A randomized controlled trial of a preventive intervention for the children of parents with depression: mid-term effects, mediators and moderators

Abstract

Abstract Background In a parallel randomized controlled trial the effectiveness of the family- and group-based cognitive-behavioural “Gug-Auf” intervention in preventing depression in children of depressed parents was evaluated. We hypothesized that the intervention would be associated with reduced incidence of depression at 15 months as well as with reduced symptom severity at 6, 12, and 15 months. We also made predictions about the role of a number of mediators and moderators. Methods Families were included if a parent (n = 100, mean age = 46.06, 61% female) had experienced depression and children (n = 135, aged 8–17 years, 53% female) without a mental illness. Families (91.5% German) were randomly allocated (50:50 block-wise; stratified by child age and parental depression) to the 12-session “GuG-Auf” intervention or no intervention. Outcomes were assessed (on an intention-to-treat basis) at 0-(T1), 6-(T2), 12-(T3) and 15-months(T4) after baseline. Primary outcome (onset of depression; T4) was assessed with standardized (blinded) clinical interviews. Secondary (unblinded) outcome was risk of depression (at T2-T4) indicated by internalizing, externalizing and symptoms of depression. Potential mediators were emotion regulation, attributional style, knowledge of depression and parenting style. Potential moderators were parental depression severity and negative life events. Analyses were conducted on an intention-to-treat basis. Results None of the children who received the intervention developed depression, whereas two of those in the control group did. The intervention significantly reduced internalizing symptoms at T3 (p = .027, d = -0.45) and T4 (p = .035, d=-0.44). Both groups showed reduced depressive symptoms (p = .029, d = -0.44). Cognitive problem-solving and negative parenting emerged as mediators. No adverse events were observed. Conclusions GuG-Auf is effective in reducing children’s risk of depression. Despite some limitations in the generalizability, these findings contribute substantially to reducing the burden of youth depression. Registration: The trial was registered on 16/04/2014 at ClinicalTrials.gov (NCT02115880) and study protocol published in BMC Psychiatry (https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-014-0263-2).