A Cognitive-Behavioral Treatment for Depression in Native American Middle-School Students

Depression and suicide are serious conditions among Native American adolescents. Despite the need for effective treatment approaches in this population, there continues to be a dearth of empirical research in this area. Intervention studies examining Native American adults at risk for depression and Native American youth at risk for suicide have found effectiveness utilizing group skill-based interventions. Group cognitive-behavioral therapy has demonstrated effectiveness among Caucasian adolescents; however, its effectiveness has never been examined with Native American youth experiencing depressive symptoms. The current study modified, implemented, and evaluated a cognitive-behavioral intervention for depression among Native American middle-school students. A modification of the Coping With Depression-Adolescent (CWD-A) course (Clarke, Lewinsohn, & Hops, 1990) for middle school students (Kahn, Kehle, Jenson, & Clark, 1990) was administered to a small group of students in a Midwestern reservation school, identified as having moderate to severe depressive symptoms based on the Children\u27s Depression Inventory. The class was also modified for cultural relevance and sensitivity and school scheduling. Nineteen of 36 eligible students participated and were assigned to the intervention (n = 10) or wait-list control group (n = 9), using a randomized block design. At pre-intervention, post-intervention, and 3-month follow-up students\u27 depressive and anxiety symptoms were measured. At post-intervention, intervention group students were interviewed to determine class acceptability and the usefulness of class materials. Findings indicated students in both groups had decreased depressive symptoms across the intervention period, with intervention group students having a faster decrease in interpersonal problems. Students in both groups had decreased anxiety symptoms from pre-to post-intervention; however, only intervention group students continued to have lower anxiety at follow-up. Both groups of students had lower school absence rates while attending the class and intervention group students were more likely to remain in the school district throughout the year. Students’ reports indicated that most students enjoyed the class and would take the class again. Students also reported the class helped improve their mood. Additionally, students in both groups decreased their depressive symptoms faster than other students in the school with depressive symptoms who did not participate in the class evaluation