Treatment of Youth Comorbid Conduct Problems and Depression

描述（由申请人提供）：对抑郁症和行为问题共病的研究表明，这些障碍中的每一种都与另一种的风险增加有关。尽管这些疾病之间存在很强的关联，但针对这些在青少年中同时发生的问题的综合治疗尚未经过测试。青少年同时患有自杀、药物滥用和反社会行为等两种疾病，导致不良后果的风险增加，因此治疗这种共病表现的重要性得到加强。本提案的主要目的是发展一个以家庭为基础的认知行为治疗方案的青少年共病行为问题和抑郁症。该干预以发展精神病理学研究为基础，采用适应性治疗策略和一套决策规则，以创新的方式整合现有的认知行为技术，以增强社区环境中协议的交付。该方案将教授解决问题、认知重组、影响调节技能和育儿技巧，以纠正这些疾病背后的技能缺陷。最终的产品将是一本18期的手册，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疾病和综合治疗原则。本项目有四个主要目标：1)开展1a阶段的工作，为被诊断为行为问题和并发抑郁症的青少年制定手动认知行为治疗方案；2)通过公开的试点试验，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)进行一项小型随机对照试验，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；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处理效果的潜在工艺变量。为了实现这些目标，将30名11- 14岁的同时存在行为问题和抑郁症的儿童分配到实验条件或在社区护理环境中进行常规治疗。治疗手册将采用迭代方法进行修订。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产生一个更有效和可行的门诊治疗方法的青少年共病行为问题和抑郁症。

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.