Child Anxiety Prevention Study Long term Extension

 描述(申请人提供)：青少年焦虑症是：1)最普遍的精神障碍，2)与严重残疾有关，3)被认为是入门障碍--因为他们预示着成人的精神疾病。因此，这些疾病是一个公共卫生问题，对个人、家庭和社会来说都是代价高昂的。能否预防这些疾病的数据至关重要。预防青少年焦虑症的系统性努力在短期内似乎是有希望的，但缺乏关于长期有效性和成本效益的数据。本申请建议对应对和促进力量(CAPS)计划的长期影响和成本效益进行评估(6)。CAPS是一种旨在预防焦虑父母的子女出现焦虑障碍的干预措施，焦虑父母是患焦虑和相关障碍的高危人群。PI的NIMH资助的先导研究和大疗效试验(K23 MH63427和R01MH077312)的数据在一年的随访中显示出令人振奋的结果。这项拟议的研究将在青年过渡到青春期和青春期的关键发展阶段时，在四年的随访期内继续评估这些高危青年(N=136)。这项研究将是对高危子女焦虑症的预防性干预的第一次长期跟踪，对该领域做出了重大贡献。这项研究还结合了几个创新特征，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)生物标记物(例如皮质醇、α-淀粉酶及其协调)，可以 帮助预测疾病的发病和病程。该申请是根据PA-11-260编写的，涉及NIH的几个优先事项，包括：1)开发和评估减少精神疾病发病率的预防性干预措施，2)评估多种结果(例如，精神障碍/维度、功能)的干预效果机制，以及3)通过评估唾液生物标记物(即 反映了HPA轴的功能)，以帮助了解精神疾病的发病和缓解。这项研究使用了严格的科学方法，包括多个告密者和独立评估者。研究结果将使该领域了解干预的影响、干预效果的机制、节省的费用以及疾病发生和病程的预测因素(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 在此样本中，重复了临床焦虑青年和健康对照组(R01 MH064089；K24 MH096760)PIS后续研究中的措施，创建了一个数据库，将能够比较高危子女、临床焦虑和健康对照组的许多结果，包括唾液生物标记物和NIMH研究领域标准(例如，执行功能、情绪控制)概述的一系列维度症状，该标准也将向科学界提供。因此，本研究有效地利用了国立卫生研究院的资金。

 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.