Validation of Preschool Depressive Syndrome

描述（由申请人提供）：许多发育研究已经检测到抑郁症高危婴儿和幼儿的早期行为和生物学变化。尽管这些高度提示性的发现，在研究人员的初步研究之前，没有足够的数据来解决六岁以下的儿童是否会表现出临床上显著的抑郁症的问题。在最早的发展点识别抑郁症的必要性，强调了已知的慢性和复发过程中，相对治疗阻力的障碍时，确定后6岁。研究者和同事们正在完成一项由联邦政府资助的关于学龄前抑郁症疾病分类学的研究。这项研究的结果是第一次证明，一个有效的抑郁综合征，可以确定在学龄前儿童使用DSM-IV MDD标准时，修改评估年龄调整的症状表现。这种综合征的初步验证是基于与许多标志物的关联，包括特定和稳定的症状群，相关疾病的家族史增加，与对照组相比显著的抑郁严重程度和社会损害。研究结果对临床抑郁症发作的持续时间以及区分综合征和亚综合征状态的标准提出了疑问。本申请建议利用本研究得出的敏感和具体的标准，以确定一个基于社区的样本抑郁学龄前儿童（和适当的控制）的实地试验和纵向随访。为了解决初步研究提出的问题，这项调查建议使用一种新的全面和年龄适当的诊断措施，除了评估多个领域的障碍，定义学龄前抑郁症的临床特征。验证学龄前抑郁症诊断标准的必要性因全国范围内对这些幼儿的抗抑郁药标签外处方的惊人增加而加剧，这代表了严重的公共卫生危机。虽然没有数据支持的治疗是一个明显的危险，但早期干预抑郁症的潜力是一个必须积极探索的令人信服的可能性。有效的诊断标准是必要的，这些未来的治疗研究，并促进调查这种疾病的发育神经生物学。

DESCRIPTION (provided by applicant): Numerous developmental studies have detected very early behavioral and biological changes in infants and toddlers at high-risk for depression. Despite these highly suggestive findings, prior to the investigator's preliminary study, there was insufficient data to address the question of whether children younger than six could manifest clinically significant depression. The need to identify depression at the earliest developmental point is underscored by the known chronic and relapsing course, and relative treatment resistance of the disorder when identified after six years of age. The investigator and colleagues are completing a federally funded study of the nosology of preschool depression. Findings from this study are the first to demonstrate that a valid depressive syndrome can be identified in preschool children using DSM-IV MDD criteria when the assessment is modified for age adjusted symptom manifestations. Preliminary validation of this syndrome has been established based on the association with numerous markers including a specific and stable symptom constellation, increased family history of related disorders, significant depression severity compared to controls and social impairment. Study findings raised questions about the duration of an episode of clinical depression and the criteria that distinguish syndromal from sub-syndromal states. This application proposes to utilize the sensitive and specific criteria derived from this study to ascertain a community based sample of depressed preschoolers (and appropriate controls) for a field trial and longitudinal follow-up. To address questions raised by the preliminary study, this investigation proposes to define the clinical characteristics of preschool depression using a new comprehensive and age appropriate diagnostic measure, in addition to assessing impairment in multiple domains. The need to validate diagnostic criteria for preschool depression is heightened by the alarming national increase in the off-label prescription of antidepressants to these young children, representing a serious public health crisis. While treatment unsupported by data is an obvious danger, the potential for earlier intervention in depression is a compelling possibility that must be aggressively explored. Valid diagnostic criteria are necessary for these future treatment studies and to facilitate investigations of the developmental neurobiology of this disorder.