Effects of Preference on Outcomes of Preventive Interventions among Ethnically Diverse Adolescents At-Risk of Depression

Abstract

Patient-centered care includes efforts to align treatment with patient preferences to improve outcomes and has not been studied in adolescent depression prevention. Within a school-based randomized trial, we examined the effects of offering a preference between two evidence-based preventive interventions for youth at risk of depression, Learning to BREATHE (L2B) and Interpersonal Therapy–Adolescent Skills Training. We examined the effects of 3 preference factors (assignment condition [preference vs. random], receipt of preferred program, and baseline program preference) on outcomes in a diverse sample of 111 adolescents (M age = 15.18 years, SD = .86): 81 (73%) girls, 45 (41%) White, 40 (36%) Asian American, 8 (7%) Latinx, 1 (1%) African American, and 17 (15%) multiracial or other race/ethnicity. Findings revealed little evidence that receiving a preferred intervention or being given a choice of interventions was linked to greater improvement or initial engagement. Further, analyses did not indicate that adolescents with baseline indications for a specific intervention would benefit more from that intervention; rather, adolescents with generally lower baseline functioning improved more regardless of the intervention received. However, receipt of L2B and a baseline preference for L2B were associated with greater improvements in about half of the outcomes examined, with effect sizes ranging from R² = 0.04 to 0.14. There was little support for the need to match interventions to adolescent preferences in school-based prevention efforts. Rather, the more scalable mindfulness-based intervention had stronger effects than the interpersonal intervention and may hold promise for diverse adolescents.

Acknowledgments

This trial could not have been conducted without the significant support of Huntington Beach Unified School District led by Doug Siembieda, with key front line contributions by interventionists at Fountain Valley High School and Huntington Beach High School: Tiffany Do, Rose Haunreiter, Kayle Latham, Connie Maddox, Cynthia Olaya, Michael Olson, Michelle Pendergast, and Sarah Verdugo. Important contributions to training and supervision were made by Gabrielle Anderson, Patricia Broderick, and Jami Young.

Additional information

Funding

This research was supported by the UCLA Asian American Studies Center, the Peabody College of Education and Human Development (PIF Fund 6402), and in-kind contributions of personnel time from the Huntington Beach Union High School District.