Long-term Effects of the Family Check-up on Depression and Suicide Across Trials and Development

项目摘要 本申请是为了响应RFA-MH-20-110，“检查长期数据的二级数据分析”而提交的， 预防干预措施的长期和/或潜在交叉效应：预防的益处是什么 精神疾病？”提出了一个为期3年的项目，汇总家庭检查的三个试验的数据- UP（FCU），一个由医疗机构支持的预防计划，旨在减少行为问题和物质 使用，以检查对抑郁症和自杀意念/企图的长期附带影响。抑郁症是一 对整个青春期的健康功能具有长期负面影响的高度流行的疾病。 与自杀有关的行为已经升级，特别是在青春期早期，往往带来悲惨的后果。 虽然已经制定了一些针对抑郁症和自杀风险的预防计划， 规模一般不大，许多年轻人对治疗没有反应，复发率很高，有证据表明， 长期耐久性是有限的（例如，Birmaher等人，2000; Beardslee等人，2013; Sandler等人，2014年）。是的， 因此，迫切需要进行研究，以确定新的和潜在的可修改的发展 这些过程可能会放大或减弱抑郁症和自杀相关行为的风险， 发展同样重要的是要检查预防计划是否改变了共同的风险过程， 可能会对抑郁症和自杀风险产生长期的附带影响，尽管他们的初衷是 是为了减少其他类型的问题行为（例如破坏性行为和物质使用）的风险。同样地， 根据在各试验中观察到的对预防性干预措施的不同反应，迫切需要 确定治疗结果异质性的研究，与观察到的（例如，性别或 种族）或潜在的（例如，风险概况）集团成员资格。这类研究往往因基数低而受阻 自杀行为的发生率，特别是在青春期早期，这是一个严重的限制，可以通过以下方式解决 综合各个预防试验的数据。 拟议的研究涉及新的二次分析，采用综合数据分析（IDA） 程序，以检查在三个大规模的预防抑郁症和自杀相关行为的影响 FCU预防计划的试验，包括2322个家庭，长期随访数据涵盖早期 从童年到成年早期这三项试验包括丰富的家庭和同龄人风险的多方法数据- 过程，并在儿童后期和青春期早期重叠的评估点，一个关键的 抑郁症和自杀风险发作的发展跨度。使用IDA技术聚合这些数据集 将提高统计能力，允许严格审查风险的发展途径， 与交叉效应相关的因素（如治疗参与的变化），此类效应的机制， 以及观察到的或潜在的青年亚组之间结果的变异性。

Project Summary This application, submitted in response to RFA-MH-20-110, “Secondary Data Analysis to Examine Long- Term and/or Potential Cross-Over Effects of Prevention Interventions: What are the Benefits for Preventing Mental Health Disorders?” proposes a 3-year project, aggregating data across three trials of the Family Check- Up (FCU), an empirically-supported prevention program designed to reduce behavior problems and substance use, to examine long-term collateral effects on depression and suicidal ideation / attempts. Depression is a highly prevalent disorder with long-term negative implications for healthy functioning across adolescence. Suicide-related behavior has escalated, particularly in early adolescence, often with tragic consequences. While a number of prevention programs targeting depression and suicide-risk have been developed, effect sizes are generally modest, many youth fail to respond to treatment, relapse rates are high, and evidence for long-term durability is limited (e.g., Birmaher et al., 2000; Beardslee et al., 2013; Sandler et al., 2014). There is, therefore, a pressing need for research that may identify novel and potentially modifiable developmental processes that may either amplify or attenuate risk for depression and suicide-related behavior across early development. It is also important to examine whether prevention programs modifying common risk-processes may achieve long-term collateral effects on depression and suicide risk, even though their original intention was to reduce risk of other types of problem behavior (e.g. disruptive behavior and substance use). Similarly, based on the variable responses to preventive interventions observed across trials, there is a critical need for research identifying heterogeneity in treatment outcomes, associated with either observed (e.g., gender or ethnicity) or latent (e.g., risk profiles) group membership. Such research is often hampered by the low base rate of suicidal behavior, in particular, in early adolescence, a serious limitation that may be addressed by synthesizing data across individual prevention trials. The proposed research involves novel secondary analyses, employing Integrated Data Analysis (IDA) procedures, to examine effects on depression and suicide-related behaviors in three large-scale prevention trials of the FCU prevention program, including 2322 families, with long-term follow-up data covering early childhood through early adulthood. The three trials include rich multimethod data on family and peer risk- processes, and overlapping assessment points in late childhood and early adolescence, a critical developmental span for depression and suicide-risk onset. Aggregating these datasets using IDA techniques will enhance statistical power, permitting rigorous examination of developmental pathways of risk, intervention factors (such as variation in treatment engagement) related to cross-over effects, mechanisms of such effects, and variability in outcomes across either observed or latent subgroups of youth.