Blues Program

About This Program

Target Population: Adolescents ages 13-19 with elevated depressive symptoms

For children/adolescents ages: 13 – 19

Program Overview

The Blues Program is a brief manualized cognitive-behavioral prevention intervention for high school-aged adolescents with elevated depressive symptoms. The program consists of 6 weekly 1-hour group sessions and home practice assignments. Weekly sessions focus on building group rapport and increasing participant involvement in pleasant activities (all sessions), learning and practicing cognitive restructuring techniques (sessions 2-4), and developing response plans to future life stressors (sessions 5-6). In-session exercises help participants learn the program skills. Home practice assignments aim to reinforce the skills taught in the sessions and help participants learn how to apply these skills to their daily life.

Program Goals

The goals of the Blues Program are:

  • Reduce current depressive symptoms
  • Prevent the onset of future major depressive disorder
  • Potentially reduce or delay the onset of substance use

Essential Components

The essential components of the Blues Program are:

  • Recommended group size of 4-7 adolescents
    • Program based on a cognitive-behavioral theoretical change orientation
    • Core components are training in 2 primary skills to reduce and prevent depression:
      • Behavioral activation:
        • Generating a list of positive activities
        • Contracting to increase activities
      • Cognitive restructuring:
        • Identifying common negative thoughts
        • Developing positive counter-thoughts using 3 techniques
    • Additional skills include goal-setting and stress response planning
    • Motivational enhancement exercises are included in sessions 1, 3, and 5
    • Availability of a detailed manual providing guidance in delivering intervention content
    • Availability of intervention adherence and therapeutic competence tracking forms.

Program Delivery

Child/Adolescent Services

Blues Program directly provides services to children/adolescents and addresses the following:

  • Current depressive symptoms (e.g., low mood, loss of interest in enjoyable activities, negative thoughts, low self-esteem) and prevention of the onset of a depressive disorder

Recommended Intensity:

Weekly 60-minute group sessions

Recommended Duration:

6 weeks

Delivery Setting

This program is typically conducted in a(n):

  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Blues Program includes a homework component:

Group members are given short home practice assignments to complete after each session (e.g., engaging in one or more planned fun activities weekly, tracking mood and negative thoughts to develop positive counter-thoughts, completing a contract to reward self for homework completion).

Languages

Blues Program has materials available in languages other than English:

French, Japanese

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

One or two counselors are needed to conduct the group sessions. It is encouraged that pairs of providers lead a group, but it can be done by a single facilitator if that is not possible. The counselor’s time to learn the intervention is the primary start-up cost, although training provided by the program developers is encouraged.

Staff also spends time recruiting individuals to participate in groups; doing outreach and reminders to make sure participants attend; preparing for sessions; and providing short (15-minute) make-up sessions for individuals who miss groups.

Regarding space requirements, facilitators must have access to a private room large enough to accommodate a group of 5-8 adolescents. Ideally, the group room would contain a large table for participants to write in session and a white/marker board for the group leader to present material.

The developer provides the facilitator intervention manual and participant workbooks at no cost. Local sites will have to cover the costs of duplicating the participant workbook.

Education and Training

Prerequisite/Minimum Provider Qualifications

This intervention is designed to be led by a variety of individuals with varying levels of clinical training, however it is recommended that at least one group leader have a master’s-level degree in a mental-health related degree. The ideal group leader would be familiar with:

  • Cognitive-behavioral methods of preventing and treating depression
  • The effects of depression on youth in U.S. culture
  • Conducting manualized groups
  • Basic therapeutic and empathy skills

Facilitators who do not have the equivalent of master’s-level training in a mental health discipline are strongly encouraged to have support and clinical supervision when delivering the program.

Prior to leading a group, all facilitators should carefully read the manual and practice each activity so they have a clear understanding of the intervention material. Providers should be comfortable managing sessions effectively so that material covered and sessions stay on track. Being able to tactfully interrupt particularly talkative participants to keep the group on track is also an important skill.

Education and Training Resources

There is a manual that describes how to deliver this program, and there is training available for this program.

Rohde, P., Stice, E., & Shaw, H. (2019). The Blues Program: 6-session CB depression prevention intervention group facilitator script. Oregon Research Institute.

Training Contact:
Training is obtained:

Training is recommended but not required to conduct the Blues Program. All outcome data supporting the Blues Program have come from providers who have been trained, supervised, and monitored for adherence and competence.

Initial training consists of an 8-hour training course for providers and supervisors who would be delivering and administering the program. This training is provided by one of the program developers. This training usually occurs in 4-hour blocks of time over 2 consecutive days. The training does have a fee that does not include travel expenses. The training can be conducted using videoconferencing as an option to save on travel costs.

To be certified as a Blues Program provider, the provider must pass an additional training requirement that consists of fidelity and adherence monitoring conducted by the program developers. The trainee audio or video records two full cycles (i.e., two sets of 6-session groups) and sends these recordings to the developer via a secure web method. The program developer reviews and rates the 12 sessions using the program’s adherence and competence forms, sending the trainee a supervision note, and summary scores via email. There is a reviewing charge per tape.

If the provider reaches adequate fidelity scores for all 12 recordings (defined as mean scores of 70 on the intervention adherence forms and 60 on the therapeutic competence forms), they are considered certified as a Blues Program facilitator and eligible to move onto the process of becoming trained to train other providers at their organization via the trainer of trainers (TOTs) model. To become a TOT, the person attends a second training (which has an additional fee associated with it) either in-person or via video conferencing in which they roleplay training and supervising other group leaders.

Number of days/hours:

Initial training: 8 hours (generally over 2 days)

Certification: Whatever amount of time is needed to record 12 or more Blues Program group sessions and upload them onto a secure website so that session recordings can be reviewed and scored for fidelity

TOT training: Generally 8 hours

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Blues Program as listed below:

The Blues Program developers collaborate with the New York Foundling Implementation Support Center, which provides pre-implementation support. Part of that support includes:

  • Determine conjointly whether Blues Program is appropriate to meet the needs of the target population, geographic area, service system mandates, service system mission
  • Identify adjustments to the target population, geographic area, service system, that would be needed to render the Blues Program a good fit
  • Identify adjustments in the implementation of Blues Program that would be needed and consider the extent to which these can be made without risking effectiveness

If you are interested in learning more about the formal support around pre-implementation, please see below. For additional information, please email BluesProgram@nyfoundling.org or call 212-727-6989.

Formal Support for Implementation

There is formal support available for implementation of Blues Program as listed below:

During pre-implementation, New York Foundling staff:

  • Provide potential providers with basic information about the Blues Program.
  • Engage service systems in considering the value of the Blues Program in solving a particular problem or addressing a particular objective critical to the service system.
  • Describe the Blues Program development, training, and quality assurance process - Steps described under Pre-Implementation Assessments above.
  • Determine sources and adequacy of funding to cover the cost of startup and ongoing implementation of Blues Program.
  • Identify service provider organizations that may be well suited to implement the Blues Program.
  • Determine whether to progress to Engagement and Commitment.
  • Cultivate and sustain engagement and commitment by the service system (and relevant collaborating systems) to adopt and implement Blues Program.
  • Enable service systems contemplating the adoption and implementation of Blues Program to understand, and truly endorse its potential value to the system and how to support successful implementation.
  • Establish an implementation workgroup and or program champion from the service system and/or the organization(s) planning to implement the Blues Program.

Fidelity Measures

There are fidelity measures for Blues Program as listed below:

Based on audio or video recordings of group sessions, ratings are made by program developers for treatment adherence and competence, based on developed scales. Protocol adherence is measured using session-specific checklists for the concepts, skills, and exercises that are outlined in the session script. Each item was rated on 100-point scales that cover presentation of key concepts and supporting material for each session component. Facilitator competence is rated using 12 items rated on 100-point scales that assess various general indices of a competent group therapist with behavioral anchors for each item.

The forms can be obtained at the Blues Program support website:https://thebluesprogram.weebly.com/

Established Psychometrics:

Reliability has been established.

  • Stice, E., Rohde, P., Seeley, J. R., & Gau, J. M. (2008). Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: A randomized efficacy trial. Journal of Consulting and Clinical Psychology, 76, 595–606. https://doi.org/10.1037/a0012645
  • Rohde, P., Stice, E., Shaw, H., & Gau, J. M. (2015). Effectiveness trial of an indicated cognitive-behavioral group adolescent depression prevention program versus bibliotherapy and brochure control at 1- and 2-year follow-up. Journal of Consulting and Clinical Psychology, 83, 736–747. https://doi.org/10.1037/ccp0000022

Implementation Guides or Manuals

There are no implementation guides or manuals for Blues Program.

Implementation Cost

There are no studies of the costs of Blues Program.

Research on How to Implement the Program

Research has not been conducted on how to implement Blues Program.

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

A meta-analysis, see citation following, has been conducted on the Blues Program, however, this article is not used for rating and therefore is not summarized:

  • Rohde, P., Brière, F. N., & Stice, E. (2018). Major depression prevention effects for a cognitive-behavioral adolescent indicated prevention group intervention across four trials. Behaviour Research and Therapy, 100, 1-6. https://doi.org/10.1016/j.brat.2017.10.013

The CEBC reviews all of the articles that have been published in peer-reviewed journals as part of the rating process. When there are more than 10 published, peer-reviewed articles, the CEBC identifies the most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The articles chosen for the Blues Program are summarized below:

Stice, E., Burton, E., Bearman, S. K., & Rohde, P. (2007). Randomized trial of a brief depression prevention program: An elusive search for a psychosocial placebo control condition. Behaviour Research and Therapy, 45, 863–876. https://doi.org/10.1016/j.brat.2006.08.008

Type of Study: Randomized controlled trial
Number of Participants: 225

Population:

  • Age — 15–22 years (Mean=18 years)
  • Race/Ethnicity — 55% Caucasians, 15% Hispanics, 17% Asians, 6% African Americans, and 7% Other or Mixed Heritage
  • Gender — 70% Female
  • Status — Participants were high school and college students with elevated depressive symptoms.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compared a brief group cognitive–behavioral depression prevention program [now called Blues Program] to a waitlist control condition and four placebo or alternative interventions. High-risk adolescents with elevated depressive symptoms were randomized to Blues Program, supportive–expressive group intervention, bibliotherapy, expressive writing, journaling, or waitlist conditions and completed assessments at baseline, termination, and 1- and 6-month follow-up. Measures utilized include the Beck Depression Inventory (BDI). Results indicate that all five active interventions showed significantly greater reductions in depressive symptoms at termination than waitlist controls; effects for the Blues Program and bibliotherapy persisted into follow-up. Blues Program, supportive–expressive, and bibliotherapy participants also showed significantly greater decreases in depressive symptoms than expressive writing and journaling participants at certain follow-up points. Limitations include reliance on self-reported measures, small sample sizes, randomization procedures where groups were randomized at different times, , the relatively brief follow-up, and the absence of perceived credibility or fidelity ratings for the interventions.

Length of postintervention follow-up: 6 months.

Stice, E., Rohde, P., Seeley, J. R., & Gau, J. M. (2008). Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: A randomized efficacy trial. Journal of Consulting and Clinical Psychology, 76, 595–606. https://doi.org/10.1037/a0012645

Type of Study: Randomized controlled trial
Number of Participants: 341

Population:

  • Age — 14-19 years (Mean=15.6 years)
  • Race/Ethnicity — 46% Caucasians, 33% Hispanics, 9% African Americans, 2% Asians, and 10% Other or Mixed Heritage
  • Gender — 56% Female
  • Status — Participants were high school students who were at risk-adolescents with elevated depressive symptoms.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the effectiveness of the Blues Program. High-risk adolescents with elevated depressive symptoms were randomized to Blues Program, group supportive–expressive intervention, bibliotherapy, or assessment-only control condition. Measures utilized include the Diagnostic and Statistical Manual of Mental Disorders, the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Beck Depression Inventory (BDI), the Eating Disorder Diagnostic Interview, and the Social Adjustment Scale–Self Report for Youth. Results indicate that Blues Program participants showed significantly greater reductions in depressive symptoms than did supportive–expressive, bibliotherapy, and assessment-only participants at posttest, though only the difference compared with assessment controls was significant at 6-month follow-up. Blues Program participants showed significantly greater improvements in social adjustment and reductions in substance use at posttest and 6-month follow-up than did participants in all 3 other conditions. Supportive–expressive and bibliotherapy participants showed greater reductions in depressive symptoms than did assessment-only controls at certain follow-up assessments but produced no effects for social adjustment and substance use. Blues Program, supportive–expressive, and bibliotherapy participants showed a significantly lower risk for major depression onset over the 6-month follow-up than did assessment-only controls. Limitations include the reliance on self-reported measures; that it was not possible to assess all outcomes that might have been affected by these interventions (e.g., anxiety disorders and social support) due to respondent burden concerns; the inclusion of participants with previous depressive episodes; and a lack of data on potential contamination across conditions.

Length of postintervention follow-up: 6 months.

Stice, E., Rohde, P., Seeley, J. R., & Gau, J. M. (2010). Testing mediators of intervention effects in randomized controlled trials: An evaluation of three depression prevention programs. Journal of Consulting and Clinical Psychology, 78, 273–280. https://doi.org/10.1037/a0018396

Type of Study: Randomized controlled trial
Number of Participants: 341

Population:

  • Age — 14–19 years (Mean=15.6 years)
  • Race/Ethnicity — 46% Caucasians, 33% Hispanics, 9% African Americans, 2% Asians, and 10% Other or Mixed Heritage
  • Gender — 56% Female
  • Status — Participants were at-risk teens with elevated depressive symptoms.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses population from Stice, Presnell, Gau, & Shaw (2007). The purpose of this study was to evaluate a new 5-step method for testing mediators hypothesized to account for the effects of depression prevention programs. At-risk teens with elevated depressive symptoms were randomized to a group cognitive–behavioral (CB) intervention [now called Blues Program], group supportive expressive intervention, CB bibliotherapy, or assessment-only control condition. Measures utilized included the Beck Depression Inventory (BDI), the Automatic Thoughts Questionnaire (ATQ), the Pleasant Events Schedule (PES), and the Loneliness Scale. Results indicate that Blues Program reduced depressive symptoms and negative cognitions and increased pleasant activities. Change in these mediators predicted change in depression, and intervention effects became weaker controlling for change in the mediators; yet, change in depression appeared typically to occur before change in the mediators. The supportive expressive intervention reduced depressive symptoms but affected only 1 of 2 mediators (emotional expression but not loneliness). Change in emotional expression did not correlate with change in depression, and change in depression usually occurred before change in the mediators. Bibliotherapy did not significantly affect depressive symptoms or the ostensive mediators (negative cognitions and pleasant activities), and change in depression usually occurred before change in the mediators. Limitations include the reliance on self-reported measures, nonspecific factors not assessed, and lack of follow-up.

Length of postintervention follow-up: None.

Stice, E., Rohde, P., Gau, J. M., & Wade, E. (2010). Efficacy trial of a brief cognitive-behavioral depression prevention program for high-risk adolescents: Effects at 1- and 2-year follow-up. Journal of Consulting and Clinical Psychology, 78, 856–867. https://doi.org/10.1037/a0020544

Type of Study: Randomized controlled trial
Number of Participants: 341

Population:

  • Age — 14–19 years (Mean=15.6 years)
  • Race/Ethnicity — 46% Caucasians, 33% Hispanics , 9% African Americans, 2% Asians, and 10% Other or Mixed Heritage
  • Gender — 56% Female
  • Status — Participants were at-risk teens with elevated depressive symptoms.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses population from Stice et al. (2008). This study evaluated the effects of a brief group cognitive–behavioral (CB) depression prevention program [now called Blues Program], for high-risk adolescents with elevated depressive symptoms at 1- and 2-year follow-up. At-risk youth were randomized to Blues Program, group supportive expressive intervention, CB bibliotherapy, or educational brochure control condition. Measures utilized included the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV), the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Beck Depression Inventory (BDI), and the Social Adjustment Scale—Self Report for Youth. Results indicate that significantly greater reductions in depressive symptoms were shown by Blues Program participants relative to assessment-only control participants by 1-year follow-up and bibliotherapy participants by 1- and 2-year follow-up but not relative to supportive–expressive participants. Supportive–expressive participants showed greater symptom reduction than Blues Program bibliotherapy participants did at 2-year follow-up. Risk for onset of major or minor depression over the 2-year follow-up was significantly lower for Blues Program participants and CB bibliotherapy participants than for assessment-only controls. Limitations include reliance on self-reported measures; some of the sample did not participate in the final follow-up assessment; did not collect objective measures of social adjustment, such as grades, school attendance, and parental report of functioning in the home, data were not collected on other outcomes that might have been affected by these interventions (e.g., anxiety disorders) because of concerns regarding respondent burden and Blues Program and supportive expressive participants were nested within groups, and this may have contributed to nonindependent data regarding change in the outcomes and increased risk for chance findings.

Length of postintervention follow-up: 1 year and 2 years.

Stice, E., Rohde, P., Gau, J, & Ochner, C. (2011). Relation of depression to perceived social support: Results from a randomized adolescent depression prevention trial. Behaviour Research & Therapy, 49, 361–366. https://doi.org/10.1016/j.brat.2011.02.009

Type of Study: Randomized controlled trial
Number of Participants: 253

Population:

  • Age — 14–19 years (Mean=15.5 years)
  • Race/Ethnicity — 46% Caucasians, 33% Hispanics, 9% African Americans, 2% Asians, and 10% Other or Mixed Heritage
  • Gender — 56% Female
  • Status — Participants were at-risk teens with elevated depressive symptoms.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses the sample from Stice et al. (2008). This study tested whether a cognitive behavioral group intervention [now called Blues Program] that significantly reduced depressive symptoms relative to bibliotherapy and educational brochure control conditions through 2-year follow-up produced improvements in perceived parental and friend social support and whether change in depressive symptoms mediated the effect on change in social support. High-risk adolescents who reported elevated depressive symptoms were randomized to Blues Program, a supportive expressive group intervention, a bibliotherapy condition, or an educational brochure control condition. Measures utilized include the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV); the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS); and the Network of Relationships Inventory. Results indicate that Blues Program participants showed significantly greater increases in perceived friend social support through 1-year follow-up relative to bibliotherapy and brochure controls, but there were no significant effects for perceived parental support. Further, change in depressive symptoms appeared to mediate the effects of the intervention on change in perceived friend support. Limitations include reliance on perceived social support rather than objectively measured social support; a lack of direct measures of negative self-statements, dependency, reassurance seeking, inappropriate/premature disclosure, passivity, or social withdrawal, making it impossible to determine which interpersonal processes affected perceived friend support; the limited assessment of the mediators; and that the Blues Program was relatively brief.

Length of postintervention follow-up: 6 months, 1 year, and 2 years.

Gau, J. M., Stice, E., Rohde, P., & Seeley, J. R. (2012). Negative life events and substance use moderate cognitive-behavioral adolescent depression prevention intervention. Cognitive Behaviour Therapy, 41, 241–250. https://doi.org/10.1080/16506073.2011.649781

Type of Study: Randomized controlled trial
Number of Participants: 173

Population:

  • Age — 14–19 years (Mean=15.5 years)
  • Race/Ethnicity — 42% Caucasians, 35% Hispanics, 10% African Americans, 2% Asians, and 11% Other or Mixed Heritage
  • Gender — 58% Female
  • Status — Participants were at-risk teens with elevated depressive symptoms.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses the sample from Stice et al. (2008). This study tested whether elevated motivation to reduce depression and initial depressive symptom severity amplified the Blues Program effects and whether negative life events, social support deficits, and substance use attenuated Blues Program effects. Participants were randomly assigned to Blues Program, supportive–expressive group, CB bibliotherapy, or an educational brochure control group. The present study included only participants from the Blues Program and educational brochure control groups. Measures utilized include the Center for Epidemiologic Studies-Depression scale, the Beck Depression Inventory (BDI), and the Network of Relationships Inventory and developer created measures. Results indicate that, for adolescents at low and medium levels of substance use or negative life events, the Blues Program intervention produced declines in depressive symptoms relative to controls. However, at high levels of substance use or negative life events, the Blues Program intervention did not significantly reduce depressive symptoms in comparison to controls. Further, the change in depressive symptoms appeared to mediate the effects of the intervention on change in perceived friend support. Limitations include the focus on change in depressive symptoms rather than onset of depressive diagnose, the limited number of potential moderators examined, and with the use of brief self-report scales, some of which were created for this study.

Length of postintervention follow-up: 2 years.

Rohde, P., Stice, E., Gau, J. M., & Seeley, J. R. (2012). Reduced substance use as a secondary benefit of indicated cognitive-behavioral adolescent depression program. Psychology of Addictive Behaviors, 26, 599–608. https://doi.org/10.1037/a0028269

Type of Study: Randomized controlled trial
Number of Participants: 341

Population:

  • Age — 14–19 years (Mean=15.6 years)
  • Race/Ethnicity — 46% Caucasians, 33% Hispanics , 9% African Americans, 2% Asians, and 10% Other or Mixed Heritage
  • Gender — 56% Female
  • Status — Participants were at-risk teens with elevated depressive symptoms.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses population from Stice et al. (2008). This study tested whether a group cognitive– behavioral (CB) depression prevention program [now called Blues Program], reduces substance use escalation over 2-year follow-up relative to two active comparison interventions and a brochure assessment control. The second aim examined whether reductions in depressive symptoms mediate Blues Program effects, as posited by the affect-regulation model of substance use. High school adolescents at risk for depression because of the presence of elevated depressive symptoms were randomized to a Blues Program, group supportive expressive group intervention, CB bibliotherapy, or educational brochure control condition. Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) and developer created measures. Results indicate that participants in Blues Program had significantly lower rates of substance use compared with brochure control participants at both 1- and 2-year follow-up and lower substance use at 2-year follow-up relative to bibliotherapy participants; no other condition differences were significant. Results also suggested that reductions in depressive symptoms from baseline to posttest accounted for changes in substance use over 2 years for participants in Blues Program relative to brochure control participants but did not mediate effects relative to those receiving bibliotherapy. Limitations include substance use was assessed with a brief survey that primarily focused on use in the previous 30 days and no data were obtained regarding lifetime substance use or the symptoms of substance abuse or dependence; examined only one potential mediator; based on the affect-regulation model and additional mediators should be examined; and attrition rate by 2-year follow-up may have impacted findings.

Length of postintervention follow-up: 2 years.

Rohde, P., Stice, E., & Gau, J. M. (2012). Effects of three depression prevention interventions on risk for depressive disorder onset in the context of depression risk factors. Prevention Science, 13, 584–593. https://doi.org/10.1007/s11121-012-0284-3

Type of Study: Randomized controlled trial
Number of Participants: 341

Population:

  • Age — 14–19 years (Mean=15.6 years)
  • Race/Ethnicity — 46% Caucasians, 33% Hispanics , 9% African Americans, 2% Asians, and 10% Other or Mixed Heritage
  • Gender — 56% Female
  • Status — Participants were at-risk teens with elevated depressive symptoms.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses population from Stice et al. (2008). This study aims to identify subgroups of adolescents with elevated depressive symptoms who had the highest likelihood of developing future major/minor depressive disorder on the basis of depression risk factors and participation in three depression prevention programs, with the goal of evaluating the preventive effect of indicated prevention interventions in the context of known risk factors. Participants were randomly assigned using computer generated random numbers to: (1) Blues Program, (2) group supportive–expressive, (3) CB bibliotherapy, or (4) brochure control. Measures utilized include the Center for Epidemiologic Studies-Depression (CES-D) scale, the Beck Hopelessness Scale (BHS), the Automatic Thoughts Questionnaire (ATQ), the Adolescent Cognitive Style Questionnaire (ACSQ), the Rosenberg Self-Esteem scale, the Network of Relationships Inventory, the Loneliness Scale, the Social Adjustment Scale-Self Report for Youth, and the Major Life Events Scale. Results indicate that, by 2-year follow-up, 14% showed onset of major or minor depressive disorders. Results also revealed that negative attributional style was the most important risk factor: Youth with high scores showed a 4-fold increase in depression onset compared to youth who did not endorse this attributional style. For adolescents with negative attributional style, prevention condition emerged as the most important predictor: Those receiving bibliotherapy showed a 5-fold reduction in depression disorder onset relative to adolescents in the three other intervention conditions. For adolescents who reported low negative attributional style scores, elevated levels of depressive symptoms at baseline emerged as the most potent predictor. Limitations include the small sample size, only 46 participants showed onset of depressive disorder during the follow-up, some of the CTA nodes contained only a small number of cases, and several risk factors were not assessed because of respondent burden concerns.

Length of postintervention follow-up: 2 years.

Brière, F. N., Rohde, P., Shaw, H., & Stice, E. (2014). Moderators of two indicated cognitive-behavioral depression prevention approaches for adolescents in a school-based effectiveness trial. Behaviour Research and Therapy, 53, 55–62. https://doi.org/10.1016/j.brat.2013.12.005

Type of Study: Randomized controlled trial
Number of Participants: 378

Population:

  • Age — 13–19 years (Mean=15.5 years)
  • Race/Ethnicity — 72% Caucasians, 6% Hispanics , 1% African Americans, 2% Asians, 1% Native American, and 18% Other or Mixed Heritage
  • Gender — 68% Female
  • Status — Participants were adolescents with elevated depressive symptoms.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The aim of this study was to identify moderators of the effects of a cognitive behavioral group-based prevention program (CB group) [now called Blues Program] and CB bibliotherapy, relative to an educational brochure control condition and to one another, in a school-based effectiveness randomized controlled prevention trial. Participants were randomly assigned within blocks created by gender and school in one of three conditions: (1) Blues Program, (2) CB bibliotherapy, or (3) educational brochure control. Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Adolescent Cognitive Style Questionnaire (ACSQ), and the Network of Relationships Inventory (NRI). Results indicate that baseline depressive symptoms interacted with condition and time. Analysis indicated that elevated baseline depressive symptoms amplified the effect of CB bibliotherapy at posttest (but not 6-month follow-up) relative to the control condition, but did not modify the effect of Blues Program relative to the control condition or relative to bibliotherapy. Specifically, CB bibliotherapy resulted in lower posttest depressive symptoms than the control condition in individuals with elevated, but not average or low baseline symptoms. Limitations include the focus on depressive symptoms reductions as opposed to onset of major depression; the reliance on self-reported measures; did not have enough minority participants to examine whether race or ethnicity moderated intervention effects; and conducted multiple moderation tests, which raises the possibility that some of the findings were due to chance.

Length of postintervention follow-up: 6 months.

Rohde, P., Stice, E., Shaw, H., & Brière, F. (2014). Indicated cognitive–behavioral depression prevention compared to bibliotherapy and brochure control: Acute effects of an effectiveness trial with adolescents. Journal of Consulting and Clinical Psychology, 82, 65–74. https://doi.org//10.1037/a0034640

Type of Study: Randomized controlled trial
Number of Participants: 378

Population:

  • Age — 13–19 years (Mean=15.5 years)
  • Race/Ethnicity — 72% Caucasians, 6% Hispanics , 1% African Americans, 2% Asians, 1% Native American, and 18% Other or Mixed Heritage
  • Gender — 68% Female
  • Status — Participants were adolescents with elevated depressive symptoms.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses population from Brière et al. (2014). This study tested whether a brief cognitive behavioral (CB) group [now called Blues Program] and bibliotherapy prevention reduce major depressive disorder (MDD) onset, depressive symptoms, and secondary outcomes relative to brochure controls in adolescents with self-reported depressive symptoms when school personnel recruit participants and deliver the intervention. Participants were randomly assigned within blocks created by gender and school in one of three conditions: (1) Blues Program, (2) CB bibliotherapy, or (3) educational brochure control. Measures utilized include the Center for Epidemiologic Studies—Depression Scale, the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Social Adjustment Scale—Self-Report for Youth, and developer created measures. Results indicate Blues Program participants showed a significantly lower risk for major depressive disorder onset, compared to both CB bibliotherapy and brochure control. Results also indicated that Blues Program resulted in lower depressive symptom severity than brochure control at posttest but not 6-month follow-up; differences between Blues Program and bibliotherapy were nonsignificant at posttest and 6-month follow-up. Condition effects were nonsignificant for social adjustment and substance use. Limitations include the reliance on self-reported measures; not enough minority participants to examine whether race or ethnicity moderated intervention effects; the CES-D response format was modified and appears to have selected a less depressed sample; possible lack of generalizability based upon ethnicity; and high attrition rate.

Length of postintervention follow-up: 6 months.

Rohde, P., Stice, E., Shaw, H., & Gau, J. M. (2015). Effectiveness trial of an indicated cognitive-behavioral group adolescent depression prevention program versus bibliotherapy and brochure control at 1- and 2-year follow-up. Journal of Consulting and Clinical Psychology, 83, 736–747. https://doi.org/10.1037/ccp0000022

Type of Study: Randomized controlled trial
Number of Participants: 378

Population:

  • Age — 13–19 years (Mean=15.5 years)
  • Race/Ethnicity — 72% Caucasians, 6% Hispanics , 1% African Americans, 2% Asians, 1% Native American, and 18% Other or Mixed Heritage
  • Gender — 68% Female
  • Status — Participants were adolescents with elevated depressive symptoms.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses population from Brière et al. (2014). The purpose of this study was to evaluate the long-term effects of Blues Program through 2-year follow-up, relative to CB bibliotherapy and brochure control, when high school personnel recruited students and delivered the program. Participants were randomly assigned within blocks created by gender and school in one of three conditions: (1) Blues Program, (2) CB bibliotherapy, or (3) educational brochure control. Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) and the Social Adjustment Scale-Self Report for Youth. Results indicated that by 2 years postintervention, Blues Program participants showed significantly lower major depressive disorder (MDD) onset versus CB bibliotherapy, but the incidence difference relative to brochure controls was nonsignificant; MDD incidence for bibliotherapy and brochure controls did not differ. Although Blues Program participants showed lower depressive symptoms at posttest versus brochure controls, there were no effects for this outcome or for social adjustment or substance use over 2-year follow-up. Results also suggested that participants with higher baseline depressive symptoms showed greater long-term symptom reductions in the Blues Program intervention versus bibliotherapy. Limitations include the reliance on self-reported measures, attrition was associated with higher initial substance use, did not measure other variables and possible lack of generalizability based upon ethnicity.

Length of postintervention follow-up: 6, 12, 18, and 24 months.

Müller, S., Rohde, P., Gau, J. M., & Stice, E. (2015). Moderators of the effects of indicated group and bibliotherapy cognitive behavioral depression prevention programs on adolescents’ depressive symptoms reductions and depressive disorder onset. Behaviour Research and Therapy, 75, 1–10. https://doi.org/10.1016/j.brat.2015.10.002

Type of Study: Randomized controlled trial
Number of Participants: 631

Population:

  • Age — 13–19 years (Mean =15.5 years)
  • Race/Ethnicity — 61% Caucasians, 6% Hispanics , 1% African Americans, 2% Asians, 1% Native American, and 18% Other or Mixed Heritage
  • Gender — 68% Female
  • Status — Participants were adolescents with elevated depressive symptoms.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilizes population from Stice et al. (2008) and Rohde et al. (2014). The purpose of this study was to evaluate the moderating effects of individual, demographic, and environmental factors on depressive symptom reductions and major depressive disorder (MDD) onset over 2-year follow-up. Participants were randomly assigned within blocks created by sex and school to one of the conditions: (1) Blues Program, (2) CB bibliotherapy, or (3) educational brochure control. 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 Adolescent Cognitive Style Questionnaire (ACSQ), the Network of Relationships Inventory, and developer created measures. Results indicated that Blues Program and bibliotherapy participants had lower depressive symptoms than controls at posttest but these effects did not persist. No MDD prevention effects were present in the merged data. Relative to controls, elevated depressive symptoms and motivation to reduce depression amplified posttest depressive symptom reduction for Blues Program, and elevated baseline symptoms amplified posttest symptom reduction effects of CB bibliotherapy. Conversely, elevated substance use mitigated the effectiveness of Blues Program relative to controls on MDD onset over follow-up. Limitations include the reliance on self-reported measures; merged data from two trials that used slightly different approaches to recruitment and facilitation; CB bibliotherapy engagement in trial 1 was higher; and pretest substance use was associated with greater attrition over 2-year follow-up.

Length of postintervention follow-up: 6, 12, 18, and 24 months.

Brière, F. N., Rohde, P., Stice, E., & Morizot, J. (2016). Group-based symptom trajectories in indicated prevention of adolescent depression. Depression and Anxiety, 33, 444–451. https://doi.org/10.1002/da.22440

Type of Study: Randomized controlled trial
Number of Participants: 631

Population:

  • Age — 13–19 years (Mean =15.5 years)
  • Race/Ethnicity — 61% Caucasians, 6% Hispanics , 1% African Americans, 2% Asians, 1% Native American, and 18% Other or Mixed Heritage
  • Gender — 68% Female
  • Status — Participants were adolescents with elevated depressive symptoms.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses population from Stice et al. (2008) and Rohde et al. (2014). This study empirically identify subgroups with distinct trajectories of depressive symptom change among adolescents enrolled in two indicated depression prevention trials and examine how cognitive-behavioral (CB) interventions and baseline predictors relate to trajectory membership. Participants were randomly assigned within blocks created by sex and school to one of the conditions: (1) Blues Program, (2) CB bibliotherapy, or (3) educational brochure control. Measures utilized include the Center for Epidemiologic Studies–Depression (CES-D), the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), and the Adolescent Cognitive Style Questionnaire. Results indicated that participants in the brochure control condition were significantly more likely to populate the high-persistent trajectory relative to either Blues Program and were significantly less likely to populate the low-declining trajectory relative to Blues Program. Several baseline factors predicted trajectory classes, but gender was the most informative prognostic factor, with males having increased odds of membership in a high-persistent trajectory relative to other trajectories. Limitations include the reliance on self-reported measures and merged samples from two RCTs with different inclusion criteria.

Length of postintervention follow-up: 6, 12, 18, and 24 months.

Additional References

No reference materials are currently available for Blues Program.

Contact Information

Paul Rohde, PhD
Agency/Affiliation: Oregon Research Institute
Website: thebluesprogram.weebly.com
Email:
Phone: (541) 484-2123 x2120

Date Research Evidence Last Reviewed by CEBC: January 2020

Date Program Content Last Reviewed by Program Staff: July 2020

Date Program Originally Loaded onto CEBC: July 2020