Prevention of Recurrence in Depression with Drugs and CT

描述(由申请人提供)：该项目是对通知编号NOT-OD-10-032和通知标题NIH宣布通过NIH基本行为和社会科学机会网络(OppNet)为竞争性修订申请(R01、R03、R15、R21/R33和R37)提供恢复法案资金的回应，重点关注数据分析方法，使研究人员能够调查心理健康和行为问题的潜在机制和过程，这些问题是广泛的行为研究领域的预防和治疗计划所针对的。具体地说，这项工作将评估统计建模方法，这些方法可用于检查预防和治疗计划(介体)的目标过程，当结果以事件开始之前的时间(生存数据)来衡量时，从而为考虑使用这些方法的研究人员提供指导。家长拨款的重点是治疗严重抑郁障碍，但作为提案的一部分，将与一位领先的方法学、健康促进和疾病预防研究人员建立合作。此外，这些方法将适用于抑郁症以外的精神健康障碍、药物滥用和健康行为(例如体重控制)，不需要在应用研究的背景下使用，尽管它们将在父母赠款的情况下使用。父母赠款，用药物和认知疗法预防抑郁症复发，是一项由NIMH资助的多点试验，在该试验中，抑郁症门诊患者被随机分为单独服用抗抑郁药物(ADM)或接受ADM和认知疗法(CT)。它的设计具有足够的能力：1)检测在ADM的治疗反应和预防复发方面可能伴随着CT的好处，2)探索治疗目标的预测因素和潜在过程，并评估它们与症状改善的关系(一个基本的行为和社会科学研究目标)，潜在地阐明添加CT可能会如何增加额外的好处，并提供关于如何改进抑郁症治疗的信息。目前正在收集对多种认知变化和治疗过程的测量，以检验关于这些结构作为症状改善的潜在机制的假设。拟议的模拟工作不包括在最初的父赠款中，它将有助于确保使用最佳方法来实现这一目标。 与公共卫生相关：抑郁症是最普遍和最令人衰弱的精神疾病之一。通过对在抑郁症治疗中将心理治疗添加到药物治疗中的益处进行估计，并确定从联合治疗中受益最大的患者亚群，该项目的发现将能够指导临床医生选择治疗方法，并改善结果。此外，还将研究影响结果的机制和过程，这将有可能导致新的治疗方法和进一步改善结果。

DESCRIPTION (provided by applicant): This project, a response to notice number NOT-OD-10-032 and notice title NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications (R01, R03, R15, R21/R33, and R37) through the NIH Basic Behavioral and Social Science Opportunity Network (OppNet), focuses on approaches to data analysis that allow researchers to investigate underlying mechanisms and processes of mental health and behavioral problems that are targeted by prevention and treatment programs in a wide range of behavioral research areas. Specifically, the work will evaluate statistical modeling approaches that can be used to examine processes targeted by prevention and treatment programs (mediators) when outcomes are measured as time until the onset of an event (survival data), and thereby provide guidance to researchers who consider using these approaches. The parent grant focuses on treatment for major depressive disorder, but as part of the proposal, collaboration will be established with a leading methodological and health promotion and disease prevention researcher. Furthermore, these approaches would apply to mental health disorders other than depression, to substance abuse, and to health behaviors (e.g., weight control), and need not be utilized in the context of applied research, though they will be in the case of the parent grant. The parent grant, Prevention of Recurrence in Depression with Drugs and Cognitive Therapy, is an NIMH-funded multi-site trial in which depressed outpatients have been randomized to antidepressant medications (ADM) alone or to ADM and cognitive therapy (CT). It was designed with power sufficient to: 1) detect benefits that might accompany the addition of CT to ADM with respect to treatment response and the prevention of recurrence, and 2) explore predictors and underlying processes that are targeted by the treatments, and assess their relationships to symptom improvement (a basic behavioral and social sciences research goal), potentially elucidating how additional benefits might accrue from adding CT and providing information about how to improve treatments for depression. Measures of multiple kinds of cognitive changes and treatment processes are being collected in order to test hypotheses about these constructs as underlying mechanisms of symptom improvement. The proposed simulation work, which is not included in the original parent grant, will help to ensure that the best approaches are used to achieve this aim. PUBLIC HEALTH RELEVANCE: Depression is one of the most prevalent and debilitating of the psychiatric disorders. By yielding estimates of the benefit of adding psychotherapy to medication therapy in the treatment of depression, and identifying subgroups of patients who most benefit from combined treatment, findings from this project will be able to guide clinicians in selecting treatments, and improving outcomes. In addition, mechanisms and processes that influence outcome will be studied, which will have the potential to lead to new treatment approaches and further improved outcomes.