Prevention of Depression in At-Risk-Adolescents

描述（由申请人提供）：本申请是四个互锁R01中的一个，旨在评估群体认知行为计划（CBP）在预防有抑郁风险的青少年抑郁方面的影响。符合条件的青少年必须有一个患有活动性抑郁症的父母；青少年本身必须有过去的抑郁发作或目前的亚综合征抑郁症状。在这项为期5年的研究中，从管理医疗机构抽取320名高危青少年（每个地点80人），随机分为CBP组或常规护理组（UC），并在入院后随访32个月，以确定CBP与UC对抑郁症发病和症状、功能水平以及医疗和精神卫生保健利用的影响。我们假设，与常规护理组的青少年相比，CBP干预组的参与者首次和反复出现抑郁障碍和症状的预期发生率将显著降低。此外，我们将探讨CBP参与者的非情感性症状和障碍的预期发生率是否降低，以及相对于对照组是否会表现出更好的整体功能。分析还将侧重于从医疗保健角度提供CBP比常规护理的增量成本效益。这项研究建立在波特兰网站先前的工作基础上（Clarke et al., 2001），显示CBP与UC的抑郁症发病率降低了近六倍，并以两种方式扩展了这项工作-首先，通过测试该计划是否可以在几个不同的网站复制，从而大大增加了原始发现的普遍性；第二，通过改变干预的时间和间隔，提供持续的会议，以延长CBP效果的持续时间。这一研究项目之所以重要，有以下几个原因：(1)抑郁症是青少年中一种慢性的、普遍的、有损健康的疾病，往往未被发现，而且随着慢性程度的增加，治疗难度加大；(2)青少年抑郁症的预防还没有大规模的研究；(3)通过在管理式护理组织中进行这项研究，将有可能确定将这种干预纳入现实世界环境中的“最佳实践”的成本和收益。这个应用程序是基于纳什维尔（朱迪·加伯，PI），并与来自波士顿（威廉·比尔兹利，PI），匹兹堡（大卫·布伦特，PI）和波特兰（格雷格·克拉克，PI）的应用程序联锁。

DESCRIPTION (provided by applicant): This application is one of four interlocking R01's to assess the impact of a group cognitive behavioral program (CBP) on the prevention of depression in adolescents at risk for depression. Eligible teens must have a parent with active depression; teens themselves must have either a past depressive episode or current subsyndromal depressive symptoms. In this 5-year study, 320 at-risk adolescents (80 at each site) drawn from managed care organizations will be randomized to either CBP or usual care (UC) and followed for 32 months post intake to determine the impact of CBP vs. UC on onset of depressive disorders and symptoms, level of functioning, and medical and mental health care utilization. We hypothesize that participants in the CBP intervention will have a significantly lower prospective incidence of first and repeated episodes of depressive disorders and symptoms compared to adolescents in the usual care group. In addition, we will explore whether participants in CBP have a reduced prospective incidence of non-affective symptoms and disorders, and will show improved global functioning relative to the comparison group. Analyses also will focus on the incremental cost-effectiveness of providing the CBP over usual care from the health care perspective. This study builds on previous work by the Portland site (Clarke et al., 2001) showing a nearly six-fold reduction in the incidence of depression in CBP vs. UC, and extends this work in two ways - first, by testing whether the program can be replicated at several different sites, thereby greatly increasing the generalizability of the original findings; and second, by changing the timing and spacing of the intervention to provide continuation sessions to prolong the duration of the effect of CBP. This program of research is significant for several reasons: (1) depression is a chronic, prevalent, and impairing condition in adolescence that is often undetected, and which is more difficult to treat as chronicity increases; (2) there have been no large-scale studies of the prevention of depression in adolescence; and (3) by basing this study in managed care organizations, it will be possible to ascertain the costs and benefits of incorporating this intervention into "best practice" in real world settings. This application is based in Nashville (Judy Garber, PI), and interlocks with applications from Boston (William Beardslee, PI), Pittsburgh (David Brent, PI), and Portland (Greg Clarke, PI).