Impact of Increasing Adolescent Depression Literacy on Treatment-Seeking Behavior

描述（由申请人提供）：这项大规模的随机化学校有效性试验将研究青少年抑郁症意识计划（ADAP）是否对寻求治疗的行为产生影响，ADAP是一项在一组前后和非随机对照研究中显示的旨在提高青少年抑郁症素养的计划。抑郁症在世界范围内普遍存在，代价高昂，是残疾和死亡的主要原因。抑郁症的发作通常发生在生命的早期，在青少年或年轻的成年人中，21%-28%的青少年在19岁时经历了严重抑郁症的发作。青春期抑郁症的发作与成年期重度抑郁症的风险增加，物质依赖，教育成绩不佳，失业和过早生育有关。这些困难在患有亚临床抑郁症的青少年中也常常很明显。抑郁症在成年期有很大的连续性，在工作，社会和家庭生活中的功能受损。未经治疗的抑郁症最严重的后果是自杀。尽管受影响的青少年和残疾与抑郁症相关的比例很高，但很少有大规模的以学校为基础的随机试验调查针对青少年抑郁症的普遍干预措施的有效性;这些研究的结果好坏参半。ADAP是一个以学校为基础的抑郁症教育计划，由约翰霍普金斯大学医学院的精神病学家和精神病护士团队于1999年开发，已在美国85所学校实施，有超过20，000名九年级学生。ADAP由学校工作人员（受过培训的健康教育教师）提供，作为标准高中健康教育课程的一部分。ADAP有效性的随机试验尚未进行。我们建议使用一项随机、普遍的以学校为基础的有效性试验，评估ADAP在美国五个地区66所学校（n= 15，000）青少年中增加抑郁症识字率和寻求治疗的有效性。我们还将确定干预影响的可能中介者和调节者（例如，获得社区精神卫生服务、教师特征、学校特征、耻辱感和忠诚度）。

DESCRIPTION (provided by applicant): This large-scale randomized school-based effectiveness trial will study whether the Adolescent Depression Awareness Program (ADAP), a program that has shown in one group pre-post and nonrandomized controlled studies to increase depression literacy among adolescents, has an impact on treatment-seeking behaviors. Depression is prevalent, costly and a major cause of disability and death worldwide. The onset of depression often occurs early in life, during teen or young adult years as 21-28 percent of adolescents experience an episode of major depression by the age of 19 years. The onset of depression during adolescence is associated with increased risk for Major depression during adulthood, substance dependence, educational underachievement, unemployment, and early parenthood. These difficulties are also often evident in adolescents with subclinical levels of depression. Depression has substantial continuity into adulthood with impaired functioning in work, social, and family life. The most severe consequence of untreated depression is suicide. Despite the high proportion of adolescents affected and disability associated with depression, there have been few large-scale school-based randomized trials investigating the effectiveness of universal interventions targeting depression among adolescents; and the results from these studies have been mixed. ADAP, a school-based depression education program developed in 1999 by a team of psychiatrists and psychiatric nurses from the Johns Hopkins University School of Medicine, has been implemented in 85 schools throughout the United States with over 20,000 ninth grade students. ADAP is delivered by school-personnel (trained health education teachers) as part of the standard high school health education curriculum. A randomized trial of the ADAP's effectiveness has not yet been conducted. We propose to assess the effectiveness of ADAP in increasing depression literacy and treatment seeking among adolescents in 66 schools (n=15,000) in five regions of the United States using a randomized, universal school-based effectiveness trial. We will also identify possible mediators and moderators of intervention impact (e.g., access to community mental health services, teacher characteristics, school characteristics, stigma, and fidelity).