FAMILY PSYCHOEDUCATION: EFFICACY IN CHILD MOOD DISORDERS

青少年的情绪障碍和自杀是主要的健康问题。与这些青少年一起工作的临床医生需要有效的干预策略。然而，对于青春期前患有抑郁症或躁狂抑郁症的儿童，尚无完善的社会心理干预措施。现有文献表明，通过家庭心理教育减少情绪表达（EE）可以改善成人情绪障碍患者的预后，但缺乏对儿童的类似研究。我们开发了一个八期，手册驱动，多家庭心理教育团体治疗计划（MFPG），旨在作为一个辅助的持续药物管理和个人/家庭心理治疗的孩子接受。初步研究表明，MFPG与家庭的多重改善有关，包括：增加对情绪障碍的了解和改善父母的应对技能；改善家庭气氛；增加对父母和儿童的社会支持的认识；提高了有效的治疗利用率。然而，这些研究在方法学上有明显的局限性。在本研究中，我们希望对165名8 - 11岁的情绪障碍儿童严格测试MFPG的疗效。参与者将从多个环境中招募，以获得社会经济地位（SES）、种族、既往治疗史和获得精神卫生服务的典型途径的可变性。儿童及其主要和次要父母/照顾者将在时间1完成治疗前评估，然后将随机分为立即MFPG加常规治疗（TAU）或等待名单条件（WLC）加TAU。所有人将在时间2（研究开始后约3个月）、时间3（7个月）和时间4（12个月）重新评估。时间4评估后，WLC+TAU家庭将接受MFPG。最终评估（时间5,15个月）将在治疗后进行。假设：1)MFPG+TAU家族在第2次、第3次和第4次的功能优于WLC+TAU家族；2)从治疗前到治疗后，所有家庭的功能都会得到改善；3)几个基线变量（更健康的儿童和父母功能，更高的照顾者对治疗的一致性，以及更多的服务获取）将与所有参与者的更好结果相关；性别和种族的差异将与结果无关。

Mood disorders and suicide in youth represent major health concerns. Clinicians working with these youth need effective intervention strategies. However, there are no well established psychosocial interventions for prepubertal children with depression or manic-depression. Existing literature suggests that reducing expressed emotion (EE) via family psychoeducation improves outcome for adults with mood disorders, but similar studies in children are lacking. We developed an eight session, manual-driven, multi-family psychoeducation group therapy program (MFPG) designed to serve as an adjunct to the ongoing medication management and individual/family psychotherapy a child receives. Preliminary studies suggest MFPG is associated with multiple improvements for families, including: increased knowledge about mood disorders and improved coping skills in parents; improved family climate; increased perceptions of social support for parents and children; and increased effective treatment utilization. However, these studies have had significant methodologic limitations. In the proposed study, we hope to rigorously test the efficacy of MFPG with 165 mood disordered children aged 8 to 11. Participants will be recruited from multiple settings to obtain variability in socioeconomic status (SES), ethnicity, prior treatment history, and typical access to mental health services. Children and their primary and secondary parents/caregivers will complete pre-treatment assessment batteries at Time 1, then will be randomized into immediate MFPG plus treatment-as-usual (TAU) or a wait-list condition (WLC) plus TAU. All will be reassessed at Time 2 (approximately 3 months after study entry), Time 3 (7 months), and Time 4 (12 months). After the Time 4 assessment, WLC+TAU families will receive MFPG. A final assessment (Time 5, 15 months) will occur post-treatment. Hypotheses are: 1) MFPG+TAU families will function better than WLC+TAU families at Times 2, 3 and 4; 2) all families will improve functioning from immediately pre-treatment to immediately post-treatment; 3) several baseline variables (healthier child and parent functioning, higher caregiver concordance regarding treatment, and greater access to services) will be associated with better outcome for all participants; and 4) differences in gender and ethnicity will be unrelated to outcome.