A Cognitive-Behavioral Multimedia Internet Program to Prevent Youth Depression

描述（由申请人提供）：抑郁症是困扰青少年的最普遍的精神障碍之一。它严重影响角色功能，通常会复发或慢性病程。由于大多数抑郁的年轻人从未接受过治疗，因此迫切需要制定有效的预防方案，使其易于实施和广泛传播。拟议的项目将完成一个交互式多媒体（IMM）认知行为治疗（CBT）项目的开发，用于预防12至15岁青少年的临床抑郁症和改善抑郁症状。该计划将通过互联网或光盘访问。根据经验验证的干预措施改编，该计划将包括每周六次CBT会议，与青少年抑郁症相关的额外浏览器模块，以及在线支持系统。六个CBT课程将包括：关于情绪和抑郁的教育；情绪和活动监测；增加积极思考；安排和参与愉快的活动；有关情绪、活动和思想的；以及对未来的规划。以能力为基础的教学设计将采用自定进度的教程、支持性的同伴推荐和行为建模小插曲来进行重复教学。其他浏览器模块包括抑郁症自我筛选，学习放松，提高社交技能，改善沟通和解决问题的能力。在线支持系统将包括一个电子公告板，每周一次与干预教练的个人会议，以及一个专家提问论坛。该计划将包括四个目标人群：学校/社区环境中的青春期男孩和女孩以及少年司法环境中的男孩和女孩。该计划的基本结构将对每个目标人群相同，但具体内容将针对每个用户群体进行定制。第一阶段的原型提供了理解抑郁症、跟踪情绪和活动水平以及参与愉快活动的培训。第一阶段计划的目标是青少年司法机构中的男女青少年。与仅提供信息的对照组相比，结果显示在知识、自我效能和使用所教技能的意图方面发生了显著的前后变化，具有较大的多变量效应量。在一周的随访中，青少年报告说，在过去一周中，他们参与愉快活动的次数显著增加。在第二阶段，该计划的范围将扩大到包括额外的技能培训，并为四个用户群体提供有针对性的版本。第二阶段的产品将设计用于互联网/唯读光碟。将在互联网上进行一项大型随机试验（n = 300），并进行为期6个月的随访，以比较干预和控制条件下抑郁症状和抑郁发病率的变化。

DESCRIPTION (provided by applicant): Depression is one of the most prevalent mental disorders to afflict adolescents. It seriously impacts role functioning and typically takes a recurrent or chronic course. Because most depressed youth never receive treatment, there is a critical need to develop effective prevention programs that can be easily implemented and widely disseminated. The proposed project will complete development of an interactive multimedia (IMM) cognitive-behavioral therapy (CBT) program for preventing clinical depression and ameliorating depressive symptomatology in young adolescents aged 12 to 15 years old. The program will be accessible via the Internet or CD-ROM. Adapted from an empirically validated intervention, the program will include six CBT weekly sessions, additional browser modules related to youth depression, and an online support system. The six CBT sessions will include: education about moods and depression; mood and activity monitoring; increasing positive thinking; scheduling and engaging pleasant activities; relating mood, activities, and thoughts; and planning for the future. The competency-based instructional design will be structured for repeat sessions using self-paced tutorials, supportive peer testimonials, and behavior modeling vignettes. Additional browser modules include depression self-screening, learning to relax, enhancing social skills, and improving communication and problem solving. The online support system will include an electronic bulletin board, personal weekly conferences with an intervention coach, and an ask-an-expert forum. The program will include four target populations: adolescent boys and girls in school/community settings and in juvenile justice settings. The basic structure of the program will be the same for each target population, but specific content will be customized to each user group. The Phase I prototype provided training on understanding depression, tracking mood and activity levels, and engaging in pleasant activities. The Phase I program was targeted to female and male youth in juvenile justice settings. Compared to an information-only control group, the results showed significant pre-post changes in knowledge, self-efficacy, and intentions to use the skills taught, with a large multivariate effect size. At one-week follow-up, youth reported significant increases for the engagement in pleasant activities over the past week. In Phase II, the scope of the program will be expanded to included additional skills training, with targeted versions for each of the four user groups. The Phase II product will be designed for use on the Internet/CD-ROM. The fully developed program will be evaluated in large a randomized trial (n = 300) on the Internet with a six-month follow-up period to compare change in depressive symptoms and incidence rates of depression between intervention and control conditions.