Treatment of Youth Comorbid Conduct Problems and Depression

描述(由申请人提供)：对抑郁症和品行问题共病的研究表明，这些障碍中的每一个都与另一个的风险增加有关。尽管这些障碍之间存在很强的关联性，但针对青少年中这些共同发生的问题的综合治疗尚未得到测试。在同时患有自杀、药物滥用和反社会行为等障碍的青少年中，负面结果的风险增加，从而加强了治疗这种并存表现的重要性。这项建议的主要目的是为患有行为问题和抑郁症的青少年开发一种基于家庭的认知行为治疗方案。这种干预以发展精神病理学研究为基础，以创新的方式整合现有的认知行为技术，使用适应性治疗策略和一套决策规则，以加强社区环境中协议的交付。该协议将教授解决问题、认知结构调整、情感调节技能和父母养育技巧，这些技能是补救这些障碍背后的技能缺陷所必需的。由此产生的产品将是一本18节的手册，包括个人课程、家庭课程和家长培训课程，将在六个月的过程中交付。综合治疗允许持续关注这两种疾病和综合治疗原则。该项目有四个主要目标：1)进行阶段1a的工作，以开发针对被诊断为行为问题和共生抑郁症的青少年的手册认知行为治疗方案；2)通过开放的试点试验，在6个家庭中测试治疗方案，以评估手册的清晰度、完整性和可行性；3)进行小型试点随机对照试验，以检查可行性、治疗依从性以及行为问题和抑郁症状的减少；以及4)制定和完善用于指导治疗模块选择的决策规则。此外，该项目还将探索可能影响治疗效果的潜在过程变量。为了实现这些目标，30名患有行为问题和抑郁症的11-14岁儿童将被分配到实验条件下或照常在社区护理环境中接受治疗。治疗手册将采用迭代办法加以修订。结果将在急性治疗后、维持治疗后和治疗后6个月进行评估。这项研究的长期目标是为患有行为问题和抑郁症的青少年提供一种更有效但可行的门诊治疗方法。 公共卫生相关性：据估计，青春期重度抑郁症的累积患病率接近30%。同样，大约16%的儿童和青少年被诊断出有行为问题。这项研究通过开发一种干预措施，在综合方案中解决这两个主要公共卫生问题，解决了青春期这两个主要公共卫生问题的共存问题。

DESCRIPTION (provided by applicant): Studies of comorbidity between depression and conduct problems suggest that each of these disorders is associated with increased risk for the other. Despite the strong association between these disorders, integrated treatments that target these co-occurring problems in youth have not been tested. The importance of treating this comorbid presentation is heightened by the elevated risk for negative outcomes in adolescents with both disorders including suicide, substance abuse, and antisocial behavior. The primary purpose of this proposal is to develop a family based cognitive behavioral treatment protocol for youths with comorbid conduct problems and depression. This intervention is based on developmental psychopathology research and integrates existing cognitive behavioral techniques in an innovative fashion using an adaptive treatment strategy and a set of decision rules to enhance the delivery of the protocol in a community setting. The protocol will teach problem solving, cognitive restructuring, affect regulation skills, and parenting techniques needed to remediate skill deficits that underlie these disorders. The resultant product will be an 18-session manual, comprised of individual sessions, family sessions, and parent training sessions, that will be delivered over the course of six months. The integrated treatment allows for ongoing attention to both disorders and a synthesis of treatment principles. There are four primary aims in this project: 1) conduct stage 1a work to develop the manualized cognitive behavioral therapy protocol for young adolescents diagnosed with conduct problems and co- occurring depression; 2) to test the treatment protocol with 6 families through an open pilot trial to assess the manual for clarity, completeness, and feasibility; 3) conduct a small pilot randomized controlled trial to examine feasibility, treatment adherence, and reductions in symptoms of conduct problems and depression; and 4) develop and refine decision rules used to guide selection of treatment modules. In addition, this project will explore potential process variables that may account for treatment effects. To accomplish these aims, thirty 11- 14 year olds with comorbid conduct problems and depression will be assigned to the experimental condition or treatment as usual in a community care setting. The treatment manual will be revised using an iterative approach. Outcome will be assessed at post-acute treatment, postmaintenance treatment, and 6 months post- treatment. The long-term objective of this research is to yield a more effective yet feasible outpatient treatment approach for youth with comorbid conduct problems and depression. PUBLIC HEALTH RELEVANCE: The cumulative prevalence of major depression in adolescence is estimated at almost 30%. Similarly, approximately 16% of children and adolescents are diagnosed with conduct problems. This study addresses the co-occurrence of these two major public health issues in adolescence by developing an intervention that addresses both problems in an integrated protocol.