Treatment of Youth Comorbid Conduct Problems and Depression

描述（由申请人提供）：抑郁症和行为问题之间的共病研究表明，这些疾病中的每一种都与另一种疾病的风险增加有关。尽管这些疾病之间有很强的关联，但针对这些青年共同发生的问题的综合治疗尚未进行过测试。治疗这种共病表现的重要性因青少年同时患有两种疾病（包括自杀、药物滥用和反社会行为）的不良结局风险升高而提高。这项建议的主要目的是发展一个以家庭为基础的认知行为治疗协议的青少年共病的行为问题和抑郁症。这种干预是基于发展的精神病理学研究，并整合了现有的认知行为技术，在一个创新的方式，使用自适应治疗策略和一套决策规则，以提高交付的协议在社区设置。该协议将教授解决问题，认知重建，影响调节技能，以及修复这些疾病背后的技能缺陷所需的育儿技巧。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，将在六个月的时间内交付。综合治疗允许持续关注两种疾病和综合治疗原则。本研究的主要目的有四：1）进行第一阶段a的工作，以开发针对青少年行为问题和抑郁症的认知行为治疗手册; 2）通过一项开放的试点试验，对6个家庭的治疗方案进行测试，以评估手册的清晰度、完整性和可行性; 3）进行一项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症状的减少;以及4）开发和完善用于指导治疗模块选择的决策规则。此外，该项目将探讨可能解释处理效果的潜在过程变量。为了实现这些目标，将30名11- 14奥尔兹的行为问题和抑郁症共病患者分配到社区护理环境中的实验条件或治疗。将采用迭代方法修订治疗手册。将在急性治疗后、维持治疗后和治疗后6个月评估结局。这项研究的长期目标是为患有抑郁症和行为问题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：青少年重度抑郁症的累积患病率估计接近30%。同样，大约16%的儿童和青少年被诊断出有行为问题。本研究通过制定一项综合方案来解决这两个问题的干预措施，解决了青春期这两个主要公共卫生问题的共同发生。

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.