Prevention of Depression in At-Risk-Adolescents

描述（由申请人提供）：本申请是四个环环相扣的 R01 之一，旨在评估团体认知行为计划 (CBP) 对预防有抑郁症风险的青少年抑郁症的影响。符合资格的青少年必须有一位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当前的亚综合征抑郁症状。在这项为期 5 年的研究中，来自管理式医疗组织的 320 名高危青少年（每个中心 80 名）将被随机分配到 CBP 或常规护理 (UC) 组，并在摄入后进行 32 个月的随访，以确定 CBP 与 UC 对抑郁症发作和症状、功能水平以及医疗和心理保健利用率的影响。我们假设，与常规护理组的青少年相比，CBP 干预的参与者首次和重复发作抑郁症和症状的预期发生率将显着降低。此外，我们将探讨 CBP 参与者的非情感症状和疾病的预期发生率是否降低，并且相对于对照组，其整体功能是否有所改善。分析还将重点关注从医疗保健角度来看，提供 CBP 相对于常规护理的增量成本效益。这项研究以波特兰中心先前的工作为基础（Clarke 等人，2001 年），该研究表明 CBP 与 UC 相比，抑郁症的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地点复制，从而大大提高原始研究结果的普遍性；其次，通过改变干预的时间和间隔来提供连续治疗，以延长 CBP 效果的持续时间。该研究计划具有重要意义，原因如下：（1）抑郁症是青春期一种慢性、普遍且损害性的疾病，常常未被发现，并且随着慢性程度的增加，治疗也更加困难； （2）目前还没有针对青春期抑郁症预防的大规模研究； (3) 通过以管理式医疗组织为基础进行这项研究，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。该应用程序位于纳什维尔（朱迪·加伯，PI），并与来自波士顿（William Beardslee，PI）、匹兹堡（David Brent，PI）和波特兰（Greg Clarke，PI）的应用程序相连。

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).