FAMILY PSYCHOEDUCATION: EFFICACY IN CHILD MOOD DISORDERS

青年人的情绪障碍和自杀是主要的健康问题。与这些年轻人一起工作的临床医生需要有效的干预策略。 然而，对于患有抑郁症或躁狂抑郁症的青春期前儿童，还没有完善的心理社会干预措施。 现有的文献表明，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，但缺乏类似的儿童研究。 我们开发了一个八节，手动驱动，多家庭心理教育团体治疗计划（MFPG），旨在作为一个辅助正在进行的药物管理和个人/家庭心理治疗的孩子接受。 初步研究表明，MFPG与家庭的多方面改善有关，包括：增加对情绪障碍的了解和提高父母的应对技能;改善家庭气氛;增加对父母和儿童社会支持的看法;以及增加有效的治疗利用率。 然而，这些研究有显著的方法学局限性。 在这项拟议的研究中，我们希望严格测试MFPG对165名8至11岁情绪障碍儿童的疗效。 参与者将从多个环境中招募，以获得社会经济地位（SES），种族，既往治疗史和典型的精神卫生服务的可变性。 儿童及其主要和次要父母/护理人员将在时间点1完成治疗前评估组合，然后随机分配至即刻MFPG+常规治疗（TAU）或等待名单条件（WLC）+TAU。 将在时间点2（入组研究后约3个月）、时间点3（7个月）和时间点4（12个月）对所有患者进行重新评估。 在时间4评估后，WLC+TAU家庭将获得MFPG。 最终评估（时间5，15个月）将在治疗后进行。 假设是：1）MFPG+TAU家族在时间2、3和4时的功能优于WLC+TAU家族; 2）所有家族从治疗前即刻到治疗后即刻的功能均得到改善; 3）几个基线变量（更健康的儿童和父母功能，更高的照顾者关于治疗的一致性，以及更多的服务获得）将与所有参与者的更好结果相关;（4）性别和种族的差异与结果无关。

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.