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

抑郁症是一个主要的公共卫生问题，每年影响超过1500万美国成年人，在育儿年龄的人中尤其普遍。抑郁父母的后代患抑郁症的风险增加，因此是预防干预的关键目标。部分通过研究人员先前的工作，该领域现在准备通过采用创新的，以家庭为基础的方法来同时预防高危儿童及其受影响父母的抑郁症，从而在降低抑郁症发病率方面取得重大进展。这种方法的基本原理是基于（a）我们的概念模型，它整合了养育过程，压力源（特别是那些与父母抑郁症有关的），以及儿童在面对压力时的自我调节技能，（B）抑郁症家族性质的有力证据，（c）以家庭和儿童为中心的抑郁症预防计划的可喜成果，（d）有证据表明，在成年人中，认知行为疗法（CBT）减少了抑郁发作及其复发，以及（e）科学家，临床医生和决策者对以家庭为基础的医疗保健模式的需求日益达成共识。这项为期5年的双中心随机对照试验将测试一项针对儿童（9-15岁）及其父母患有抑郁症（过去或现在）的家庭抑郁症预防（FDP）计划。这种“双重预防”的方法是一种新的综合现有的证据为基础的干预技术，从儿童预防和成人治疗模式。参与家庭（N=300）将随机分配至FDP（12周一次+ 3个月一次）或书面信息对照（WI）条件。父母和孩子将在干预前、中期和干预后立即进行评估，并在基线后6个月、12个月、18个月和24个月进行评估。这种单一的综合干预旨在预防儿童和父母的抑郁症状和发作，减少相关疾病，并改善功能（目标1）。我们还将评估FDP相对于WI控制的成本效益（CE），并以儿童预防和成人抑郁症治疗（目标1）的里程碑式研究的CE为基准。此外，我们将研究调解人（例如，养育行为;父母的认知;儿童的应对），并评估儿童和父母的过程和结果之间的双向影响（目标2）。最后，我们将探讨版主[例如，父母抑郁严重程度（目标3）]的干预结果的关系。

DESCRIPTION (provided by applicant): 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 i 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 th 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.