Harnessing Network Science to Personalize Scalable Interventions for Adolescent Depression

项目总结/摘要 高达80%的美国青少年抑郁症患者从未接受过治疗。一个经常被忽视的贡献者， 这种差异是青少年无法独立获得护理。从历史上看，青少年获得心理健康的机会 治疗和研究需要父母的同意，但许多青少年引用父母作为访问的障碍， 心理健康支持。将父母定位为治疗的守门人可能会阻止所有人，但最有特权的人除外 青少年获得抑郁症相关的支持。到目前为止，美国的一些（但不是全部）州已经制定了法律， 允许12岁以上的青少年在没有父母的情况下同意接受精神卫生保健， 这些政策的安全性和实用性。例如，在多个NIH资助的试验中，我的研究团队 从我们的大学IRB获得家长同意的豁免，允许我们运行在线单次会议的试验 干预（SSI），其中青少年抑郁症患者可以自我参考我们的研究（DP 5 OD 028123-S1）。我们 结果表明，青少年可以安全地参与在线SSI，并且SSI可以将抑郁症的严重程度降低到3 月后放弃父母同意的要求似乎也提高了我们样本的多样性， 招募黑人，西班牙裔，亚洲人和美洲原住民青少年的人口比例， 最近的全国性试验（N= 2，452）。大多数青少年治疗试验包括白色比例>90%的样本。因此，在本发明中， 国家政策允许青少年自我参考某些类型的心理健康支持， 照顾不同的青少年。尽管存在这种可能性，但对于研究人员，临床医生或 帮助青少年自我推荐接受心理健康研究或治疗。描述青少年的 观点是创造以青年为中心的政策的必要步骤， 青少年应该（也不应该）能够自我参考心理健康干预和研究。因此，我们认为， 这个补充项目的目标是描述青少年对青少年自我推荐进入精神病院的看法。 健康研究和治疗，整合来自青少年抑郁症患者的调查和访谈数据 （N=30来自父母资助样本，其父母参与了研究同意，N=15抽取了社会调查。 媒体招募的样本，其父母将不参与研究同意）。具体目标是（1） 描述青少年认为青少年获得心理健康支持的好处和风险， 父母的知识/同意;（2）衡量青少年对这一主题的看法是否因以下支持而不同： 亲自提供与在线提供;涉及治疗师的支持与不涉及治疗师的支持（即，自助;以及 青少年认为他们的身份和症状塑造了他们对青少年父母知识/同意的看法 心理健康研究和治疗;（3）比较青少年对（1）和（2）的反应， 父母是否参与研究知情同意程序。这项研究将产生必要的见解 关于青少年独立参与心理健康治疗和研究的政策， 对青少年获得精神卫生保健的广泛影响。

Project Summary/Abstract Up to 80% of U.S. adolescents with depression will never access treatment. An often-overlooked contributor to this discrepancy is teens’ inability to access care independently. Historically, teens’ access to mental health treatment and research has required parental consent, yet many teens cite parents as a barrier to accessing mental health support. Positioning parents as gatekeepers to treatment may prevent all but the most privileged teens from accessing depression-related support. To date, some (but not all) U.S. states have enacted laws allowing youth aged ≥12 to consent, without a parent, to mental health care, and emerging research supports the safety and utility of these policies. For instance, across multiple NIH-funded trials, my research team has secured waivers of parent consent from our University IRB, allowing us to run trials of online single-session interventions (SSIs) in which teens with depression can self-refer into our studies (DP5OD028123-S1). Our results show that teens can safely engage in online SSIs, and that SSIs can reduce depression severity up to 3 months later. Waiving parental consent requirements also seemed to boost our sample’s diversity, allowing us to recruit population-congruent proportions of Black, Hispanic, Asian, and Native American adolescents in a recent nationwide trial (N=2,452). Most youth therapy trials include samples that are >90% white. Thus, national policies allowing teens to self-refer into certain kinds of mental health support may improve access to care for diverse adolescents. Despite this possibility, there are no formal policies for researchers, clinicians, or families for facilitating adolescents’ self-referral into mental health research or treatment. Characterizing teens’ perspectives is a necessary step toward creating youth-centered policies to guide circumstances under which teens should (and should not) be able to self-refer into mental health interventions and research. Therefore, the goal of this supplement project is to characterize adolescents’ views on teens’ self-referral into mental health research and treatment, integrating survey-based and interview data from adolescents with depression (N=30 from the Parent Grant sample, whose parents were involved in study consent, and N=15 drawn a social media-recruited sample, whose parents will not be involved in study consent). Specific aims are (1) to characterize what adolescents view as the benefits and risks of teens accessing mental health support without parent knowledge/consent; (2) to gauge whether adolescents’ views on this topic differ for supports that are offered in-person versus online; supports that do versus do not involve a therapist (i.e., self-help); and whether teens perceive their identities and symptoms as shaping their views on parental knowledge/consent in teen mental health research and treatment; and (3) to compare responses to (1) and (2) across teens whose parents were and were not involved in study consent procedures. This study will yield necessary insights toward policies on adolescents’ independent participation in mental health treatment and research, with sweeping implications for teens’ access to mental health care.