1/2 Bending Adolescent Depression Trajectories Through Personalized Prevention

描述（由申请人提供）：抑郁症是一种普遍存在的精神疾病，对发病率有重要影响。为了减轻这一巨大的公共卫生负担，重点放在减少青少年抑郁的风险和首次发病率上是一个优先事项。该项目将创新地结合风险因素研究和基于证据的预防项目，将推进个性化预防方法的知识，这可能能够更好地“弯曲”青春期激增的抑郁症的轨迹。这项合作R01研究的主要目标是检查抑郁症预防项目的效果是否可以通过将基于理论的风险概况与符合他们需求的干预措施相匹配来最大化。这个两个地点的研究将随机分配具有高认知和/或人际关系风险的青少年到两种预防干预措施中，这两种干预措施旨在解决抑郁症的不同风险因素：应对压力（CWS），一种认知行为计划，以及人际心理治疗-青少年技能训练（IPT-AST），一种人际计划。我们将把这些匹配的资料建立在预防前数据的基础上，这些数据来自一个特征鲜明的年轻人样本，我们一直在跟踪他们，作为预测抑郁症发展轨迹的合作多波自然研究的一部分（NIMH 5R01 MH077195/MH077178; Hankin and Young, pi）。我们将从最初的3年级和6年级队列中纳入青少年，他们将在7年级和10年级进行这项拟议的预防试验。来自丹佛大学（University of Denver）和罗格斯大学（Rutgers University）的210名参与者将根据认知风险和人际风险进行分层，并随机分配到两种预防条件下。独立评估人员将在基线、干预中期、干预后和随访（每6个月至干预后36个月）对参与者进行评估。该研究的目标是：(1)通过检查个人随着时间（预防计划前后三年）的轨迹变化，并通过将预防青年的轨迹与同年龄队列的变化进行比较，证明预防计划可以改变青少年的抑郁轨迹；(2)基于个体风险特征，通过将青少年与CWS或IPT-AST进行匹配和错配，评估个性化预防抑郁轨迹弯曲的方法；(3)研究弯曲抑郁轨迹的机制，并测试预防方案是否通过其假设的过程起作用；(4)探讨遗传易感性、情绪调节和气质如何影响个体对IPT-AST和CWS的反应。经过3年的前瞻性自然数据收集，本研究将实施基于证据的预防计划，为个性化医疗和改变首次发病抑郁症的发展轨迹提供重要数据。

DESCRIPTION (provided by applicant): Depression is a prevalent mental illness contributing significantly to morbidity. To decrease this substantial public health burden, focus on reducing risk and first incidence of depression during adolescence is a priority. This project, which will innovatively combine risk factor research and evidence-based prevention programs, will advance knowledge on personalized approaches to prevention that may be able to better "bend trajectories" of depression that surge throughout adolescence. The primary goal of this collaborative R01 study is to examine whether the effects of depression prevention programs can be maximized by matching youth with theoretically-based risk profiles to interventions that fit their needs. This two site study will randomly assign adolescents with high cognitive and/or interpersonal risk to two preventive interventions that are designed to address distinct risk factors for depression: Coping with Stress (CWS), a cognitive behavioral program, and Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), an interpersonal program. We will base these matching profiles on pre-prevention data from a well-characterized sample of youth whom we have been following as part of a collaborative multi-wave naturalistic study to predict developmental trajectories of depression (NIMH 5R01 MH077195/MH077178; Hankin and Young, PIs). We will include adolescents, from the original 3rd and 6th grade cohorts, who will be in 7th and 10th grades for this proposed prevention trial. A total of 210 participants across two sites, University of Denver and Rutgers University, will be stratified on cognitive and interpersonal risk and randomized to the two prevention conditions. Independent evaluators will assess participants at baseline, mid-intervention, post-intervention and follow-up (every 6 months up to 36 months post-intervention). The goals of the study are to (1) demonstrate that prevention programs can modify depression trajectories among youth by examining within person changes in trajectories over time (three years before and three years after the prevention programs) and by comparing trajectories of prevention youth with changes in same aged cohorts; (2) evaluate a personalized prevention approach to bending depression trajectories by matching and mismatching youth to either CWS or IPT-AST based on individual risk profiles; (3) examine mechanisms of bending depression trajectories and test whether the prevention programs operate via their hypothesized processes; and (4) explore how genetic susceptibility, emotion regulation, and temperament may affect individual response to IPT-AST and CWS. By implementing evidence-based prevention programs after 3-years of prospective naturalistic data collection, this study will contribute essential data on personalized medicine and altering developmental trajectories of first-onset depression.