Integrated Treatment for Comorbid Depression and Obesity in Adolescents

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 et al., 1999)，女性的累积患病率（35%）高于男性（19%）。在美国，大约17%的儿童和青少年被BMI超过95百分位数定义为肥胖，超过30%的儿童和青少年的BMI在85到95百分位数之间（Ogden et al., 2008）。超重儿童和青少年患2型糖尿病的风险增加（Pinhas-Hamiel et al., 1996），成人肥胖的风险很大（Guo et al., 1994）。有相当大比例的青少年既超重又抑郁，从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和精神疾病的青少年的治疗几乎没有受到关注。由于大量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。这项建议的目的是将抑郁症和超重的治疗结合起来，在一次干预中解决这些共同发生的疾病。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高效和有效的治疗方法。研究计划将分为3个主要阶段：开发阶段（阶段1a），试点研究阶段（阶段1b）和修订阶段。在开发阶段（1a阶段），针对超重青少年的治疗和针对抑郁青少年的CBT治疗将被改编成一个综合方案，使用CBT技术、锻炼成分和关于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，并通过对6名青少年的公开试验获得一些初步的临床经验。在随机试验研究阶段（1b期），综合干预将与单独接受CBT治疗抑郁症的对照组（N=40）进行比较。在试点阶段，将评估管理该计划的可行性和可接受性。此外，我们将比较两组在治疗结束和6个月随访期间抑郁情绪的变化。在修订阶段，将根据在开发和试点研究阶段取得的经验和观察，进一步发展和完善干预手册。

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.