Integrated Treatment for Comorbid Depression and Obesity in Adolescents

青少年共病抑郁症和肥胖症的综合治疗

• 批准号: 7995251
• 负责人: ELISSA JELALIAN
• 金额: $ 23.03万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-12-01 至 2012-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7995251
• 关键词: Acute; Address; Adherence; Adolescence; Adolescent; Adult; Age; Attention; Audiotape; Behavior Therapy; Belief; Blood Pressure; Body Weight decreased; Child; Childhood; Cholesterol; Clinical; Cognitive Therapy; Combined Modality Therapy; Comorbidity; Confidence Intervals; Control Groups; Data; Depressed mood; Development; Diet Habits; Disease remission; Eating; Education; Emotional disorder; Exercise; Feasibility Studies; Feedback; Female; Gender; Goals; Grant; Guidelines; Health; Individual; Intervention; Interview; Length; Literature; Major Depressive Disorder; Manuals; Medical; Mental Depression; Nature; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Overweight; Parents; Participant; Phase; Physical activity; Pilot Projects; Prevalence; Protocols documentation; Public Health; Randomized; Recruitment Activity; Refractory; Research; Research Personnel; Risk; Running; Sampling; School-Age Population; Series; Staging; Techniques; Teenagers; Testing; Training; Training Programs; Treatment Protocols; United States; Weight; Work; base; depressive symptoms; effective therapy; experience; falls; follow-up; intervention effect; male; meetings; pilot trial; programs; psychosocial; public health relevance; satisfaction

DESCRIPTION (provided by applicant): Lifetime prevalence of major depression is estimated at 28% by age 18 (Lewinsohn et al., 1999), with higher cumulative rates in females (35%) than males (19%). Approximately 17% of children and adolescents in the United States are obese as defined by a BMI above the 95th percentile, with more than 30% falling between the 85th and 95th percentiles (Ogden et al., 2008). Overweight children and adolescents are at increased risk for type 2 diabetes (Pinhas-Hamiel et al., 1996) and overwhelming risk for adult obesity (Guo et al., 1994). There is a substantial percentage of adolescents who are both overweight and depressed with estimates from clinical samples averaging 25%. Treatment of teens with comorbid medical and psychiatric conditions such as overweight/obesity and depression has received little to no attention in the psychosocial treatment research literature. Due to the large number of adolescents who are both depressed and overweight, developing a behavioral treatment that addresses both problems simultaneously has important public health significance. The purpose of this proposal is to combine treatments for depression and overweight to address these co-occurring conditions in one intervention. The long-term objectives of this research are to develop efficient and effective treatments for co-occurring physical and emotional disorders. The research program will be divided into 3 major phases: a development phase (Stage 1a), a pilot study phase (Stage 1b), and a revision phase. During the development phase (Stage 1a), a treatment for overweight teens and CBT treatment for depressed teens will be adapted into one integrated protocol that addresses depression using CBT techniques, an exercise component, and advice regarding healthy eating. As part of this phase, we will adapt existing intervention manuals and therapist training materials, and gain some initial clinical experience with the intervention via an open trial with 6 teens. During the randomized pilot study phase (Stage 1b), the integrated intervention will be compared to a control group receiving CBT treatment for depression alone (N=40 in total). During the pilot phase, the feasibility and acceptability of administering the program will be assessed. In addition, we will compare change in depressed mood at end of treatment and 6 month follow-up periods across the two groups. During the revision phase, the intervention manual will be further developed and refined, based on experiences and observations made during the development and pilot study phases. PUBLIC HEALTH RELEVANCE: The cumulative prevalence of major depression in adolescence is estimated at almost 30%. Similarly, approximately 17% of children and adolescents are obese and another 30% at risk for overweight. 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. The intervention protocol will integrate cognitive-behavioral treatment for depression with exercise plus education about healthy eating to achieve its goals.

描述（由申请人提供）：到18岁时，重度抑郁症的终生患病率估计为28%（Lewinsohn等人，1999年），女性的累积发病率（35%）高于男性（19%）。在美国，大约17%的儿童和青少年是肥胖的，如通过BMI高于第95百分位数所定义的，其中超过30%落在第85百分位数和第95百分位数之间（Ogden等人，2008年）。超重的儿童和青少年患2型糖尿病的风险增加（Pinhas-Hamiel等人，1996）和成人肥胖的压倒性风险（Guo等人，1994年）。有相当大比例的青少年既超重又抑郁，临床样本估计平均为25%。在心理社会治疗研究文献中，对患有超重/肥胖和抑郁症等共病的青少年的治疗很少或根本没有受到关注。由于大量的青少年既抑郁又超重，开发一种同时解决这两个问题的行为治疗具有重要的公共卫生意义。该提案的目的是将抑郁症和超重的治疗联合收割机，以解决这些共同发生的条件在一个干预。这项研究的长期目标是为同时发生的身体和情绪障碍开发有效的治疗方法。研究计划将分为3个主要阶段：开发阶段（第1a阶段），试点研究阶段（第1b阶段）和修订阶段。在开发阶段（第1a阶段），超重青少年的治疗和抑郁青少年的CBT治疗将被改编成一个综合方案，使用CBT技术，运动成分和有关健康饮食的建议来解决抑郁症。作为这一阶段的一部分，我们将调整现有的干预手册和治疗师培训材料，并通过6名青少年的开放试验获得一些初步的干预临床经验。在随机化初步研究阶段（阶段1b），将综合干预与仅接受CBT治疗抑郁症的对照组（共40例）进行比较。在试点阶段，将评估实施该计划的可行性和可接受性。此外，我们将比较两组治疗结束时和6个月随访期抑郁情绪的变化。在修订阶段，将根据制定和试点研究阶段的经验和观察，进一步制定和完善干预手册。 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17%的儿童和青少年肥胖，另外30%的人有超重的风险。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。该干预方案将整合抑郁症的认知行为治疗与运动以及健康饮食教育，以实现其目标。