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Washington State Institute for Public Policy
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Blues Program (prevention program for students at risk for depression)

Children's Mental Health: Depression
Benefit-cost methods last updated December 2024.  Literature review updated May 2018.
The Blues Program is a prevention program targeting 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 homework practice assignments. Sessions focus on engaging in pleasant activities, cognitive restructuring techniques, and response plans for future life stressors. In one study, school counselors and nurses delivered the intervention. All interventions took place in a school setting. 
 
ALL
BENEFIT-COST
META-ANALYSIS
CITATIONS
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2023).  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 $7 Benefits minus costs ($405)
Participants $2 Benefit to cost ratio ($0.44)
Others $5 Chance the program will produce
Indirect ($137) benefits greater than the costs 48%
Total benefits ($123)
Net program cost ($282)
Benefits minus cost ($405)

^WSIPP’s benefit-cost model does not monetize this outcome.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on 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. See Estimating Program Effects Using Effect Sizes for additional information on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change 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. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age No. of effect sizes Treatment N 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
Clinical diagnosis of major depression or symptoms measured on a validated scale.
 16 4 290 -0.149 0.090 16 0.000 0.310 18 -0.389 0.001
Substance use^
Nonspecified substance use (i.e., alcohol, cannabis, or illicit drugs) that does not rise to the level of "disordered."
 16 3 240 -0.065 0.096 16 n/a n/a n/a -0.171 0.365
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
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Major depressive disorder K-12 grade repetition $2 $0 $0 $1 $2
Labor market earnings associated with major depression $0 $0 $0 $0 $0
Health care associated with major depression $5 $1 $5 $2 $14
Mortality associated with depression $0 $0 $0 $1 $1
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($141) ($141)
Totals $7 $2 $5 ($137) ($123)
Click here to see populations selected
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $234 2017 Present value of net program costs (in 2023 dollars) ($282)
Comparison costs $0 2017 Cost range (+ or -) 20%
The Blues Program typically consists of six, one-hour group sessions, co-facilitated by two therapists. Program costs are based on published cost estimations, retrieved in August 2018 from https://www.blueprintsprograms.org/program-costs/blues-program. Costs reflect on-site training, trainer travel, and therapist and supervisor salaries and benefits, as well as teaching supplies.
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.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative 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 discounted dollars. 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.

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., Seeley, J.R., & Gau, J.M. (2008). Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: A randomized efficacy trial. Journal of Consulting and Clinical Psychology, 76(4), 595-606.