Depression Outcomes Associated With an Intervention Implemented in Employment Training Programs for Low-Income Adolescents and Young Adults

Abstract

IMPORTANCE Recent estimates indicate that 6.5 million adolescents and young adults in the United States are neither in school nor working. These youth have significant mental health concerns that require intervention. OBJECTIVE To determine whether a mental health intervention, integrated into an employment training program that serves adolescents and young adults disconnected from school and work, can reduce depressive symptoms and improve engaged coping strategies. DESIGN, SETTING, AND PARTICIPANTS A quasi-experimental study was conducted; 512 adolescents and young adults newly enrolling in one employment training program site were intervention participants, while 270 youth from a second program site were enrolled as controls. Participants were aged 16 to 23 years and not in foster care. Study recruitment took place from September 1, 2008, to May 31, 2011, with follow-up data collection occurring for 12 months after recruitment. Propensity score matching adjusted for observed baseline differences between the intervention and control groups. MAIN OUTCOMES AND MEASURES Depressive symptoms measured on a Center for Epidemiologic Studies Depression Scale (CES-D) and engaged coping strategies. RESULTS The mean age of participants was 19 years, 93.7% were African American, and 49.4% were male. Six-and 12-month follow-up rates were 61.0% (n = 477) and 56.8% (n = 444), respectively. Males in the intervention group with high baseline depressive symptoms exhibited a statistically significant decrease in depressive symptoms at 12 months (5.64-point reduction in CES-D score; 95% CI,-10.30 to-0.96; P = .02) compared with similar males in the control group. A dosage effect was observed at 12 months after the intervention, whereby males with greater intervention exposure showed greater improvement in depressive symptoms compared with similar males with lower intervention doses (effect on mean change in CES-D score, −3.37; 95% CI,-6.72 to-0.09; P = .049). Males and females in the intervention group were more likely than participants in the control group to increase their engaged coping skills, with statistically significant differences found for males (effect on mean change in CES-D score, 0.32; 95% CI, 0.14-0.50; P = .001) and females (effect on mean change in CES-D score, 0.19; 95% CI, 0.01-0.37; P = .047) at 12 months. CONCLUSIONS AND RELEVANCE Given the growing number of adolescents and young adults using employment training programs and the mental health needs of this population, increased efforts should be made to deliver mental health interventions in these settings that usually focus primarily on academic and job skills. Ways to extend the effect of intervention for females and those with lower levels of depressive symptoms should be explored.

Moderators of the effects of indicated group and bibliotherapy cognitive behavioral depression prevention programs on adolescents' depressive symptoms and depressive disorder onset

“…Nonetheless, the novel moderation effect of motivation to reduce depression is consistent with prior research on patients’ response to CB treatment (Keijsers et al, 1999) and the moderation effect of substance use on MDD onset was medium in magnitude, which increase confidence in these results. Our finding that higher baseline depressive symptoms amplify the intervention effects has previously emerged in multiple trials (e.g., Jaycox et al, 1994; Spence et al, 2003; Tandon et al, 2015), thus providing greater confidence in its reliability.…”

“…Meta-analyses indicate that programs targeting participants with high initial symptoms typically produce stronger depressive symptom reductions than universal programs (Horowitz & Garber, 2006; Stice et al, 2009). Individual trials have also found that symptom reductions in prevention trials are stronger for participants with high versus low baseline symptoms (e.g., Jaycox, Reivich, Gillham, & Seligman, 1994; Spence, Sheffield, & Donovan, 2003; Tandon et al, 2015; Wilksch & Wade, 2014). Theoretically, those with elevated symptoms have greater potential to show symptom reductions.…”

Committed to work but vulnerable: self‐perceptions and mental health in NEET 18‐year olds from a contemporary British cohort

“…More young people should be trained in professional/technical and ‘soft’ skills, which may also enhance optimism. Second, reducing NEET youths’ depression, anxiety and substance abuse problems by providing them with mental health services may enable them to more effectively cope with challenges, develop confidence in their abilities, and take better advantage of training and back‐to‐work opportunities (Cook, ; Tandon et al., ). Third, it will be critical to identify and provide enhanced educational guidance to young adolescents (i.e.…”

Psychotherapeutic and vocational interventions among young adults with work disability due to mental disorders in Finland

“…Current practice guidelines recommend psychotherapeutic interventions in the treatment of mild to moderate depression, bipolar disorder and alsoas regards cognitive behavioural psychotherapy (CBT) -in the treatment of psychotic disorders and schizophrenia [10]. Several types of vocational interventions have also been developed to prepare young adults with mental disorders for competitive employment, and earlier research has recommended integrating vocational interventions into clinical treatment to facilitate return to work [12,17,18,19]. The participation rates in both implemented and planned interventions seem low, considering that the young adults in the studied group were granted a fixed-term work disability pension that aimed at return to work or education after rehabilitation.…”

“…Also, the integration of vocational services may be beneficial for psychiatric treatment results [17]. A major problem may be related to poor integration between interventions and clinical care.…”