1/4-Prevention of Depression: Impact on the Transition to Early Adulthood

描述（由申请人提供）：此A1竞争性更新是四个协作，链接R 01之一，建议检查认知行为计划（CBP）的长期影响，以预防青少年13-17岁时提供的抑郁症。由于家族性（父母抑郁）和个体因素（既往抑郁史和/或当前亚综合征抑郁症状），样本处于高风险状态。在最初的研究中，我们成功招募了99%（N=316）的拟定目标招募的320名青少年，4个研究中心的招募情况相同。参与者被随机分为CBP或常规治疗（TAU），两种情况下的保留率相同（92%）。8个月随访的结果表明，CBP对抑郁发作具有显著的预防作用（HR= 0.60，95% CI，0.38 - 0.96;效应量，d= 0.25），因此复制并扩展了Clarke等人的早期单中心研究，（2001年）的第10页。目前提案的目的是（a）研究CBP对预防成年早期关键发育过渡期（一个面临多种新生活挑战和压力源的时期）抑郁症的长期影响;（B）评估潜在的生物学（例如，遗传的）和社会心理的（例如，儿童期虐待、压力性生活事件）对干预措施反应的调节因素;（c）检查CBP计划对抑郁症后遗症的更广泛影响，包括其他精神和医疗健康问题、健康风险行为和发展能力的实现障碍;以及（d）评估CBP的长期成本效益，确定CBP对关键经济结果影响的标志（例如，工作场所生产力），并检查预防或延迟CBP青少年情绪障碍发作的长期经济效益。我们将探讨青少年抑郁症在调解这些结果在年轻的成年人的潜在作用。这些目标与NIMH服务和干预研究司（DSIR）的最高优先领域一致，因为该项目将评估创新预防策略的持久性和更广泛的影响以及成本效益，将通过增加无抑郁天数来减少自杀负担，并将有助于个性化的干预和识别新的预防目标，通过我们的研究生物和心理社会调节剂的治疗效果。从这项研究中获得的知识将被用来确定谁是最有可能和最不可能从这个预防计划中受益的个人，并将为预防抑郁症的新颖和创新的策略提供经验基础。在我们最初的研究中，我们发现我们可以预防高危青少年的抑郁症，但我们还不知道这种预防是否持续，以及它是否改善了青少年的学业，就业和与他人的关系。这项拟议中的研究将是第一个研究抑郁症是否继续被预防，因为这些青少年成为年轻人。这项研究还将确定最有可能从该计划中受益的青年，并将告知我们如何制定未来的预防计划，帮助那些没有受益的青年。

DESCRIPTION (provided by applicant): This A1competitive renewal is one of four collaborative, linked R01s that proposes to examine the long-term effects of a Cognitive Behavioral Program (CBP) for preventing depression provided when adolescents were 13-17 years old. The sample is at high risk by virtue of familial (parental depression) and individual factors (past history of depression and/or current subsyndromal depressive symptoms). In the original study, we successfully enrolled 99% (N=316) of our proposed target recruitment of 320 adolescents, with equal recruitment across the 4 sites. Participants were randomized into either CBP or treatment as usual (TAU), with equally high retention (92%) in both conditions. Results through the 8-month follow-up indicated a significant prevention effect of CBP with regard to depressive episodes (HR=.60, 95% CI, .38-.96; effect size, d=.25), thus replicating and extending the earlier, single site study by Clarke et al., (2001). The aims of the current proposal are to (a) study the longer term impact of CBP on preventing depression during the critical developmental transition to early adulthood, a period of multiple new life challenges and stressors; (b) assess potential biological (e.g., genetic) and psychosocial (e.g., childhood abuse, stressful life events) moderators of response to the intervention; (c) examine the broader impact of the CBP program on sequelae of depression including other mental and medical health problems, health risk behaviors, and impairment in the attainment of developmental competencies; and (d) assess the long-term cost-efficacy of CBP, identify markers of the impact of CBP on key economic outcomes (e.g., workplace productivity), and examine the longer-term economic benefits of preventing or delaying the onset of mood disorders in adolescents with CBP. We will explore the potential role of adolescent depression in mediating these outcomes in young adulthood. These aims are consistent with the areas of highest priority for the NIMH Division of Services and Intervention Research (DSIR) insofar as this project will evaluate the durability and broader effects as well as cost-efficacy of an innovative prevention strategy, will potentially reduce the burden of suicidality by increasing depression-free days, and will both aid in the personalization of the intervention and the identification of new prevention targets through our study of biological and psychosocial moderators of treatment effects. Knowledge gained from this study will be used to identify individuals who are most and least likely to benefit from this prevention program, and will provide an empirical foundation for novel and innovative strategies for the prevention of depression. In our original study, we found that we can prevent depression among at-risk youth, but we do not yet know if this prevention lasts and whether it improves youths' schooling, employment, and relationships with others. The proposed study will be the first to examine whether depression continues to be prevented as these teens become young adults. This study also will identify youth who are most likely to benefit from this program, and will inform us about how to create future prevention programs that help those youth who did not benefit.