Family Based Prevention of Child Anxiety

描述（由申请人提供）：焦虑症是儿童和青少年中最常见的精神疾病之一，患病率平均为5-10%。这些障碍与学业、家庭、社会和心理功能的显著短期和长期损害有关。虽然药物和认知行为疗法已经被发现是有效的治疗方法，但预防青少年焦虑症的努力仍然有限。鉴于发病率高、相关损害和治疗这些疾病的费用（成年人每年估计为420亿美元），预防措施可能对公共卫生产生重大影响。家庭总体研究表明，焦虑父母的孩子患焦虑症的风险较高，因此是预防的重要目标人群。PI的K23试点研究结果发现，以家庭为基础的短暂干预使这一人群的焦虑症发病率降低了30-50%。本R01应用的目的是评估该干预措施在减轻焦虑症状和预防焦虑父母后代出现焦虑障碍方面的功效。此外，本研究将检验干预效果的理论基础中介。将采用2（干预条件：预防与信息监测对照）× 4（评估期：干预前、干预后、6个月和12个月随访）实验设计对干预进行评估。本研究采用严格的科学方法，包括随机对照设计，多信息提供者和措施来评估关键结构，独立评估者（IEs）来评估结果和中介变量，并对治疗师和IEs进行强化培训，以确保高质量的研究实施。这项研究将是第一个旨在预防焦虑父母的后代患上焦虑症的研究。这一应用响应了国家精神疾病预防研究咨询精神健康工作组（2001年）的建议，以及早前来自医学研究所精神疾病预防委员会和NIMH预防指导委员会（Mrazek & Haggerty， 1994年）的建议，以发展和评估针对青少年的预防性干预措施。儿童和青少年的焦虑症是一种常见的使人衰弱的疾病。虽然认知行为治疗是有效的，但预防工作将通过减少治疗需求和改变高危儿童的生活轨迹，对公共卫生产生重大影响。焦虑成年人的后代患这些疾病的风险很大，也是预防工作的重要目标。本R01申请的目的是评估PI在一项试点研究中开发的短期心理社会干预是否可以预防焦虑父母的后代出现焦虑障碍。

DESCRIPTION (provided by applicant): Anxiety disorders are among the most common psychiatric illnesses in children and adolescents with prevalence rates averaging 5-10%. These disorders are associated with significant short- and long-term impairment in academic, familial, social, and psychological functioning. Although medication and cognitive-behavioral therapies have been found to be effective treatments, efforts to prevent anxiety disorders in youth have been limited. In light of the high prevalence, the associated impairment, and the cost of treating these disorders (estimated at 42 billion dollars a year for adults), preventive measures could have a significant public health impact. Family aggregate studies indicate that children of anxious parents are at an elevated risk for developing anxiety disorders and thus an important target population for prevention. Results from the PI's K23 pilot study found that a brief family-based intervention reduced the incidence of anxiety disorders in this population by 30-50%. The purpose of this R01 application is to evaluate the efficacy of this intervention for reducing anxiety symptoms and preventing the onset of anxiety disorders in the offspring of anxious parents. In addition, this study will examine theoretically-based mediators of intervention effects. The intervention will be evaluated using a 2 (intervention condition: prevention versus an information- monitoring control) x 4 (assessment period: pre-, post-intervention, 6-, and 12-month follow-up) experimental design. This study uses rigorous scientific methods including a randomized controlled design, multiple informants and measures to assess key constructs, independent evaluators (IEs) to assess outcome and mediator variables, and intensive training for therapists and IEs to assure a high quality of study implementation. This study will be the first aimed at preventing anxiety disorders in the offspring of anxious parents. This application responds to recommendations made by the National Advisory Mental Health Work Group on Mental Disorders Prevention Research (2001) and earlier recommendations from both the Institute of Medicine's Committee on Prevention of Mental Disorders and the NIMH's Prevention Steering Committee (Mrazek & Haggerty, 1994) to develop and evaluate preventive interventions for youth. Anxiety disorders in children and adolescents are common and debilitating illnesses. While cognitive-behavioral treatment is effective, prevention efforts would have a significant public health impact by reducing the need for treatment and altering the life trajectories of at risk children. Offspring of anxious adults are at a significant risk for developing these disorders and an important target for prevention efforts. The purpose of this R01 application is to evaluate whether a short-term psychosocial intervention, developed by the PI in a pilot study, can prevent the onset of anxiety disorders in the offspring of anxious parents.