SOFTAD Substance Use Outcomes Following Treatment for Adolescents with Depression

描述(申请人提供)：药物滥用是美国青少年中的一个主要公共卫生问题，与严重的负面后果有关，包括高风险的性行为和青少年死亡的主要原因：事故、凶杀和自杀。物质使用障碍(SUD)是青少年精神障碍的三种最常见形式之一。预防这类疾病是公共卫生的优先事项。国家药物滥用研究所(NIDA)和国家精神卫生研究所(NIMH)最近发布了RFA：DA-03-007，呼吁调查儿童精神病理学和儿童干预对随后药物滥用的影响。这个项目，青少年抑郁症治疗后的物质使用结果(SOFTAD)是对完成NIMH青少年抑郁症治疗研究(TADS)的青少年的扩展跟踪。我们开发并正在协调TADS，这是一项12个地点的研究，在432名患有严重抑郁障碍(MDD)的青少年中比较认知行为疗法(CBT)、氟西汀(Floxetine)、CBT和Flx的联合治疗和安慰剂，以及相互之间的纵向比较。TADS是第一个包括药物使用和滥用措施的青少年MDD治疗研究。我们建议加强对药物使用结果和相关家庭因素的衡量，并将TADS治疗的随访期延长至五年，以解决RFA：DA-03-007中强调的关键问题。这些包括治疗MDD(和特定治疗)对随后的药物使用结果的影响，在情感和药物使用领域确定成功结果的调节因素和中介因素，以及临床样本中青少年MDD与药物使用或滥用之间的纵向关系。每六个月将对大约300名青少年进行跟踪和评估。将收集自我报告、家长报告和诊断性访谈措施。主要的假设是，MDD的成功治疗将减少后续的药物使用问题，以及其他问题，将使用卡方、Logistic回归和结构方程建模进行检验。SOFTAD将由杜克临床研究所(DCRI)协调，该研究所是协调TADS的同一组织，从而实现显著的效率和成本节约。

DESCRIPTION (provided by applicant): Substance abuse is a major public health problem among adolescents in the United States, associated with serious negative outcomes including high-risk sexual behavior and the leading causes of adolescent death: accidents, homicide and suicide. Substance use disorders (SUD's) are one of the three most common forms of adolescent psychiatric disturbance. Prevention of such disorders is a public health priority. The National Institute on Drug Abuse (NIDA) and the National Institute of Mental Health (NIMH) recently released RFA: DA-03-007, calling for investigations into the impact of child psychopathology and childhood interventions on subsequent drug abuse. This project, Substance use Outcomes Following Treatment for Adolescent Depression (SOFTAD) is an extended follow-up of adolescents who have completed the NIMH Treatment for Adolescents with Depression Study (TADS). We developed and are coordinating TADS, a 12-site study comparing cognitive behavior therapy (CBT), fluoxetine (FLX), combined CBT and FLX acutely to one another and to placebo, and longitudinally to one another in 432 adolescents with Major Depressive Disorder (MDD). TADS is the first adolescent MDD treatment study to include measures of substance use and abuse. We propose to enhance the measurement of substance use outcomes and related family factors and to extend the follow-up period from TADS treatment to five years in order to address critical questions emphasized in RFA: DA-03-007. These include the impact of treating MDD (and of specific treatments) on subsequent substance use outcomes, the identification of moderators and mediators of successful outcome in the affective and substance use domains, and the longitudinal relationship between adolescent MDD and substance use or abuse in a clinical sample. Approximately 300 adolescents will be followed and assessed every six months. Self-report, parent-report and diagnostic interview measures will be collected. The major hypothesis, that successful treatment of MDD will reduce subsequent substance use problems, and additional questions, will be tested using chi-square, logistic regression, and structural equation modeling. SOFTAD will be coordinated by the Duke Clinical Research Institute (DCRI), the same organization coordinating TADS, thus realizing substantial efficiencies and cost savings.