Reducing Health Risk Behavior & Improving Health Adolescent Depression

描述（由申请人提供）：本申请是为了响应RFA-MH-06-002邀请以艾滋病毒干预为模型的精神障碍的健康行为改变研究，提交一项随机试验，以评估健康行为干预对减少健康风险行为和促进重度抑郁症（MDD）青少年健康的影响。青春期重度抑郁症是一种常见的损害性疾病，会导致严重的残疾、发病率和死亡率。健康风险行为经常与青少年重度抑郁症共病，增加了该疾病的个人、社会和社会负担。减少青少年重度抑郁症健康风险行为的有效干预措施对于预防负面健康后果和改善健康和精神健康结果非常重要。该提案建立在我们小组在艾滋病毒预防行为干预（Rotheram-Borus）和抑郁青少年初级保健干预（Asarnow）方面的专业知识基础上。我们将招募300名在初级保健访问时通过筛查确定患有重度抑郁症的青少年。青少年将被随机分配到1)健康行为干预组，或2)常规护理组。干预措施针对健康危险行为的四个主要领域：烟草使用；酗酒和吸毒；性活动;和肥胖。基于我们之前的艾滋病毒预防干预措施和我们在初级卫生保健服务中整合青少年抑郁症行为干预措施的工作，干预措施采用协作护理模式，由护理经理支持初级卫生保健提供者，并提供10次认知行为健康教育干预，旨在减少健康风险行为，促进和维持积极的健康行为。与成功的艾滋病毒预防规划一样，干预措施同时处理多种风险因素，在多个系统层面（个人、家庭、组织）进行干预，并强调将青年与护理联系起来。在基线和6个月和12个月随访时监测结果。我们假设，与接受常规护理的青少年相比，随机接受干预的青少年会有更少的健康风险行为（我们的主要结果），并改善了次要结果（抑郁、对护理的满意度和生活质量/功能）。研究结果将为改善重度抑郁症青少年健康和减少健康风险行为的战略提供重要指导。

DESCRIPTION (provided by applicant): This application for a randomized trial to evaluate a health behavior intervention for reducing health risk behaviors and promoting health in adolescents with major depressive disorder (MDD) is being submitted in response to RFA-MH-06-002 inviting research on health behavior change in mental disorders modeled from HIV interventions. MDD in adolescence is a common and impairing disorder which leads to significant disability, morbidity, and mortality. Health risk behaviors are frequently comorbid with adolescent MDD, adding to the personal, social, and societal burden of the disorder. Effective interventions for reducing health risk behavior in adolescent MDD are important for preventing negative health consequences and improving both health and mental health outcomes. The proposal builds on our group's expertise in behavioral interventions for HIV prevention (Rotheram-Borus) and primary care interventions for depressed adolescents (Asarnow). We will enroll 300 adolescents with MDD identified through screening at the time of a primary care visit. Adolescents will be randomized to either 1) the health behavior intervention, or 2) usual care. The intervention targets four major areas of health risk behavior: tobacco use; alcohol and drug use; sexual activity; and obesity. Based on our prior HIV preventive interventions and our work integrating behavioral interventions for adolescent depression within primary health care services, the intervention employs a collaborative care model, with a Care Manager supporting the primary care provider and delivering a 10-session cognitive-behavioral health education intervention aimed at reducing health risk behaviors and promoting and maintaining positive health behaviors. Like successful HIV prevention programs, the intervention addresses multiple risk factors simultaneously, intervenes at multiple system levels (individual, family, organization), and emphasizes linking youth to care. Outcomes are monitored at baseline and at 6 and 12-month follow-ups. We hypothesize that adolescents randomized to the intervention, compared to adolescents in usual care, will have fewer health risk behaviors (our primary outcome) and improved secondary outcomes (depression, satisfaction with care, and quality of life/functioning). Results will provide critical guidance to the field regarding strategies for improving health and reducing health risk behaviors in adolescents with MDD.