1/2 Bending Adolescent Depression Trajectories Through Personalized Prevention

描述(申请人提供)：抑郁症是一种流行的精神疾病，对发病率有很大影响。为了减少这一重大的公共卫生负担，重点是降低青春期抑郁症的风险和首次发病率。这个项目将创新性地将风险因素研究和循证预防计划结合起来，将促进对个性化预防方法的了解，这种方法可能能够更好地“弯曲”青春期激增的抑郁症的轨迹。这项合作的R01研究的主要目标是检查抑郁症预防计划的效果是否可以通过将具有理论基础的风险特征的年轻人与符合他们需求的干预措施相匹配来最大化。这项两个地点的研究将随机将具有高认知和/或人际风险的青少年分配到两个旨在解决抑郁的不同风险因素的预防性干预措施中：应对压力(CWS)，认知行为计划，以及人际心理治疗-青少年技能培训(IPT-AST)，人际计划。我们将根据一个特征良好的青年样本的预防前数据来匹配这些样本，作为预测抑郁症发展轨迹的合作多波自然主义研究的一部分(NIMH 5R01 MH077195/MH077178；Hankin and Young，Pis)。在这项拟议的预防试验中，我们将包括原来的3年级和6年级的青少年，他们将在7年级和10年级。丹佛大学和罗格斯大学两个地点的总共210名参与者将根据认知和人际风险进行分层，并随机接受两种预防条件。独立评估员将在基线、干预中期、干预后和后续(干预后每6个月至干预后36个月)对参与者进行评估。本研究的目标是：(1)证明预防计划可以通过检查个人内轨迹随时间的变化(预防计划前三年和预防计划后三年)以及通过将预防青年的轨迹与同一年龄段队列中的变化进行比较来证明预防计划可以改变青年中的抑郁轨迹；(2)通过基于个人风险特征将青年与CWS或IPT-AST匹配和不匹配来评估个性化的预防方法；(3)检查弯曲抑郁轨迹的机制并测试预防计划是否通过其假设的过程起作用；以及(4)探索遗传易感性、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后，通过实施循证预防计划，这项研究将为个性化药物和改变首发抑郁症的发展轨迹提供必要的数据。

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.