Family Cognitive-Behavioral Prevention of Depression

描述（由申请人提供）：父母患有抑郁症的孩子患抑郁症和其他精神疾病的风险明显增加。三种社会心理机制与这些儿童的精神病理风险增加有关——紧张的亲子互动，儿童对这些紧张互动的反应和应对方式，以及儿童的消极认知。具体而言，以侵入性和退缩为特征的父母行为以及儿童的消极归因风格与儿童问题的增加有关。相比之下，儿童使用二级控制应对（认知重组、接受、分心）与较低的问题有关。基于这些发现，我们已经为抑郁症父母及其家庭建立了一种预防性干预的可行性和可接受性。本研究将在随机临床试验中检验以家庭为基础的认知行为干预的有效性，以防止父母抑郁对后代的不良影响。抑郁的父母，他们的配偶和他们的孩子（9到16岁）将被随机分配到多家庭认知行为小组干预组或自学控制组。12期（8期急性期和4期随访期）家庭认知行为干预将包括对儿童的应对技能培训和对抑郁父母及其配偶的养育技能培训。对照组的家庭将只收到关于抑郁症及其对家庭影响的书面教育材料。在前、后、6个月、12个月、18个月和24个月的随访中实施的措施将包括评估情绪障碍和其他精神障碍，儿童的内化和外化问题。还将评估干预效果的可能中介因素，包括父母的抑郁症状和抑郁发作，父母的干扰和退缩，以及儿童的应对和压力反应。我们的目标是确定这种干预的效果，这种干预的独特之处在于，它专注于帮助抑郁父母的孩子应对与父母的压力互动，并提高抑郁父母的育儿技巧。

DESCRIPTION (provided by applicant): Children of depressed parents are at significantly increased risk for depression and other forms of psychopathology. Three psychosocial mechanisms are associated with increased risk for psychopathology in these children---stressful parent-child interactions, the ways that children respond to and cope with these stressful interactions, and children's negative cognitions. Specifically, parenting behavior that is characterized by intrusiveness and withdrawal and children's negative attributional style are associated with increased problems in children. In contrast, children's use of secondary control coping (cognitive restructuring, acceptance, distraction) is related to lower problems. Based on these findings, we have established the feasibility and acceptability of a preventive intervention for depressed parents and their families. This study will examine in a randomized clinical trial the efficacy of a family-based cognitive behavioral intervention to prevent the adverse effects of parental depression on offspring. Depressed parents, their spouses, and their children (ages 9 to 16-years-old) will be randomly assigned to a multifamily cognitive behavioral group intervention or to a self-study control condition. The 12 session (8 acute and 4 follow-up) family cognitive behavioral intervention will include coping skills training for children and parenting skills training for depressed parents and their spouses. Families in the control condition will receive only written educational materials about depression and its effects on families. Measures administered at pre-, post- and 6-, 12-, 18-, and 24-month follow-ups will include assessment of mood disorders and other psychiatric disorders, internalizing and externalizing problems in children. Possible mediators of the effects of the intervention will also be evaluated, including parental depressive symptoms and episodes of depression, parental intrusiveness and withdrawal, and children's coping and stress responses. Our goal is to determine the efficacy of this intervention that is unique in its focus on helping children of depressed parents to cope with stressful interactions with their parents, and to improve the parenting skills of depressed parents.