Preventing Depression in Disconnected African American Adolescents & Young Adults

描述(由申请人提供)：这份R34奖项的申请书建议完善和进行一项同伴主导的认知行为干预的试点RCT，以确定在社区就业培训计划中预防失学市中心青少年和年轻人抑郁和其他负面后果的可行性、可接受性和结果。这项研究的具体目的是：(1)完善同伴领导的认知行为干预的干预方案，制定干预保真度清单，为提供干预的同伴领导者制定培训手册，并培训同伴领导者提供干预；(2)对142名16-22岁的青少年和年轻人进行随机对照试验，比较参与同伴领导认知行为干预的青少年与参与注意控制条件的青少年的结果；以及(3)获得设计和实施更大规模的随机试验所需的信息和经验。为实现具体目标1，将完善我们的同伴主导干预，制定干预忠诚度清单，为同伴干预者编写培训手册，并培训同伴干预者。为了实现具体目标2，我们将进行同伴主导的认知行为干预的试点RCT。142名抑郁症状加重但目前没有抑郁发作的青少年和年轻人将被随机分配到我们的9个疗程的干预或9周的生活技能注意力控制中。干预后、干预后6个月和干预后12个月的评估将测量抑郁症状、抑郁发作、焦虑和创伤后应激障碍症状、认知评估、积极应对策略、生活质量以及教育和就业里程碑。为了实现具体目标3，我们将使用我们的试点RCT的结果(例如，实施忠诚度、招聘、出勤率)来制定R01申请，并在我们的R34项目的最后一年提交。这个项目对公共卫生的意义是巨大的。鉴于一致的证据表明抑郁症是一种使人衰弱的慢性疾病，干预措施必须试图防止最初的抑郁症发作。青春期和青壮年是进行预防干预的理想时期，因为这一年龄段的抑郁症发病率很高。该项目的创新也是值得注意的，因为它将心理健康服务带到了就业培训计划中，这些计划正在与新的联邦资金倡议一起颁布。这些就业培训方案为大量青少年和年轻人提供服务，这些青少年和年轻人无法通过现有的心理健康干预措施获得帮助。该项目符合R34机制的目标，即鼓励研究开发和/或试点测试新的或调整的干预措施，并与国家卫生研究院服务和干预研究部的两个高度优先领域合作，开发创新干预措施并使其个性化，以便在不同人群中最佳使用，并利用战略伙伴关系和社区参与来加强研究能力和基础设施。 公共卫生相关性：抑郁症是一个重大的公共卫生问题，青少年和年轻人是受影响最大的群体。该项目测试了一种同伴主导的干预措施，旨在防止失学和未就业并参加就业培训计划的青少年和年轻人(16-22岁)抑郁的发病和恶化-这一群体此前并不是心理健康研究的重点。我们的干预可能会给社会带来巨大的好处，因为在这些人群中预防抑郁症有可能增加参与者的就业能力，并最终实现经济自给自足。

DESCRIPTION (provided by applicant): This application for an R34 award proposes to refine and conduct a pilot RCT of a peer-led cognitive-behavioral intervention to determine the feasibility, acceptability, and outcomes for preventing depression and other negative outcomes among out-of-school inner-city adolescents and young adults in a community-based employment training program. The specific aims of this study are: (1) to refine the intervention protocol for the peer-led cognitive behavioral intervention, develop an intervention fidelity checklist, develop a training manual for peer leaders who deliver the intervention, and train peer leaders to deliver the intervention; (2) to conduct a pilot RCT of 142 adolescents and young adults, aged 16-22, that compares outcomes for youth involved with our peer-led cognitive-behavioral intervention with outcomes from youth participating in an attention control condition; and (3) to obtain the information and experiences required for designing and implementing a larger randomized trial. To achieve Specific Aim 1, will refine our peer-led intervention, develop an intervention fidelity checklist, develop a training manual for peer interventionists, and train peer interventionists. To achieve Specific Aim 2, we will conduct a pilot RCT of our peer-led cognitive behavioral intervention. 142 adolescents and young adults with elevated depressive symptoms but without a current depressive episode will be randomized to our 9-session intervention or a 9-week life skills attention control. Assessments post- intervention, 6 months, and 12 months post-intervention will measure depressive symptoms, depressive episodes, anxiety and PTSD symptoms, cognitive appraisals, engaged coping strategies, quality of life, and education and employment milestones. To achieve Specific Aim 3, we will use findings from our pilot RCT (e.g., implementation fidelity, recruitment, attendance) to develop a R01 application to be submitted during the final year of our R34 project. The public health significance of this project is substantial. Given consistent evidence that depression is a debilitating and chronic condition, interventions must attempt to prevent initial depressive episodes from occurring. Adolescence and young adulthood is an ideal time for preventive interventions to occur given the high depression incidence rate in this age group. The innovation of this project is also notable, as it brings mental health services to employment training programs that are being promulgated with new federal funding initiatives. These employment training programs serve large numbers of adolescents and young adults who are not reached by existing mental health interventions. This project is consistent with the goal of the R34 mechanism to encourage research on the development and/or pilot testing of new or adapted interventions and with two high priority areas of NIMH'S Division of Services and Intervention Research to develop innovative interventions and personalize them for optimal use in diverse populations and to employ strategic partnerships and community participation to enhance research capacity and infrastructure. PUBLIC HEALTH RELEVANCE: Depression is a significant public health problem, with adolescents and young adults among the most affected. This project tests a peer-led intervention that aims to prevent the onset and worsening of depression in adolescents and young adults (16-22) who are out-of-school and not in the workforce and enrolled in an employment training program-a group that has not been the focus of previous mental health research. Our intervention may have great benefits to society, as preventing depression among this population has the potential to increase the employability, and ultimately, economic self-sufficiency of participants.