Preventing Depression in Disconnected African American Adolescents & Young Adults

描述（由申请人提供）：本R34奖申请建议完善和实施一项同伴主导的认知行为干预的试点随机对照试验，以确定在社区就业培训项目中，在校外的市中心青少年和年轻人中预防抑郁症和其他负面结果的可行性、可接受性和结果。本研究的具体目的是：(1)完善同伴领导认知行为干预的干预方案，编制干预保真度检查表，编制实施干预的同伴领导培训手册，并对实施干预的同伴领导进行培训；(2)对142名16-22岁的青少年和年轻人进行随机对照试验，比较同伴主导的认知行为干预和注意控制条件干预的结果；(3)获得设计和实施更大规模随机试验所需的信息和经验。为了实现具体目标1，将完善我们的同伴主导的干预，制定干预保真度清单，为同伴干预者制定培训手册，并培训同伴干预者。为了实现具体目标2，我们将进行一项同伴主导的认知行为干预的试点随机对照试验。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为9期干预组或9周生活技能注意力控制组。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、参与应对策略、生活质量、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，实施保真度，招聘，出勤率）来开发R01申请，并在R34项目的最后一年提交。该项目的公共卫生意义重大。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发作的发生。鉴于青少年和青年期抑郁症的高发病率，这是进行预防性干预的理想时期。这个项目的创新也值得注意，因为它将心理健康服务引入了就业培训项目，这些项目正在由新的联邦资金倡议颁布。这些就业培训方案为大量现有心理健康干预措施无法触及的青少年和年轻人提供服务。该项目与R34机制的目标是一致的，即鼓励对新的或适应性干预措施的开发和/或试点测试进行研究，并与NIMH服务和干预研究部门的两个高度优先领域相一致，即开发创新的干预措施并使其个性化，以便在不同人群中获得最佳使用，并采用战略伙伴关系和社区参与来增强研究能力和基础设施。

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.