Early Intervention in Depression Dyadic Emotion Development Therapy for Preschool

描述（由申请人提供）：此R34申请建议进一步开发和试点学龄前抑郁症的早期干预。拟议的研究的具体目的是进一步修改和调整已被证明有效的手动二元早期干预学龄前破坏性障碍，亲子互动疗法（PCIT，Eyberg，1988），适用于学龄前抑郁症。已对标题为PCIT-情感发展（艾德）的拟议治疗进行了修改，以包括专注于“情感发展”的额外治疗成分。新的艾德模块从发展的角度解决早期情绪反应的偏差，并基于情绪障碍的情绪发展模型。PCIT-ED被认为是一种对儿童抑郁症具有发展敏感性的早期干预策略，其重点是加强亲子关系，并利用父母作为“治疗师的手臂”。父母的支持在学龄前抑郁症的严重程度的中介作用已经建立支持的概念，即二元关系是一个理想的目标，早期干预抑郁症。PCIT以前已成功地适用于焦虑症。临床学龄前抑郁综合征的有效性现已在两个独立的研究样本中建立。一个特定的和稳定的症状星座，相关疾病的家族史，生物学相关的证据，和低热情的观察证据已经found. Replication这些验证结果，以及在发展和适应性功能的基础上，在多个环境中的独立评分的显着损害的新证据也已建立。这些发现证实了这种早发性抑郁综合征的临床意义和在学龄前阶段进行干预的必要性。提出了一项2阶段研究，从“开放病例系列”开始，在此期间，将对每个治疗疗程进行系统评估，并对手册进行修改，以最大限度地提高可接受性和保真度。随后将进行一项初步可行性研究，其中N=30例受试者将随机分配至PCIT-ED组或积极育儿教育对照组。与早期干预在几种精神疾病中更有效的证据相一致，在学龄前阶段干预抑郁症可能会在快速发育和神经生物学变化期间提供更大的治疗效果的机会窗口。由于缺乏针对青春期前儿童的安全和明确有效的治疗方法，因此强调了对抑郁症进行新的和早期干预的公共卫生需求。PHS 398（Rev. 09/04）Page Form Page 2该项目的公共卫生目标是寻找治疗儿童抑郁症的新的和可能更有效的方法。该项目的重点是尽可能早地识别抑郁症，并使用针对亲子关系的新治疗方法。这是必要的，因为抑郁症是一种严重的慢性疾病，目前几乎没有安全有效的治疗方法。

DESCRIPTION (provided by applicant): This R34 application proposes to further develop and pilot an early intervention for depression during the preschool period. The specific aim of the proposed study is to further modify and adapt a proven effective manualized dyadic early intervention for preschool disruptive disorders, Parent Child Interaction Therapy (PCIT, Eyberg, 1988), for application to preschool depression. The proposed treatment entitled PCIT- Emotion Development (ED) has been modified to include additional treatment components that focus on "emotion development". The new ED module addresses deviations in early emotional reactivity from a developmental perspective and is based on an emotion development model of mood disorders. PCIT-ED is proposed as a developmentally sensitive early intervention strategy for childhood depression focused on strengthening the parent-child relationship and utilizing the parent as an "arm of the therapist". The mediating role of parenting support in preschool depression severity has been previously established supporting the notion that the dyadic relationship is an ideal target for early intervention in depression. PCIT has been previously successfully adapted for application to anxiety disorders. The validity of a clinical preschool depressive syndrome has now been established in two independent study samples. Evidence of a specific and stable symptom constellation, family history of related disorders, biological correlates, and observational evidence of low enthusiasm have been found. Replication of these validation findings as well as new evidence for significant impairment in developmental and adaptive functioning based on independent raters in multiple contexts has also been established. These findings confirm the clinical significance of this early onset depressive syndrome and the need for intervention for during the preschool period. A 2-stage study is proposed, beginning with an "open case series" during which each treatment session will be systematically assessed and the manual will be modified to maximize acceptability and fidelity. This will be followed by a pilot feasibility study in which N=30 subjects will be randomized to PCIT-ED or an active parenting education control condition. In keeping with evidence of greater efficacy of earlier intervention in several mental disorders, intervention for depression during the preschool period may provide a window of opportunity for greater therapeutic efficacy during a period of rapid developmental and neurobiological change. The public health need for novel and earlier interventions in depression is underscored by the lack of available safe and clearly effective treatments for prepubertal children. PHS 398 (Rev. 09/04) Page Form Page 2 The public health goal of this project is to find new and potentially more effective methods for treating childhood depression. The project focuses on the earliest possible identification of depression and the use novel therapeutic approaches that target the parent-child relationship. This is needed because depression is a serious and chronic disorder for which there are currently few safe and effective treatments established.