1/2-Family Cognitive Behavioral Prevention of Depression in Youth and Parents

项目摘要/摘要 抑郁症是一个主要的公共健康问题，每年影响超过1500万美国成年人，尤其是 在育儿年龄的人中很普遍。抑郁父母的子女患抑郁症的风险增加， 因此，它们是预防性干预的关键目标。在一定程度上受到调查人员先前工作的影响， 菲尔德现在准备通过采用一种 以家庭为基础的创新方法，同时预防高危儿童和儿童的抑郁 受影响的父母。这种方法的基本原理是基于(A)我们的概念模型，该模型集成了育儿 过程、压力源(特别是与父母抑郁有关的压力源)和儿童的自我调节 面对压力的技能，(B)抑郁症家族性质的有力证据，(C)以下方面的可喜结果 以家庭和儿童为重点的抑郁症预防方案，(D)证据表明，在成年人中，认知行为 治疗(CBT)减少抑郁发作及其复发，以及(E) 科学家、临床医生和政策制定者就基于家庭的医疗保健模式的必要性进行了讨论。建议的5- 一年，两个地点的随机对照试验将测试一项针对儿童的家庭抑郁预防(FDP)计划 (9-15岁)及其患有抑郁障碍的父母(过去或现在)。这种“双重预防”方法是一种 从儿童预防和成人干预中提取现有循证干预技术的新综合 治疗模式。参与的家庭(N=300)将随机接受FDP(每周12次，每月3次 会话)或书面信息控制(WI)条件。父母和孩子将在前、中、中、 干预后即刻，基线后6个月、12个月、18个月和24个月。这一单一的集成 干预措施旨在预防儿童和父母的抑郁症状和发作，减少 改善相关障碍和改善功能(目标1)。我们还将评估FDP的成本效益(CE) 相对于儿童预防和成人领域具有里程碑意义的研究的控制和基准CE 抑郁症治疗(目标1)。此外，我们将检查中介因素(例如，父母的行为；父母的 认知；儿童的应对)，并评估儿童和父母过程之间的双向影响 成果(目标2)。最后，我们将探索[例如，父母抑郁严重性(目标3)]的调节因素 干预-结果关系。

PROJECT SUMMARY / ABSTRACT Depression is a major public health problem affecting over 15 million U.S. adults annually and is especially prevalent in those of parenting age. Offspring of depressed parents are at increased risk of depression and therefore are a critical target for preventive interventions. Informed in part by the investigators' prior work, the field is now poised to make significant advances toward reducing the rate of depression by adopting an innovative, family-based approach to simultaneously preventing depression in at-risk children and in their affected parents. The rationale for this approach is based on (a) our conceptual model that integrates parenting processes, stressors (particularly those associated with parental depression), and children's self-regulatory skills in the face of stress, (b) strong evidence of the familial nature of depression, (c) promising results from family- and child-focused depression prevention programs, (d) evidence that in adults, cognitive-behavioral therapy (CBT) reduces both depressive episodes and their recurrence, and (e) growing consensus among scientists, clinicians, and policymakers on the need for family-based models of healthcare. The proposed 5- year, two-site randomized controlled trial will test a Family Depression Prevention (FDP) program for children (ages 9-15) and their parents with depressive disorders (past or current). This "dual prevention" approach is a novel synthesis of existing evidence-based intervention techniques drawn from child prevention and adult treatment models. Participating families (N=300) will be randomized to either FDP (12 weekly + 3 monthly sessions) or a written information control (WI) condition. Parents and children will be evaluated at pre-, mid-, and immediately post-intervention, and at 6-, 12-, 18-, and 24-months from baseline. This single integrated intervention aims to prevent depressive symptoms and episodes in both children and parents, reduce associated disorders, and improve functioning (Aim 1). We also will assess the cost-effectiveness (CE) of FDP relative to the WI control and benchmarked against the CE of landmark studies in child prevention and adult depression treatment (Aim 1). Additionally, we will examine mediators (e.g., parenting behaviors; parents' cognitions; children's coping) and evaluate bidirectional effects between child and parent processes and outcomes (Aim 2). Finally, we will explore moderators [e.g., parental depression severity (Aim 3)] of the intervention-outcome relation.