Longitudinal Risk Factors For Depression and Development of Individual Risk Models

项目摘要 社交焦虑症(SAD)是严重抑郁障碍(MDD)的重要危险因素 这种共病构成了高度损害的综合征和症状学的恶性循环，与 巨大的医疗成本和社会负担。尽管许多小组级别的研究检查了以下风险因素 MDD具体地说，有有限的群体和个人水平的研究来评估患有SAD的个人 过渡到抑郁发作。临床和理论证据表明，每个患者都可能表现出 独特、个性化的风险因素模式，可能会为所展示的关系增加重要背景 在集团层面的因素之间。因此，在受试者之间和受试者内配对纵向设计是很重要的。 我提出了一对综合研究，将评估个体样本中的风险因素。 易患抑郁症。研究1的发现将推进精神病理学的大规模模型，并将 为负价和社会加工的认知行为机制提供证据(即， 从属关系和依恋)RDoC系统在特别容易受到 抑郁症。研究2的结果将阐明个人特有的风险因素模式，以高- 研究1中登记的妇女的风险样本。来自这些个人风险模型的信息可以被利用来 提高现有治疗和预防工作的效力。 在研究1中，易患抑郁症的人将完成两项临床诊断 面谈和自我报告评估相隔大约三个月。研究1的数据将是 利用群体水平的分析和结果进行评估，将为抑郁诱因提供急需的证据 在社交焦虑水平升高的个人中。患有SAD的高危女性样本将是 从研究1招募到研究2，将使用新的针对个人的方法(ISM)，通过 个人移动设备，以及唾液皮质醇评估，以衡量纵向认知行为 和生理危险因素。来自研究2的ISM数据将使用以人为中心的分析进行评估，以 为SAD患者构建抑郁的个体风险模型。研究2的IRM结果将 补充和提供研究1的基于小组的发现的背景，这些发现跟踪以下方面的纵向风险因素 抑郁症的增加。将检查皮质醇的基础水平以及皮质醇唤醒反应。 使用多水平建模来确定生理模式以及认知-行为因素 预测抑郁症。这对综合研究考察了样本的群体和特定于个人的趋势 患抑郁症的高危人群和结果具有重要的意义。随着ISM方法越来越多地 通过使用个人移动技术可扩展到在更大的人群中传播，未来的工作使用 ISM影响深远，可以为个人化的治疗指示提供信息，并推进预防工作 针对易患抑郁症的人群。 好了！

Project Summary Social anxiety disorder (SAD) is an important risk factor for major depressive disorder (MDD) and together this comorbidity constitutes a highly impairing syndrome and vicious cycle of symptomatology, associated with tremendous health costs and societal burden. Despite much group-level research examining risk factors for MDD specifically, there is limited group and individual-level research evaluating how individuals with SAD transition into depressive episodes. Clinical and theoretical evidence suggests that each patient may exhibit a unique, personalized pattern of risk factors that may add important context to relationships demonstrated between group-level factors. Thus, it is important to pair both between and within-subjects longitudinal designs. I propose an integrated pair of studies that will evaluate risk factors among a sample of individuals vulnerable to depression. Findings from Study 1 will advance large-scale models of psychopathology and will provide evidence for the cognitive-behavioral mechanisms of the negative valence and social processing (i.e., affiliation and attachment) RDoC systems among individuals who are especially vulnerable to increases in depression. Findings from Study 2 will elucidate individual-specific patterns of risk factors measured in a high- risk sample of women enrolled in Study 1. Information from these individual risk models can be harnessed to improve the efficacy of existing treatment and prevention efforts. In Study 1, individuals who are vulnerable to increases in depression will complete two clinical diagnostic interviews and self-report assessments spaced approximately three months apart. Data from Study 1 will be evaluated using group level analyses and results will provide much needed evidence for depressogenic factors among individuals with elevated levels of social anxiety. A high-risk sample of women with SAD will be recruited from Study 1 into Study 2 that will use novel individual-specific methodology (ISM) administered via personal mobile devices, along with salivary cortisol assessment, to measure longitudinal cognitive-behavioral and physiological risk factors. ISM data from Study 2 will be evaluated using person-centered analyses to construct individual risk models (IRM) of depression for individuals with SAD. Results from Study 2 IRM will complement and provide context for Study 1 group-based findings that track longitudinal risk factors for increases in depression. Basal levels of cortisol, as well as cortisol awakening response, will be examined using multilevel modeling to determine how physiological patterns, along with cognitive-behavioral factors, predict depression. This integrated pair of studies examines group and individual-specific trends for a sample at high-risk for depression and results have important implications. As ISM methods are becoming increasingly scalable for dissemination in larger populations via the use of personal mobile technology, future work using ISM is far-reaching and can inform personalized directives for treatment, as well as advance prevention efforts for groups of individuals vulnerable to depression. !