Preventing Youth Depression: A Multimedia Internet-Based Parent Program

描述（由申请人提供）：抑郁症是困扰青少年的最普遍的精神障碍之一。它严重影响角色功能，通常会复发或慢性病程。也有越来越多的证据表明抑郁症是家族遗传的。由于大多数抑郁的年轻人从未接受过治疗，因此迫切需要制定易于获得的预防方案。这个项目将开发和测试一种交互式多媒体干预，旨在通过教父母干预孩子的技巧来预防青少年抑郁症。该项目整合了两种经验验证的方法，使用交互式多媒体技术干预青少年：认知行为技能培训和育儿技能培训技术。经过经验检验的框架将适用于通过互联网或CD-ROM进行自我管理。干预将包括六个以知识和技能为基础的干预环节：关于青少年抑郁症的教育、情绪和活动监测、积极思考、愉快的活动参与、将情绪和活动联系起来、以及对未来的规划。额外的浏览器（即无限制访问）模块将包括：抑郁症的自我筛查，加强个人关系，学习放松，改善沟通和解决问题，抑郁症资源和育儿资源。以能力为基础的教学设计将采用自定节奏的视频教程、家庭成员和同伴的推荐以及行为建模小插曲来组织多个会议。该计划将针对三个用户群体：单身母亲、单身父亲和夫妇。该计划的基本结构将对每个目标人群相同，但具体内容将针对每个群体进行定制。第一阶段的原型针对11至14岁的单身母亲，他们报告抑郁症状加重，提供了理解抑郁、监测情绪和参与愉快活动的培训。一项受试者内部的前后设计测试了该计划的可行性，参与者被跟踪了一周。结果显示，在父母知识、自我效能、青少年抑郁症状、情绪、愉快活动参与等方面有显著的前后变化。研究对象发现该程序易于使用，用户满意度很高。II期产品将在一项大型随机试验中进行评估（N = 320对亲子）；参与者将被跟踪三个月。研究结果表明，使用所教授的认知行为技能，家长的知识和自我效能有所提高，育儿技能也有所提高；这些变化的父母结果预计调解干预条件和减少青少年抑郁症状之间的关联。II期产品的潜在商业应用是员工援助计划、健康计划和疾病管理组织。公共卫生相关性：抑郁症是青少年中最普遍的精神障碍之一，然而大多数人得不到治疗。父母在孩子的心理健康中扮演着重要的角色，但却缺乏获得支持服务和培训计划的机会。有证据表明，认知行为疗法和育儿技能培训都是帮助预防青少年抑郁症的有效干预策略，因此迫切需要为父母制定一个培训计划，将这些方法结合起来，便于实施和广泛传播。

DESCRIPTION (provided by applicant): Depression is one of the most prevalent mental disorders to afflict adolescents. It seriously impacts role functioning and typically takes a recurrent or chronic course. There is also mounting evidence for familial transmission of depression. Because most depressed youth never receive treatment, there is a critical need to develop easily accessed prevention programs. This project will develop and test an interactive multimedia intervention aimed at preventing youth depression by teaching parents skills for intervening with their children. The program integrates two empirically validated approaches for intervening with youth using interactive multimedia technology: cognitive-behavioral skills training and parenting skills training techniques. An empirically tested framework will be adapted for self- administration via the Internet or CD-ROM. The intervention will consist of six knowledge- and skills-based intervention sessions: education about youth depression, mood and activity monitoring, positive thinking, pleasant activity engagement, linking mood and activities, and planning for the future. Additional browser (i.e., unrestricted access) modules will include: self-screening for depression, enhancing personal relationships, learning to relax, improving communication and problem-solving, depression resources, and parenting resources. The competency-based instructional design will be structured for multiple sessions using self-paced video-based tutorials, family member and peer testimonials, and behavior modeling vignettes. The program will be targeted to three user groups: single mothers, single fathers, and couples. The basic structure of the program will be the same for each target population, but specific content will be customized to each group. The Phase I prototype, targeted to single mothers of 11 to 14-year-olds reporting elevated depressive symptoms, provided training on understanding depression, monitoring mood, and engaging in pleasant activities. A within-subjects pre-post design tested the feasibility of the program in which participants were followed over a 1-week period. The results indicated significant pre-post change in parent knowledge and self- efficacy to use the skills taught as well as youth depressive symptomatology, mood, and pleasant activity engagement. Subjects found the program easy to use and gave it high user satisfaction ratings. The Phase II product will be evaluated in a large randomized trial (N = 320 parent-child dyads); participants will be followed over a three-month period. Results are expected to show increased parent knowledge of and self-efficacy for using the cognitive-behavioral skills taught as well as improvement in parenting skills; these changes in parent outcomes are expected to mediate the association between intervention condition and decreases in youth depressive symptomatology. The potential commercial applications of the Phase II product are to employee assistance programs, health plans, and disease management organizations. PUBLIC HEALTH RELEVANCE: Depression is one of the most prevalent mental disorders among adolescents, however most go untreated. Parents play a significant role in their child's mental health yet lack access to support services and training programs. Given the evidence that cognitive-behavioral therapy and parenting skills training are both effective intervention strategies to help prevent youth depression, there is a critical need to develop a training program for parents incorporating these approaches that can be easily implemented and widely disseminated.