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

描述（由申请人提供）：本a1竞争性更新是四个协作性关联r01之一，旨在研究13-17岁青少年提供的认知行为计划（CBP）预防抑郁症的长期效果。由于家族性（父母抑郁）和个体因素（既往抑郁史和/或当前亚综合征性抑郁症状），样本处于高风险。在最初的研究中，我们成功招募了我们计划招募320名青少年的99% (N=316)，在4个地点平均招募。参与者被随机分为CBP或常规治疗（TAU），两种情况下的保留率都同样高（92%）。8个月的随访结果表明，CBP对抑郁发作有显著的预防作用（HR= 0.60, 95% CI, 0.38 - 0.96；效应量，d= 0.25），从而复制并扩展了Clarke et al.（2001）早期的单点研究。当前提案的目的是(a)研究CBP在向成年早期的关键发育过渡期间预防抑郁症的长期影响，这是一个充满多种新的生活挑战和压力源的时期；(b)评估对干预反应的潜在生物（如遗传）和社会心理（如童年虐待、压力生活事件）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损害；(d)评估CBP的长期成本效益，确定CBP对关键经济结果（如工作场所生产力）影响的标志，并检查预防或延迟患有CBP的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在青年成年期介导这些结果的潜在作用。这些目标与NIMH服务和干预研究部（DSIR）最优先考虑的领域是一致的，因为该项目将评估一种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潜在地减轻自杀负担，通过我们对治疗效果的生物和社会心理调节因子的研究，将有助于干预措施的个性化和确定新的预防目标。从这项研究中获得的知识将用于识别最可能和最不可能从这项预防计划中受益的个体，并将为预防抑郁症的新颖和创新策略提供经验基础。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能持续下去，以及它是否能改善青少年的学业、就业和与他人的关系。这项提议的研究将是第一个研究抑郁症是否在这些青少年成年后继续得到预防的研究。这项研究还将确定最有可能从这项计划中受益的青少年，并将告诉我们如何制定未来的预防计划，帮助那些没有受益的青少年。

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.