Prevention of Depression in At-Risk-Adolescents

描述(申请人提供)：这份申请是四个连锁的R01‘S评估团体认知行为计划(CBP)在预防抑郁高危青少年抑郁的影响之一。符合条件的青少年必须有一位患有积极抑郁症的父母；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，从管理护理组织中抽取的320名高危青少年(每个地点80名)将被随机分为CBP组或普通护理组(UC)，并在服药后跟踪观察32个月，以确定CBP组和UC组对抑郁障碍的发病和症状、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干预组的参与者的抑郁障碍和症状的首次和重复发作的预期发生率将显著降低。此外，我们将探索CBP的参与者是否降低了非情感性症状和障碍的预期发生率，并将显示出相对于对照组而言全球功能的改善。分析还将侧重于从卫生保健的角度提供CBP的成本效益高于常规护理的增量成本效益。这项研究建立在波特兰网站(Clarke等人，2001)之前的工作基础上，该工作表明CBP与UC相比，抑郁症的发生率降低了近6倍，并以两种方式扩展了这项工作-第一，通过测试该计划是否可以在几个不同的地点复制，从而极大地增加了原始发现的概括性；第二，通过改变干预的时间和间隔来提供持续治疗，以延长CBP的效果持续时间。这项研究计划具有重要意义，原因有几个：(1)抑郁症是青春期一种慢性、流行和损害的疾病，通常没有被发现，随着慢性病的增加，这种疾病更难治疗；(2)还没有关于预防青春期抑郁症的大规模研究；以及(3)通过将这项研究建立在管理型护理组织的基础上，将有可能确定将这种干预措施纳入现实世界环境中的“最佳实践”的成本和收益。该应用程序基于纳什维尔(Judy Garber，PI)，并与来自波士顿(William Beardslee，PI)、匹兹堡(David Brent，PI)和波特兰(Greg Clarke，PI)的应用程序互锁。

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).