Effectiveness Trial of Treatment to Reduce Serious Antisocial Behavior in Emerging Adults with Mental Illness

 描述（由申请人提供）：严重的反社会行为，包括刑事犯罪，对社会来说是极其昂贵的。这种行为的发生率在成年初期是最高的。反社会行为在患有精神疾病（MI）的新兴成年人（EAs）中特别高;研究结果表明，大多数患有MI的EAs将在25岁之前被捕，大多数人多次被捕，并受到严重指控。因此，有一个明确的公共卫生需要有效的治疗，以减少严重的反社会行为的EA与MI。令人惊讶的是，目前还没有有效的干预措施来减少EA中严重的反社会行为，无论是否有MI。有效的青少年反社会行为干预解决了这种行为的综合原因。同样，该团队已经开发并完成了一项针对患有MI和严重反社会行为的EA的定义明确的年龄定制干预研究，该研究解决了EA反社会行为的相关性，并提供了MI治疗。该干预措施是对行之有效的青少年反社会行为干预措施多系统治疗（MST）的一种适应。MST-EA是一个单一的来源，针对反社会行为的EA相关性，包括有报酬的活动（学校，工作，住房和积极的关系）和减少物质使用，部分是通过针对自我调节不良的近端机制。MST-EA还通过减少MI症状来解决这些相关性。研究小组已经在一项成功完成的基于社区的开放试验（R34 MH 081374 -01，PI：Davis）中确定了这种干预的安全性、可行性和初步疗效。这项拟议中的研究将严格评估MST- EA对减少严重反社会行为的有效性。具体而言，240名患有MI和最近被捕或从司法机构释放的EA将被随机分配接受MST-EA或治疗（TAU）。将在第0、2、4、6、8、12和16个月完成评估，并使用并行报告和系统记录确认结局数据。第一个目标将是评估效果超过 MST-EA改善治疗最终结局的时间：减少严重的反社会行为。第二个目的是评价MST-EA对（a）治疗的关键近端目标（自我调节）和（B）治疗的拟议中间结局（有酬活动、物质使用和MI问题）的影响。最终的目的是确定MST-EA对最终结果的影响是否是其对治疗的近端目标和中间结果的影响的结果。目前没有任何反社会行为治疗在这个年龄组中表现出有效性。拟议研究的最终效果将是减少反社会行为和其他公共健康相关行为（MI症状，物质使用，无家可归，失业），其中一个最高风险的MI人群。由于强调治疗机制和几乎没有MI研究集中在EA，这项创新研究具有很高的潜力，以推进该领域。

 DESCRIPTION (provided by applicant): Serious antisocial behavior, including criminal offending, is extremely costly to society. Rates of such behavior are highest during emerging adulthood. Antisocial behavior is especially high among emerging adults (EAs) with mental illness (MI); findings suggest the majority of EAs with MI will be arrested by age 25, most with multiple arrests, and for serious charges. Thus, there is a clear public health need for effective treatments to reduce serious antisocial behavior in EAs with MI. Astonishingly, there are no established interventions with evidence of efficacy to reduce serious antisocial behavior among EAs, with or without MI. Effective antisocial behavior interventions in adolescents address the comprehensive causes of that behavior. Similarly, this team has developed and completed research on a well-defined age-tailored intervention for EAs with MI and serious antisocial behavior that addresses the correlates of EA antisocial behavior, and provides MI treatment. The intervention is an adaptation of the well-established effective juvenile antisocial behavior intervention, Multisystemic Therapy (MST). MST-EA is a single source that targets the EA correlates of antisocial behavior, including gainful activity (school, work, housing, and positive relationships) and reduced substance use, in part by targeting the proximal mechanism of poor self-regulation. MST-EA also addresses these correlates through reducing MI symptoms. The investigative team has already established the safety, feasibility, and preliminary efficacy of thi type of intervention in a successfully completed community-based open trial (R34MH081374-01, PI: Davis). The proposed study will rigorously evaluate the effectiveness of MST- EA for reducing serious antisocial behavior. Specifically, 240 EAs with MI and recent arrests or release from justice facilities will be randomized to receive MST-EA or Treatment as Usual (TAU). Assessments will be completed at months 0, 2, 4, 6, 8, 12, and 16, with confirmation of outcome data using collateral reports and system records. The first aim will be to evaluate the effect over time of MST-EA for improving the ultimate outcome of treatment: reduced serious antisocial behavior. The second aim is to evaluate the effect of MST-EA on (a) the key proximal target of treatment (self-regulation) and (b) the proposed intermediate outcomes of treatment (gainful activity, substance use, and MI problems). The final aim will be to determine whether MST-EA's effect on the ultimate outcome is the result of its effect on the proximal target and intermediate outcomes of treatment. There is a current absence of any antisocial behavior treatments with demonstrated efficacy in this age group. The ultimate effect of the proposed research would be decreased antisocial behavior and other public health-related behaviors (MI symptoms, substance use, homelessness, unemployment) among one of the highest-risk population of individuals with MI. With an emphasis on treatment mechanisms and the near absence of MI research focused on EAs, this innovative research has high potential to advance the field.