Prevention of depression in at-risk adolescents: longer-term effects.
Prevention of depression in at-risk adolescents: longer-term effects.
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DOI：
10.1001/jamapsychiatry.2013.295
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发表时间：
2013-11
期刊：
影响因子：
25.8
通讯作者：
Garber, Judy
中科院分区：
文献类型：
--
作者：
Beardslee, William R.;Brent, David A.;Weersing, V. Robin;Clarke, Gregory N.;Porta, Giovanna;Hollon, Steven D.;Gladstone, Tracy R. G.;Gallop, Robert;Lynch, Frances L.;Iyengar, Satish;DeBar, Lynn;Garber, Judy
抑郁父母的青春期子女本身就有很高的抑郁障碍风险。为了确定群体认知行为预防(CBP)计划的积极效果是否延伸到更长期(多年)的随访。一项四点随机对照试验纳入了316名青少年(年龄13-17岁)，他们的父母患有当前和/或既往抑郁障碍；青少年有抑郁史，目前抑郁症状加重，或两者兼有。CBP计划包括每周8次、90分钟的小组会议，然后是6个月的继续会议。青少年被随机分配到CBP计划或常规护理(UC)组。主要结果是可能或确定的抑郁症发作(抑郁症状评分≥；4)，持续至少2周，直到第33个月的随访评估。在33个月的随访期中，与UC相比，CBP条件下的年轻人抑郁发作的首发明显较少。父母在基线时的抑郁显著缓和了干预效果。当父母在摄入时没有抑郁时，CBP优于UC(NNT比=6)，而当父母在基线时积极抑郁时，CBP和UC的平均发病率没有显著差异。干预、基线父母抑郁和地点之间的三方交互作用表明，父母抑郁对干预效果的影响因地点而异。在近三年的时间里，CBP计划在预防高危青少年抑郁发作方面显示出与常规护理相比显著的持续效果。重要的下一步将是加强CBP干预，以进一步增强其预防效果，改善父母目前抑郁时的干预结果，并进行更大规模的实施试验，以测试CBP预防青少年抑郁症计划对公共健康的更广泛影响。
Adolescent offspring of depressed parents are at high risk for experiencing depressive disorders themselves. To determine whether the positive effects of a group cognitive-behavioral prevention (CBP) program extended to longer term (multi-year) follow-up. A four-site, randomized, controlled trial enrolled 316 adolescent (ages 13-17 years) offspring of parents with current and/or prior depressive disorders; adolescents had histories of depression, current elevated depressive symptoms, or both. The CBP program consisted of 8 weekly, 90-minute group sessions followed by 6 monthly continuation sessions. Adolescents were randomly assigned to either the CBP program or usual care (UC). The primary outcome was a probable or definite episode of depression (Depression Symptom Rating score ≥; 4) for at least 2 weeks through the month 33 follow-up evaluation. Over the 33-month follow-up period, youths in the CBP condition had significantly fewer onsets of depressive episodes compared to those in UC. Parental depression at baseline significantly moderated the intervention effect. When parents were not depressed at intake, CBP was superior to UC (NNT ratio=6), whereas when parents were actively depressed at baseline, average onset rates between CBP and UC were not significantly different. A three-way interaction among intervention, baseline parental depression, and site indicated that the impact of parental depression on intervention effectiveness varied across sites. The CBP program showed significant sustained effects compared to usual care in preventing the onset of depressive episodes in at-risk youth over a nearly three-year period. Important next steps will be to strengthen the CBP intervention to further enhance its preventive effects, improve intervention outcomes when parents are currently depressed, and conduct larger implementation trials to test the broader public health impact of the CBP program for preventing depression in youth.
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