Longterm Treatment Effects on Juvenile Justice Girls' Depression and Suicide Risk

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DESCRIPTION (provided by applicant): The aims of the proposed project address gaps in the evidence base concerning interventions with girls in the juvenile justice system (JJS). All aims focus on the extent to which a delinquency-focused intervention disrupts depressive symptoms and suicide risk trajectories in young adulthood for these high-risk females. Participants are 164 women who were involved in the JJS as adolescents. The women initially participated at ages 13-17 in a randomized controlled trial to test the effectiveness of Multidimensional Treatment Foster Care (MTFC, Chamberlain, 2003) versus treatment as usual (TAU) at reducing delinquency and drug abuse. Delinquency, depressive symptoms, and suicidal thoughts were measured four times across the original 2-year follow-up period. A study is currently underway (R01 DA024672: February 2009-December 2012) in which in- person and telephone assessments of these women will be conducted across multiple 6-month intervals in young adulthood (18-28 years). The aims of this R01, however, do not address the course of depressive symptoms or suicide risk among these high-risk women. In the present application, we capitalize on rich existing longitudinal data and the active assessment phase in the R01 study to propose a new focus on the effects of MTFC on these problems. Specifically, we propose to 1) conduct a lifetime assessment of the number and timing of suicide attempts; and 2) augment R01 assessments planned at 6-month intervals to include self-reported suicidal thoughts and behaviors. Two of these assessments will occur prior to the proposed study, and will be supported with limited internal resources; we request funding for three additional measurement occasions (at 6-month intervals), for a total of five assessments in young adulthood. Using existing and proposed data collection, we will pursue three aims that estimate MTFC effects on depressive symptoms and suicide risk in young adulthood, and specify three key mechanisms of indirect effects. In Aim 1, we will use latent growth modeling to characterize the course of depressive symptoms across 9 time points in adolescence and young adulthood, and then to test intervention effects; girls randomly assigned to MTFC are expected to show decreases in depressive symptoms over time relative to girls assigned to TAU. Aim 2 tests whether changes in three domains already demonstrated to be impacted by MTFC (Chamberlain et al., 2007; Leve et al., 2007) mediate effects of the intervention on changes in depressive symptoms; specifically, MTFC is expected to reduce depressive symptoms through early adulthood via decreased delinquency and teenage pregnancy/child-bearing, and educational attainment. Aim 3 tests the effects of MTFC on suicide attempts and whether such effects are mediated by intervention-related reductions in delinquency and depressive symptoms. Findings will suggest directions for development and augmentation of interventions for JJS girls. Thus, the proposed study answers calls for innovative approaches to reaching high risk youth who do not benefit from existing depression prevention paradigms (Avenevoli et al., 2006). PUBLIC HEALTH RELEVANCE: Adolescent girls with serious conduct problems are at high risk for depression and suicide. Yet, effective treatments for these problems in this group are lacking. We examine whether a delinquency-focused intervention for girls in the juvenile justice system will reduce depressive symptoms and rates of suicide attempt into young adulthood via changes in delinquency, teen pregnancy rates, and educational attainment.