Prevention of depression in at-risk adolescents: a randomized controlled trial.
Prevention of depression in at-risk adolescents: a randomized controlled trial.
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DOI：
10.1001/jama.2009.788
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发表时间：
2009-06-03
影响因子：
120.7
通讯作者：
Iyengar, Satish
中科院分区：
文献类型：
--
作者：
Garber, Judy;Clarke, Gregory N.;Weersing, V. Robin;Beardslee, William R.;Brent, David A.;Gladstone, Tracy R. G.;DeBar, Lynn L.;Lynch, Frances L.;D'Angelo, Eugene;Hollon, Steven D.;Shamseddeen, Wael;Iyengar, Satish
抑郁父母的青少年后代患抑郁症的风险明显增加。尽管一些较小的针对性预防试验发现抑郁风险可以降低，但这些结果尚未被复制并扩展到不同环境中的大规模高危人群。确定团体认知行为（CB）预防计划与常规护理在预防抑郁症发作方面的效果。一项在美国4个城市进行的多中心随机对照试验，从2003年8月至2006年2月招募了316名患有当前或既往抑郁症的父母的青少年（13-17岁）后代。青少年有抑郁症病史，目前升高但亚诊断抑郁症状，或两者兼而有之。在基线、8周干预后和6个月持续期后进行评估。青少年被随机分配到CB预防计划，包括每周8次，90分钟的小组会议，然后是6个月的延续会议或分配到单独接受常规护理。临床访谈者诊断的可能或明确的抑郁发作（即抑郁症状评分≥4）持续至少2周的发生率和风险比（HR）。通过延续治疗后的随访，CB预防项目中的患者抑郁发作的发生率和HR低于常规治疗中的患者（21.4% vs 32.7%; HR，0.63; 95%置信区间[CI]，0.40-0.98）。青少年在CB预防计划中也表现出自我报告的抑郁症状比常规护理中有更大的改善（系数，-1.1; z =-2.2; P = 0.03）。基线时父母抑郁缓解了干预效应（HR，5.98; 95% CI，2.29-15.58; P = .001）。在基线时父母没有抑郁的青少年中，CB预防计划在预防抑郁发作方面比常规护理更有效（11.7%对40.5%; HR，0.24; 95%CI，0.11-0.50），而对于父母目前患有抑郁症的青少年，在预防抑郁事件方面，CB预防计划并不比常规护理更有效（31.2% vs 24.3%; HR，1.43; 95%CI，0.76-2.67）。根据临床诊断和自我报告的抑郁症状，CB预防计划在9个月的随访期内具有显着的预防效果，但这种效果对于目前患有抑郁症的青少年并不明显。clinicaltrials.gov标识符：NCT 00073671
Adolescent offspring of depressed parents are at markedly increased risk of developing depressive disorders. Although some smaller targeted prevention trials have found that depression risk can be reduced, these results have yet to be replicated and extended to large-scale, at-risk populations in different settings. To determine the effects of a group cognitive behavioral (CB) prevention program compared with usual care in preventing the onset of depression. A multicenter randomized controlled trial conducted in 4 US cities in which 316 adolescent (aged 13–17 years) offspring of parents with current or prior depressive disorders were recruited from August 2003 through February 2006. Adolescents had a past history of depression, current elevated but sub-diagnostic depressive symptoms, or both. Assessments were conducted at baseline, after the 8-week intervention, and after the 6-month continuation phase. Adolescents were randomly assigned to the CB prevention program consisting of 8 weekly, 90-minute group sessions followed by 6 monthly continuation sessions or assigned to receive usual care alone. Rate and hazard ratio (HR) of a probable or definite depressive episode (ie, depressive symptom rating score of ≥4) for at least 2 weeks as diagnosed by clinical interviewers. Through the postcontinuation session follow-up, the rate and HR of incident depressive episodes were lower for those in the CB prevention program than for those in usual care (21.4% vs 32.7%; HR, 0.63; 95% confidence interval [CI], 0.40–0.98). Adolescents in the CB prevention program also showed significantly greater improvement in self-reported depressive symptoms than those in usual care (coefficient,−1.1; z = −2.2; P = .03). Current parental depression at baseline moderated intervention effects (HR, 5.98; 95% CI, 2.29–15.58; P = .001). Among adolescents whose parents were not depressed at baseline, the CB prevention program was more effective in preventing onset of depression than usual care (11.7% vs 40.5%; HR, 0.24; 95% CI, 0.11–0.50), whereas for adolescents with a currently depressed parent, the CB prevention program was not more effective than usual care in preventing incident depression (31.2% vs 24.3%; HR, 1.43; 95% CI, 0.76–2.67). The CB prevention program had a significant prevention effect through the 9-month follow-up period based on both clinical diagnoses and self-reported depressive symptoms, but this effect was not evident for adolescents with a currently depressed parent. clinicaltrials.gov Identifier: NCT00073671
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DOI：
10.1097/01.chi.0000242228.75516.21
发表时间：
2006-12-01
影响因子：
13.3
作者：
Kennard, Betsy;Silva, Susan;March, John
通讯作者：
March, John
影响因子：
2.7
作者：
EFRON, B
通讯作者：
EFRON, B
DOI：
10.1097/01.chi.0000240838.78984.e2
发表时间：
2006-12-01
影响因子：
13.3
作者：
Curry, John;Rohde, Paul;March, John
通讯作者：
March, John
影响因子：
1.9
作者：
Ascher, BH;Farmer, EMZ;Angold, A
通讯作者：
Angold, A
影响因子：
--
作者：
Birmaher, B;Brent, DA;Ulloa, RE
通讯作者：
Ulloa, RE