PREVENTION OF RECURRENCE OF MAJOR DEPRESSIVE BEHAVIOR

近四分之一的年轻人将在18岁前经历严重抑郁障碍(MDD)，其中约一半人将在第一次发作后的两年内复发。由于MDD对个人和社会的衰弱影响，包括这些公民过度使用医疗服务，这是一个重大的国家健康问题。我们将从编写一份综合人际、认知和行为计划的干预手册开始，旨在防止大学新生中MDD的复发。该项目包括每周12次的小组会议，在大一的两个学期进行。我们还将制定可靠的遵守和能力衡量标准，以评估预防计划实施的忠诚度和质量。在拟议的试点研究中，我们将随机将96名曾患有MDD但目前没有抑郁的大学新生随机分配到复发预防计划或照常治疗；所有这些学生都将在基线、6个月、12个月和18个月参加标准评估，包括诊断性访谈。在第一年，我们将编写手册，制定遵守和能力衡量标准，随机将24名参与者分配到两种情况之一，并在6个月后重新评估他们。在第二年，我们将为每种情况随机分配另外24名参与者，在6个月时重新评估他们，并在12个月和18个月时对第一年的参与者进行随访。在第三年，我们将在12个月和18个月时对第二年的参与者进行随访，分析和报告数据，并修订预防手册。拟议研究的结果将使我们能够：制定修订的预防手册，将用于随后的大型随机对照试验，研究大学环境中MDD的复发；估计后续预防研究的效果和样本量；并开始在社区精神卫生中心和卫生保健组织中制定预防MDD在年轻人中复发的手册。

Nearly one-quarter of young adults will experience a Major Depressive Disorder (MDD) by the age of 18, and about one-half of these individuals will suffer from a recurrence during the two years following the first episode. Because of the debilitating effects of MDD on the individual and society, including the overuse of medical services by these citizens, this is a major national health problem. We will begin by writing an intervention manual for an integrated interpersonal, cognitive, and behavioral program designed to prevent the recurrence of MDD among entering college freshmen. The program consists of 12 weekly group sessions conducted over both semesters of the freshmen year. We will also develop reliable adherence and competence measures to evaluate the fidelity and quality of the implementation of the preventive program. In the proposed pilot study we will randomly assign 96 college freshmen who have had a previous MDD but are not currently depressed to either the recurrence prevention program or to treatment as usual; all these students will participate in standard assessment, including diagnostic interviews, at baseline, 6-, 12-, and 18-months. During the first year we will write the manual, develop the adherence and competence measures, randomly assign 24 participants each to one of the two conditions, and re-assess them at 6 months. During the second year, we will randomly assign 24 more participants to each condition, re-assess them at 6 months, and follow-up the first year participants at 12- and 18-months. During the third year we will follow-up the second year participants at 12- and 18-months, analyze and report the data, and revise the prevention manual. Results from the proposed study should allow us to: develop a revised prevention manual which will be employed in a subsequent large randomized controlled trial studying the prevention of recurrence of MDD in college settings; estimate the effect and sample sizes for the subsequent prevention study; and, begin to develop a manual for prevention of recurrence of MDD among young adults in community mental health centers and HMOs.