Child Anxiety Prevention Study Long term Extension

 描述（由申请人提供）：青少年焦虑症是：1）最普遍的精神疾病，2）与严重残疾有关，3）被认为是网关障碍-因为它们预测成人精神疾病。因此，这些疾病是一个公共卫生问题，对受影响的个人、家庭和社会来说代价高昂。关于这些疾病是否可以预防的数据至关重要。预防青少年焦虑症的系统性努力在短期内似乎很有希望，但缺乏长期有效性和成本效益的数据。本申请提出了应对和促进力量（CAPS）计划的长期影响和成本效益的评估（6）。CAPS是一种干预措施，旨在预防焦虑父母的后代发生焦虑症，这是一个患焦虑症和相关疾病的高风险人群。来自PI的NIMH资助的试点研究和大型疗效试验（K23 MH 63427和R 01 MH 077312）的数据在一年的随访中显示了有希望的结果。这项拟议的研究将继续评估这些风险青年（N = 136）在四年的随访期，作为青年过渡到青春期和青年期的关键发展阶段。这项研究将是对高危后代焦虑症预防性干预的第一个长期随访，为该领域做出了重大贡献。该研究还纳入了几个创新特征，包括1）干预的成本效益分析，2）基于理论的干预效果机制的检查，以及3）生物标志物（例如，皮质醇、α淀粉酶及其协调）， 有助于预测疾病发作和病程。该应用程序是为响应PA- 11-260而编写的，并解决了NIH的几个优先事项，包括：1）开发和评估减少精神疾病发生率的预防性干预措施，2）评估许多结果的干预效果机制（例如，精神障碍/尺寸，功能）和3）通过评估唾液生物标志物（即，那些 反映HPA轴功能），以帮助了解精神疾病的发病和缓解。该研究采用了严格的科学方法，包括多名知情人和独立评估人员。调查结果将告知该领域的干预影响，干预效果的机制，成本节约，以及疾病发作和病程的预测因子（包括生物标志物）。最后，这项研究还利用了一个难得的科学机会，通过收集数据 在该样本中，重复了临床焦虑青年和健康对照PI随访研究（R 01 MH 064089; K24 MH 096760）中的测量，建立了一个数据库，该数据库将能够比较高风险后代、临床焦虑和健康对照的许多结果，包括唾液生物标志物和NIMH研究领域标准（例如，执行功能，情绪控制），这也将提供给科学界。因此，本研究有效地利用了NIH的资金。

 DESCRIPTION (provided by applicant): Anxiety disorders in youth are: 1) the most prevalent psychiatric disorders, 2) associated with severe disability, and 3) considered gateway disorders-- as they predict adult psychiatric illnesses. Consequently, these disorders are a public health problem that is costly to afflicted individuals, families, and society. Data on whether these illnesses can be prevented is paramount. Systematic efforts to prevent anxiety disorders in youth appear promising in the short term but data on long-term effectiveness and cost-benefits are lacking. This application proposes an evaluation of the long-term impact and cost-benefits of the Coping and Promoting Strength (CAPS) program (6). CAPS is an intervention aimed at preventing the onset of anxiety disorders in offspring of anxious parents, a population at high risk for developing anxiety and related disorders. Data from the PI's NIMH-funded pilot study and large efficacy trial (K23 MH63427 and R01MH077312) demonstrated promising results at a one year follow-up. This proposed study will continue to evaluate these at risk youth (N = 136) over a four year follow-up period as youth transition into the critical developmental stages of adolescence and young adulthood. This study will be the first long-term follow-up of a preventive intervention for anxiety disorders in high risk offspring, making a major contribution t the field. The study also incorporates several innovative features including 1) a cost-benefit analysis of the intervention, 2) the examination of theory-based mechanisms of intervention effects, and 3) biological markers (e.g., cortisol, alpha amylase, and their coordination) that may help predict illness onset and course. The application was prepared in response to PA- 11-260 and addresses several NIH priorities including: 1) developing and evaluating preventive interventions that reduce the incidence of mental illness, 2) assessing mechanisms of intervention effects across many outcomes (e.g., mental disorders/dimensions, functioning) and 3) incorporating findings from translational science by evaluating salivary biomarkers (i.e., those that reflect HPA axis functioning) to help understand psychiatric illness onset and remission. The study uses rigorous scientific methods including multiple informants and independent evaluators. Findings will inform the field about the intervention impact, mechanisms of intervention effects, costs savings, and predictors (including biomarkers) of illness onset and course. Finally, the study also takes advantage of a rare scientific opportunity by collecting data in this sample that duplicate measures in the PIs follow-up study of clinically anxious youth and healthy controls (R01 MH064089; K24 MH096760) creating a database that will enable comparisons of high risk offspring, clinically anxious, and healthy controls on a number of outcomes including salivary biomarkers and a range of dimensional symptoms outlined the NIMH Research Domain Criteria (e.g., executive functioning, emotion control) that will also be available to the scientific community. Thus, the present study makes efficient use of NIH funds.