Depression prevention program shows unequal effectiveness among youth

A depression prevention program that has helped white youth wasn't effective for Black youth, raising concerns about the need for more research to help racially diverse groups, according to new research published by the American Psychological Association. 

"I was very surprised that we couldn't help Black youth as much as white youth, and we don't know why there was such a profound difference in the outcomes." said lead researcher Patrick Pössel, Dr. rer. soc., a professor of counseling psychology at the University of Louisville.

Pössel and some colleagues in Germany developed the LARS&LISA depression prevention program about 25 years ago, which was implemented successfully in schools in Germany and later in Tennessee.

The current study, published online in the Journal of Consulting and Clinical Psychology, included 425 freshman students (57% Black, 43% white) in a Louisville, Kentucky, high school serving primarily low-income students. Half of the students were in a control group while the other half participated in the 10-week LARS&LISA program.

The LARS&LISA program, which includes vignettes with two characters named Lars and Lisa, uses group sessions designed to build motivation through personal goal setting followed by aspects of cognitive behavioral therapy. Students are encouraged to recognize unhelpful thoughts and replace them with more helpful thoughts. In addition, they learn about the pros and cons of assertive, aggressive, passive-aggressive and withdrawing behaviors. They also practice the skills needed to form new social networks.

The students completed questionnaires about depressive symptoms before and after the LARS&LISA program and in a follow-up survey four months later. White youth who participated in the program reported significantly fewer depressive symptoms after completing the program and at the follow-up period. However, Black youth in the program didn't differ from the control group, with no significant benefits found after completing the program or at the follow-up period.

The study couldn't determine why the program was unsuccessful for Black youth so more research is needed, not only on that issue but to identify whether other depression treatment programs or models may experience the same shortcomings, Pössel said.

Psychological theories and treatment programs are largely developed based on white, middle-class, female American clients or college students in psychology courses. We need to take a step back and examine the consequences of these limitations. It's essential to be attentive to cultural and racial differences and not assume there's a one-size-fits-all approach."

Patrick Pössel, lead researcher

Other researchers found similar concerns with another youth depression prevention program that is based on cognitive behavioral therapy techniques. That study found the Penn Resiliency Program helped white and Latino youth but showed no significant effects on the depressive symptoms for Black youth. Other studies have found that Black youth's experiences with racism may put them at higher risk of depression, anxiety and suicide. 

In the current study, the participants were from one high school in Louisville, Kentucky, who participated in the LARS&LISA program so the findings may not be generalizable across the United States or to other youth depression prevention programs. Only students who identified as white or Black were included in the analysis so there were no findings for other racial groups.