Preventing Depression in Disconnected African American Adolescents & Young Adults

描述（由申请人提供）：这项R34奖的申请建议完善和进行同伴主导的认知行为干预的试点RCT，以确定可行性，可接受性和结果，以预防抑郁症和其他不良后果在校外内城青少年和年轻人中，以社区为基础的就业培训计划。本研究的具体目的是：（1）完善同伴主导认知行为干预的干预方案，编制干预忠实度检查表，编制实施干预的同伴领导者培训手册，培训同伴领导者实施干预;（2）对142名16-22岁的青少年和年轻人进行试点RCT，比较了参与我们同伴主导的认知行为干预的年轻人与参与注意力控制条件的年轻人的结果;以及（3）获得设计和实施大型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，制定干预保真度检查表，制定同伴干预者的培训手册，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次干预或9周的生活技能注意力控制。干预后、干预后6个月和12个月的评估将测量抑郁症状、抑郁发作、焦虑和PTSD症状、认知评估、参与应对策略、生活质量以及教育和就业里程碑。为了实现具体目标3，我们将使用试点RCT的结果（例如，实施保真度，招聘，出勤），以制定R 01应用程序，在我们的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发生。青春期和青年期是进行预防干预的理想时期，因为这个年龄组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纳入了就业培训方案，这些方案正在与新的联邦资助倡议一起颁布。这些就业培训计划为大量青少年和年轻人提供服务，这些青少年和年轻人没有得到现有的心理健康干预措施的帮助。该项目符合R34机制的目标，即鼓励对新的或经调整的干预措施的开发和/或试点测试进行研究，并与NIMH服务和干预研究司的两个高度优先领域相一致，即开发创新干预措施并使其个性化，以便在不同人群中得到最佳使用，并利用战略伙伴关系和社区参与来提高研究能力和基础设施。 抑郁症是一个重要的公共卫生问题，青少年和年轻人受影响最大。该项目测试了一种同伴主导的干预措施，旨在预防青少年和年轻人（16-22岁）抑郁症的发作和恶化，这些青少年和年轻人没有上学，没有参加工作，参加了就业培训计划，这一群体不是以前心理健康研究的重点。我们的干预可能对社会有很大的好处，因为预防这一人群中的抑郁症有可能提高就业能力，并最终提高参与者的经济自给自足。

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.