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

描述（由申请人提供）：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，在育儿年龄尤其普遍。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。部分受研究人员先前工作的影响，该领域现在准备通过采用一种创新的、以家庭为基础的方法来同时预防处于危险中的儿童及其受影响的父母的抑郁症，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，该模型整合了养育过程、压力源（特别是与父母抑郁相关的压力源）和儿童面对压力时的自我调节技能，(b)抑郁症家族性的有力证据，(c)以家庭和儿童为中心的抑郁症预防项目取得了令人鼓舞的结果，(d)有证据表明，在成人中，认知行为疗法（CBT）可以减少抑郁症发作和复发。(e)科学家、临床医生和政策制定者对以家庭为基础的医疗模式的需求日益达成共识。这项为期5年的两点随机对照试验将测试家庭抑郁症预防（FDP）计划，该计划适用于患有抑郁症（过去或现在）的儿童（9-15岁）及其父母。这种“双重预防”方法是从儿童预防和成人治疗模式中提取的现有循证干预技术的新综合。参与家庭（N=300）将随机分配到FDP（每周12次+每月3次）或书面信息控制（WI）条件。父母和孩子将在干预前、中期和干预后立即以及从基线开始的6、12、18和24个月进行评估。这种单一的综合干预旨在预防儿童和家长的抑郁症状和发作，减少相关疾病，并改善功能（目的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的里程碑式研究的成本效益为基准（目的1）。此外，我们将研究中介（例如，父母行为；父母的认知；孩子的应对），并评估孩子和父母的过程和结果之间的双向影响（目标2）。最后，我们将探讨干预-结果关系的调节因素[例如，父母抑郁严重程度（Aim 3）]。

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.