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

描述(由申请人提供)：这项A1竞争更新是四个合作的、相互关联的R01之一，该R01建议检查13-17岁青少年提供的预防抑郁症的认知行为计划(CBP)的长期影响。由于家庭因素(父母抑郁)和个人因素(既往抑郁史和/或当前亚综合征抑郁症状)，样本处于高危状态。在最初的研究中，我们成功地招募了我们建议的320名青少年目标招募中的99%(N=316)，4个地点的招募人数相等。参与者被随机分为CBP或常规治疗(TAU)，在两种情况下都有同样高的保留率(92%)。通过8个月的随访，结果表明CBP对抑郁发作有显著的预防效果(HR=0.60，95%CI，0.38-0.96；效果大小，d=0.25)，从而复制和扩展了Clarke等人(2001)早期的单部位研究。当前提案的目的是：(A)研究CBP在向成年早期的关键发展过渡期间对预防抑郁症的较长期影响；(B)评估潜在的生物学(例如，遗传)和心理社会(例如，童年虐待、应激性生活事件)调节因素对干预的反应；(C)检查CBP计划对抑郁症后遗症的更广泛影响，包括其他心理和医学健康问题、健康危险行为，以及在获得发展能力方面的损害；以及(D)评估CBP的长期成本效益，确定CBP对关键经济成果(例如工作场所生产力)的影响的指标，并审查预防或推迟CBP青少年情绪障碍发病的长期经济效益。我们将探索青春期抑郁在青春期调节这些结果中的潜在作用。这些目标与NIMH服务和干预研究部(DSIR)的最优先领域一致，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，将有可能通过增加无抑郁天数来减少自杀负担，并将通过我们对治疗效果的生物和心理社会调节因素的研究，帮助个性化干预和确定新的预防目标。从这项研究中获得的知识将被用来确定最有可能和最不可能从这一预防计划中受益的个人，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年中的抑郁症，但我们还不知道这种预防是否持续，以及它是否改善了年轻人的教育、就业和与他人的关系。这项拟议的研究将第一次检查这些青少年成长为年轻人后，抑郁症是否继续得到预防。这项研究还将确定最有可能从这一计划中受益的青年，并将告诉我们如何创建未来的预防计划，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.