Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects.
Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects.
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DOI：
10.1016/j.jaac.2015.12.015
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发表时间：
2016-03
影响因子：
13.3
通讯作者：
Brent DA
中科院分区：
文献类型：
--
作者：
Weersing VR;Shamseddeen W;Garber J;Hollon SD;Clarke GN;Beardslee WR;Gladstone TR;Lynch FL;Porta G;Iyengar S;Brent DA
评估父母患有抑郁症的青少年后代的认知行为预防（CBP）计划的预测因子和调节因子。这项四个地点的随机试验在310名具有抑郁症家族（父母抑郁症）和个体（青年抑郁症史或当前亚综合征症状）风险的青少年中评估了CBP与常规社区护理（UC）的比较。根据Garber等人的报告，9个月内CBP有显著的预防作用;然而，当父母在基线时抑郁时，CBP和UC的结果没有显著差异。本文扩展了这些分析，并检查了一系列人口统计学，临床和背景特征的家庭作为预测因子和调节因子，并使用递归分区构建分类树来组织临床反应亚组。青少年抑郁发作的预测因素为功能低下（HR=0.95，95% CI：0.92-0.98）和更高的无望感（风险比[HR]=1.06，95% CI：1.01-1.11）。当父母目前在基线时抑郁时，CBP的上级效应减弱（HR=6.38，95% CI：2.38-17.1）或有轻度躁狂病史（HR=67.5，95% CI：10.9-417.1），或当青少年报告抑郁症状更严重时（HR=1.04，95% CI：1.00-1.08）、焦虑程度较高（HR=1.05，95% CI：1.01-1.08）、绝望程度较高（HR=1.10，95% CI：1.01-1.20）或功能较低（HR=0.94，95% CI：0.89-1.00）。不同临床应答簇的发作率差异显著（0%至57%）。青少年的抑郁症是可以预防的，但在高危家庭中，当青少年处于相对健康的时刻时，这些项目可能会产生上级效果。未来的项目可能会通过针对可改变的阴性临床反应指标来加强。
To assess predictors and moderators of a cognitive-behavioral prevention (CBP) program for adolescent offspring of parents with depression. This four-site randomized trial evaluated CBP compared to usual community care (UC) in 310 adolescents with familial (parental depression) and individual (youth history of depression or current subsyndromal symptoms) risk for depression. As reported by Garber et al., a significant prevention effect favored CBP through 9 months; however, outcomes of CBP and UC did not significantly differ when parents were depressed at baseline. The current paper expanded on these analyses and examined a range of demographic, clinical, and contextual characteristics of families as predictors and moderators and used recursive partitioning to construct a classification tree to organize clinical response subgroups. Depression onset was predicted by lower functioning (HR=0.95, 95% CI: 0.92-0.98) and higher hopelessness (hazard ratio [HR]=1.06, 95% CI: 1.01-1.11) in adolescents. The superior effect of CBP was diminished when parents were currently depressed at baseline (HR=6.38, 95% CI: 2.38-17.1) or had a history of hypomania (HR=67.5, 95% CI: 10.9-417.1), or when adolescents reported higher depressive symptoms (HR=1.04, 95% CI: 1.00-1.08), higher anxiety (HR=1.05, 95% CI: 1.01-1.08), higher hopelessness (HR=1.10, 95% CI: 1.01-1.20), or lower functioning (HR=0.94, 95% CI: 0.89-1.00) at baseline. Onset rates varied significantly by clinical response cluster (0% to 57%). Depression in adolescents can be prevented, but programs may produce superior effects when timed at moments of relative wellness in high-risk families. Future programs may be enhanced by targeting modifiable negative clinical indicators of response.