolescents Course (CWD-A) or to care as usual. Measures utilized include the Center for Epidemiological Studies—Depression Scale (CES-D) and the Global Assessment of Functioning Scale (GAF). Results indicate that there were improved scores on the CES-D and the GAF scales for the preventive treatment group in comparison with care as usual, with the comparison group being over 5 times more likely to develop depression at one year. Limitations include the protective effect of treatment was no longer significant at two years, multi-stage case-finding stage mechanism used to identify potentially depressed patients would be difficult to duplicate in many settings, and lack of generalizability due to age and sex of participants.

Length of controlled postintervention follow-up: 2 years.

Clarke, G. N., Hornbrook, M., Lynch, F., Polen, M., Gale, J., O’Connor, E., Seeley, J. R., & Debar, L. (2002). Group cognitive-behavioral treatment for depressed adolescent offspring of depressed parents in a health maintenance organization. Journal of the American Academy of Child & Adolescent Psychiatry, 41(3), 305–313. https://doi.org/10.1097/00004583-200203000-00010

Type of Study: Randomized controlled trial
Number of Participants: 123

Population:

• Age — Youth: 13–18 years, Parents: 30–65 years
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were adolescents whose parents with diagnosed with major depression or dysthymia.

Location/Institution: Kaiser Permanente, Portland, Oregon

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of group cognitive-behavioral therapy (CBT) for depressed adolescent offspring of depressed parents in a health maintenance organization (HMO). Participants were randomly assigned to either usual HMO care or usual care plus a 16-session Adolescent Coping With Depression Course (CWD-A). Measures utilized include the Family Schedule for Affective Disorders and Schizophrenia (F-SADS), the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic (K-SADS), the Center for Epidemiologic Studies-Depression Scale (CES-D), the Child Behavior Checklist (CBCL) and the Hamilton Depression Rating Scale (HAM-D). Results indicate that there were no significant advantages of the CWD-A program over usual care for depression diagnoses, continuous depression measures, nonaffective measures, or functioning outcomes. Limitations include small sample size, study would be hard to duplicate due to selection process, and lack of generalizability due to ethnicity and age of participants.

Length of controlled postintervention follow-up: 12 and 24 months.

Rohde, P., Clarke, G. N., Mace, D. E., Jorgensen, J. S., & Seeley, J. R. (2004). An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 43(6), 660–668. https://doi.org/10.1097/01.chi.0000121067.29744.41

Type of Study: Randomized controlled trial
Number of Participants: 93

Population:

• Age — 13–17 years
• Race/Ethnicity — 75 White
• Gender — 45 Female
• Status — Participants were adolescents meeting criteria for major depression disorder and conduct disorder.

Location/Institution: Department of Youth Services of Lane County, Oregon

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of the Adolescent Coping With Depression Course (CWD-A) with nonincarcerated adolescents. Participants were randomly assigned to either CWD-A or a life skills/tutoring control condition. Measures utilized include the Schedule for Affective Disorder and Schizophrenia for School Age Children–Epidemiologic Version 5 (K-SADS-E-5) the Longitudinal Interval Follow-up Evaluation (LIFE), the Beck Depression Inventory II (BDI-II), the Children’s Global Adjustment Scale, the Social Adjustment Scale–Self-Report for Youth, the Child Behavior Checklist (CBCL), and the Hamilton Depression Rating Scale (HAM-D). Results indicate that major depressive disorder recovery rates posttreatment were greater in CWD-A compared with life skills/tutoring control. CWD-A participants reported greater reductions in BDI-II and HAM-D scores and improved social functioning post-treatment. Group differences in major depressive disorder recovery rates at 6- and 12-month follow-up were nonsignificant, as were differences in conduct disorder both posttreatment and during follow-up. Limitations include small sample size, retrospective recall may have been compromised, unable to differentiate condition from therapist effects, may not generalize to other racial/ethnic groups or to the broader population of depressed adolescents with comorbid conduct disorder and other psychiatric disorders, and randomization process resulted in unequal gender representation in the two conditions.

Length of controlled postintervention follow-up: 6 and 12 months.

Clarke, G. N., Debar, L., Lynch, F., Powell, J., Gale, J., O’Connor., E., Ludman, E., Bush, T., Lin, E. H. B., Von Korff, M., & Hertert, S. (2005). A randomized effectiveness trial of brief cognitive-behavioral therapy for depressed adolescents receiving antidepressant medication. Journal of the American Academy of Child and Adolescent Psychiatry, 44(9), 888–898. https://doi.org/10.1016/S0890-8567(09)62194-8

Type of Study: Randomized controlled trial
Number of Participants: 152

Population:

• Age — Youth: 12–18 years, Parents: 30–65 years
• Race/Ethnicity — Not specified
• Gender — Youth: 78% Female; Parents: 92% Female
• Status — Participants were diagnosed with major depression.

Location/Institution: Kaiser Permanente Northwest Region, Portland, Oregon

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of collaborative-care, cognitive-behavioral therapy (CBT) program adjunctive to selective serotonin reuptake inhibitor (SSRI) treatment in HMO pediatric primary care. Participants were randomly assigned to either treatment-as-usual (TAU) control condition consisting primarily of SSRI medication delivered outside the experimental protocol versus TAU SSRI plus brief CBT (adult and Adolescent Coping With Depression Course [CWD-A]). Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL), the Short Form-12 Mental Component Scale, the Social Adjustment Scale-Self Report for Youth, the Child Behavior Checklist (CBCL), the Center for Epidemiological Studies–Depression Scale (CES-D), the Hamilton Depression Rating Scale (HAM-D), the Youth Self-Report (YSR), and the Children’s Global Adjustment Scale. Results indicate that CBT was found advantageous on the Short Form-12 Mental Component Scale, reductions in TAU outpatient visits, and days’ supply of all medications. No effects were detected for major depressive disorder episodes; a nonsignificant trend favoring CBT was detected on the CES-D. Limitations include attrition at the latter follow-up points; telephone administration of self-report measures may have yielded different results than if those instruments had been completed privately by participants; and outcomes are not reported per treatment program, therefore cannot determine which program had an effect on participants.

Length of controlled postintervention follow-up: 12 and 24 months.

Rohde, P., Waldron, H. B., Turner, C. W., Brody, J., & Jorgensen, J. (2014). Sequenced versus coordinated treatment for adolescents with comorbid depressive and substance use disorders. Journal of Consulting and Clinical Psychology, 82(2), 342–348. https://doi.org/10.1037/a0035808

Type of Study: Randomized controlled trial
Number of Participants: 170

Population:

• Age — 13–18 years
• Race/Ethnicity — 61% Non-Hispanic White
• Gender — 22% Female
• Status — Participants were adolescents meeting criteria for major comorbid depressive disorder and substance use disorders.

Location/Institution: Portland, Oregon, and Albuquerque, New Mexico

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of three methods of integrating interventions for depression [Adolescent Coping With Depression Course (CWD-A)] and substance use disorders (Functional Family Therapy; FFT), examining (a) treatment sequence effects on substance use and depression outcomes and (b) whether the presence of major depressive disorder (MDD) moderated effects. Participants were randomized to (a) FFT followed by CWD-A (FFT/CWD), (b) CWD-A followed by FFT (CWD/FFT), or (c) coordinated FFT and CWD-A (CT). Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Life Version (K-SADS-PL), the Children’s Depression Rating Scale–Revised (CDRS–R), and the Timeline Followback Interview (TLFB). Results indicate that FFT/CWD achieved better substance use outcomes than CT at posttreatment, and 6- and 12-month follow-ups; substance use effects for CWD/FFT were intermediate. For participants with baseline MDD, the CWD/FFT sequence resulted in lower substance use than either FFT/CWD or CT. Depressive symptoms decreased significantly in all 3 treatment sequences with no evidence of differential effectiveness during or following treatment. Attendance was lower for the second of both sequenced interventions. A large proportion of the sample received treatment outside the study, which predicted better outcomes in the follow-up. Limitations include lack of control group, the CWD-A intervention was modified for use with this population, and specific outcomes not reported for each intervention.

Length of controlled postintervention follow-up: 6 and 12 months.

The following studies were not included in rating CWD-A on the Scientific Rating Scale...

Clarke, G. N., Hawkins, W., Murphy, M., Sheeber, L. B., Lewinsohn, P. M., & Seeley, J. R. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention. Journal of the American Academy of Child and Adolescent Psychiatry, 34(3), 312–321. https://doi.org/10.1097/00004583-199503000-00016

Note: This study was not used in rating the Adolescent Coping With Depression Course (CWD-A) since it used a modification of the program. The purpose of the study was to assess prevention of unipolar depressive episodes in high school adolescents with an elevated risk of depressive disorder utilizing a modification of the Adolescent Coping With Depression Course (CWD-A). Participants were high school students in health classes who were screened for depression using the Center for Epidemiological Studies—Depression Scale (CES-D), and those with elevated scores underwent a diagnostic interview. Students diagnosed with current depression were referred to services. The remaining at-risk group was randomly assigned to receive preventive treatment, or to care as usual. Participants were re-evaluated for depression at 6 and 12 months. Measures utilized include the Center for Epidemiologic Studies-Depression Scale (CES-D), the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version (K-SADS-E), the Longitudinal Interval Follow-up Evaluation (LIFE), and the Hamilton Depression Rating Scale (HDRS). Results indicate that 14.5% of the intervention group and 25.7% of the care-as-usual group had incidences of affective disorders during the follow-up period according to diagnostic interview data, although scores on the CES-D, and the Hamilton Depression Rating Scale did not show a difference, possibly due their use only at isolated points in time. Limitations include the lack of an "attention-placebo" control group; and several subjects were lost from the study during the case finding, intervention, and follow-up periods.