Washington State Institute for Public Policy
Blues Program (group CBT prevention program for high school students at risk for depression)
Children's Mental Health: Depression
Benefit-cost estimates updated December 2016.  Literature review updated May 2015.
This prevention program targets high school and college students with depressive symptoms who do not have major depression. The program consists of six weekly one-hour group sessions and home practice assignments. Sessions focus on engaging in pleasant activities, cognitive restructuring techniques, and response plans for future life stressors.
BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2015). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $11 Benefits minus costs ($141)
Participants $3 Benefit to cost ratio ($0.23)
Others $10 Chance the program will produce
Indirect ($51) benefits greater than the costs 41 %
Total benefits ($26)
Net program cost ($115)
Benefits minus cost ($141)
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
K-12 grade repetition $3 $0 $0 $1 $4
Labor market earnings associated with major depression $4 $8 $0 $2 $14
Health care associated with major depression $10 $3 $13 $5 $32
Costs of higher education ($5) ($8) ($3) ($3) ($19)
Adjustment for deadweight cost of program $0 $0 $0 ($57) ($57)
Totals $11 $3 $10 ($51) ($26)
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $114 2014 Present value of net program costs (in 2015 dollars) ($115)
Comparison costs $0 2014 Cost range (+ or -) 10 %
The Blues Program typically consists of six 1-hour group sessions. In the studies we reviewed, there was an average of 6.85 students per group with an average of 73 students served by each teaching team. The program was team-taught by either a graduate student and undergraduate assistant or two school personnel (typically a school counselor or school nurse). We used the average salary and benefits for a certified school counselor and certified school nurse in the 2014-2015 school year (http://www.k12.wa.us/safs/PUB/PER/1415/ps.asp) as the cost for staff time. Program leaders received an average of ten hours of training.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Major depressive disorder 4 292 -0.201 0.125 18 0.000 0.019 19 -0.313 0.015
Citations Used in the Meta-Analysis

Rohde, P., Stice, E., Shaw, H., & Gau, J.M. (2014). Cognitive-behavioral group depression prevention compared to bibliotherapy and brochure control: nonsignificant effects in pilot effectiveness trial with college students. Behaviour Research and Therapy, 55, 48-53.

Rohde, P., Stice, E., Shaw, H., & Gau, J.M. (2014). Effectiveness trial of an indicated cognitive-behavioral group adolescent depression prevention program versus bibliotherapy and brochure control at 1- and 2-year follow-up. Unpublished Manuscript.

Stice, E., Burton, E., Bearman, S.K., & Rohde, P. (2006). Randomized trial of a brief depression prevention program: An elusive search for a psychosocial placebo control condition. Behaviour Research and Therapy, 45(5), 863-876.

Stice, E., Rohde, P., Gau, J.M., & Wade, E. (2010). Efficacy trial of a brief cognitive-behavioral depression prevention program for high-risk adolescents: effects at 1- and 2-year follow-up. Journal of Consulting and Clinical Psychology, 78(6), 856-67.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov