OBJECTIVE Depression represents a major public health concern, and prevalence increases significantly during adolescence. The high school transition may exacerbate the risk of depression for youth with pre-existing vulnerability. The High School Transition Program (HSTP) is a brief, skills-based intervention that has demonstrated efficacy in preventing depression in adolescents. The current study aimed to evaluate the theorized mechanisms of change of the HSTP intervention by testing a multiple mediation model including school attachment (SA) and self-esteem (SE) as two mediators of treatment outcomes. METHOD Students (N= 497; 61.5% girls) with elevated depressive symptoms, identified for the intervention program via an eighth-grade screening, were randomized to a brief intervention (n = 247) or the HSTP (n = 233) from 2003 to 2008. Participants completed measures at five time points. The first assessment occurred at the start of the second semester of eighth grade and the last assessment occurred at the end of ninth grade. A multiple mediation model tested whether SA and SE contributed to changes in depression for youth in the HSTP. RESULTS The mediation model, including contemporaneously assessed SE and SA, was not supported. There was evidence of sequential mediation, such that students who participated in the HSTP intervention reported higher SA, which in turn predicted improved SE, and in turn contributed to amelioration of depressive symptoms. CONCLUSION The HSTP intervention ameliorated depressive symptoms by targeting factors specific to the school transition (ie, SA). Results suggest youth at risk for depression may benefit from prevention efforts that enhance students' capacity to effectively manage identified environmental stressors, such as school transitions. CLINICAL TRIAL REGISTRATION INFORMATION Middle School to High School Transition Project: Depression and Substance Abuse Prevention; https://clinicaltrials.gov/; NCT00071513.

中文翻译：

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预防抑郁症的变化机制：向高中过渡的基于学校的预防试验。

目的 抑郁症是一个主要的公共卫生问题，其患病率在青春期显着增加。高中过渡可能会加剧本来就存在脆弱性的青少年患抑郁症的风险。高中过渡计划 (HSTP) 是一项简短的、基于技能的干预措施，已证明可以有效预防青少年抑郁症。本研究旨在通过测试多重中介模型（包括学校依恋（SA）和自尊（SE）作为治疗结果的两个中介变量）来评估 HSTP 干预变化的理论机制。方法 抑郁症状加重的学生（N = 497；61.5% 是女孩），通过八年级筛选确定参加干预计划，从 2003 年到2008 年。参与者在五个时间点完成了测量。第一次评估发生在八年级第二学期开始时，最后一次评估发生在九年级末。多重中介模型测试了 SA 和 SE 是否会导致 HSTP 中青少年抑郁症的变化。结果 不支持中介模型，包括同时评估的 SE 和 SA。有顺序中介的证据，例如参与 HSTP 干预的学生报告了较高的 SA，这反过来又预测 SE 的改善，进而有助于抑郁症状的改善。结论 HSTP 干预通过针对学校过渡（即 SA）的特定因素来改善抑郁症状。结果表明，有抑郁风险的青少年可能会受益于预防工作，这些预防工作可以提高学生有效管理已识别的环境压力因素（例如学校过渡）的能力。临床试验注册信息 初中到高中过渡项目：抑郁症和药物滥用预防；https://clinicaltrials.gov/；NCT00071513。