2/2-Evaluation of Family Focused Treatment for Childhood Depression

描述（由申请人提供）：儿童期抑郁症是一种损害性的，经常复发和持续的障碍，影响当前和以后的发展，导致很高的个人，社会和经济成本。尽管早发性抑郁症的成本很高，目前的实践参数强调心理社会治疗的初始过程，以及对青少年抑郁症的广泛研究，但我们目前缺乏评估儿童抑郁症心理社会治疗的随机对照试验。目前的应用程序旨在解决这方面的知识差距关于儿童患抑郁症的最佳心理治疗策略。我们提出了一项2点随机对照试验，以评估以家庭为中心的治疗（FFT）的疗效，并将其与模仿“常规”社区护理的以个人为中心的心理治疗（IP）进行比较。本应用程序建立并扩展了我们最初通过NIMH治疗发展基金开展的工作，在该基金中，我们开发并操作了FFT，并进行了初步试验，证明FFT在抑郁症结果、整体功能、父母报告的内在化、外在化和总体问题方面取得了显著改善，并在治疗后9个月的随访中取得了持续和加强的成果。FFT采用人际模式来了解抑郁症状是如何维持的，强调发展家庭技能/策略以改变人际关系过程，并致力于建立一个支持康复和增强抗压能力和复原力的家庭环境。考虑到抑郁症儿童对父母的依赖性、FFT治疗多个家庭成员需求的潜力，以及我们的数据支持对抑郁症、功能障碍和其他并发症状的益处，这种方法可能特别适合于抑郁症儿童的发展需求。拟议的项目将招募140名患有抑郁症（重度抑郁症和/或心境恶劣障碍）的儿童（8-12岁）。儿童将被随机分配接受为期14周的FFT或IP试验。在研究开始、治疗后立即和治疗后9个月的随访中，所有参与者将接受临床状态、社会心理和家庭功能的强化评估。我们假设FFT将与更快地从抑郁中恢复、症状和社会心理功能的更大改善以及相关症状/综合征（焦虑和对立障碍）的减少有关。后续评价将检查治疗成果的维持情况。评估潜在的调节变量（情绪表达、共病外化障碍的存在）和中介变量（家庭功能、父母抑郁）。为了提高外部有效性和促进招募一个大的，多样化的样本，研究将在两个地点进行-波士顿大学和加州大学洛杉矶分校。儿童期发病的抑郁症是一种损害性的、经常复发和持续的疾病，影响当前和以后的发展，造成高昂的社会和经济成本，开发有效的治疗方法至关重要。以家庭为中心的治疗（FFT）是专门针对抑郁的前青少年及其家庭而开发的，它提出了一种人际关系模型，用于理解抑郁症状是如何维持的，强调发展家庭技能/策略以改变人际关系过程，并致力于建立一个支持康复和增强抗压能力和复原力的家庭环境。当前申请的目标是进行FFT治疗抑郁学龄青少年的随机对照试验。

DESCRIPTION (provided by applicant): Childhood-onset depression is an impairing and often recurrent and persistent disorder that impacts current and later development resulting in high personal, social, and economic costs. Despite the costs of early-onset depression, the emphasis in current practice parameters on an initial course of psychosocial treatment, and extensive research on adolescent depression, we currently lack randomized controlled trials evaluating psychosocial treatments for children with depressive disorders. The present application aims to address this gap in knowledge regarding optimal psychosocial treatment strategies for children suffering from depressive disorders. We propose a 2-site randomized controlled trial to evaluate the efficacy of Family Focused Treatment (FFT), as compared to an individual client-centered psychotherapy (IP) modeled after "usual" community care. This application builds on and extends work conducted through our initial NIMH treatment development grant in which we developed and manualized the FFT and carried out a preliminary trial demonstrating that the FFT resulted in significant improvements in depression outcomes, global functioning, and reductions in parent reported internalizing, externalizing, and total problems, with gains persisting and strengthening by the 9-month post-treatment follow-up. FFT adopts an interpersonal model for understanding how depressive symptoms are maintained, emphasizes developing family skills/strategies for altering interpersonal processes, and works on building a family environment that supports recovery and enhances stress resistance and resilience. This approach may be particularly appropriate to the developmental needs of depressed children, given their dependence on parents, the potential of FFT to address the needs of multiple family members, and our data supporting benefits on depression, functioning, and other co-occurring symptoms. The proposed project will enroll 140 children (ages 8-12) with depressive disorders (major depression and/or dysthymic disorder). Children will be randomly assigned to receive a 14-week trial of either FFT or IP. At study entry, immediately post-treatment, and at a 9-month post-treatment follow-up all participants will undergo intensive evaluation of clinical state and psychosocial and family functioning. We hypothesize that FFT will be associated with quicker recovery from depression, greater improvement in symptoms and psychosocial functioning, and reduction in associated symptoms/syndromes (anxiety and oppositional disorders). Follow-up evaluations will examine maintenance of treatment gains. Potential moderating (Expressed Emotion, presence of comorbid externalizing disorder) and mediating (family functioning, parental depression) variables will be evaluated. To enhance external validity and facilitate recruitment of a large, diverse sample, the study will be conducted at two sites -- Boston University and UCLA. Childhood-onset depression is an impairing and often recurrent and persistent disorder that impacts current and later development resulting in high social and economic costs, and development of efficacious treatments is of critical importance. Family-Focused Treatment (FFT), developed to specifically target depressed pre- adolescents and their families, presents an interpersonal model for understanding how depressive symptoms are maintained, emphasizes developing family skills/strategies for altering interpersonal processes, and works on building a family environment that supports recovery and enhances stress resistance and resilience. The goal of the current application is to conduct a randomized controlled trial of FFT for the treatment of depressed school-aged youth. PUBLIC HEALTH RELEVANCE: Childhood-onset depression is an impairing and often recurrent and persistent disorder that impacts current and later development resulting in high social and economic costs, and development of efficacious treatments is of critical importance. Family-Focused Treatment (FFT), developed to specifically target depressed pre- adolescents and their families, presents an interpersonal model for understanding how depressive symptoms are maintained, emphasizes developing family skills/strategies for altering interpersonal processes, and works on building a family environment that supports recovery and enhances stress resistance and resilience. The goal of the current application is to conduct a randomized controlled trial of FFT for the treatment of depressed school-aged youth.