2/2-Evaluation of Family Focused Treatment for Childhood Depression

描述（由申请人提供）：儿童期发作的抑郁症是一种损害性的，经常复发和持续的疾病，影响当前和以后的发展，导致高个人，社会和经济成本。尽管早发性抑郁症的成本，在当前的实践参数的心理治疗的初始过程中的重点，以及对青少年抑郁症的广泛研究，我们目前缺乏随机对照试验评估心理治疗抑郁症儿童。本申请旨在解决关于患有抑郁症的儿童的最佳心理社会治疗策略的知识方面的这一差距。我们提出了一个两个网站的随机对照试验，以评估家庭为中心的治疗（FFT）的疗效，相比，一个单独的客户为中心的心理治疗（IP）仿照“通常”的社区护理。该应用程序建立在我们最初的NIMH治疗开发补助金的基础上，并扩展了通过该补助金进行的工作，在该补助金中，我们开发并手动化了FFT，并进行了初步试验，证明FFT显著改善了抑郁症结局，全球功能，并减少了父母报告的内化，外化和总问题，通过9个月的治疗后随访，收益持续并得到加强。FFT采用人际关系模型来理解抑郁症状是如何维持的，强调发展家庭技能/策略来改变人际关系过程，并致力于建立一个支持恢复和增强抗压能力和复原力的家庭环境。这种方法可能特别适合抑郁症儿童的发展需求，因为他们依赖父母，FFT有潜力解决多个家庭成员的需求，我们的数据支持抑郁症，功能和其他并发症状的益处。拟议的项目将招募140名患有抑郁症（重度抑郁症和/或心境恶劣障碍）的儿童（8-12岁）。儿童将被随机分配接受为期14周的FFT或IP试验。在研究入组时、治疗后即刻和治疗后9个月随访时，所有受试者将接受临床状态、心理社会和家庭功能的强化评价。我们假设FFT将与抑郁症的更快恢复，症状和心理社会功能的更大改善以及相关症状/综合征（焦虑和对立障碍）的减少相关。后续评估将检查治疗收益的维持情况。将评价潜在的调节（情绪表达，存在共病外化障碍）和中介（家庭功能，父母抑郁）变量。为了提高外部效度并促进大规模、多样化样本的招募，该研究将在波士顿大学和加州大学洛杉矶分校两个地点进行。儿童期发作的抑郁症是一种损害性的、经常复发的和持续性的疾病，影响当前和以后的发展，导致高昂的社会和经济成本，开发有效的治疗方法至关重要。以家庭为中心的治疗（FFT），专门针对抑郁症前青少年及其家庭，提出了一个人际关系模型，以了解抑郁症状是如何维持的，强调发展家庭技能/策略，以改变人际关系过程，并致力于建立一个家庭环境，支持恢复，提高抗压能力和弹性。本申请的目的是进行FFT治疗抑郁学龄青年的随机对照试验。 公共卫生相关性：儿童期发作的抑郁症是一种损害性的、经常复发的和持续性的疾病，影响当前和以后的发展，导致高昂的社会和经济成本，开发有效的治疗方法至关重要。以家庭为中心的治疗（FFT），专门针对抑郁症前青少年及其家庭，提出了一个人际关系模型，以了解抑郁症状是如何维持的，强调发展家庭技能/策略，以改变人际关系过程，并致力于建立一个家庭环境，支持恢复，提高抗压能力和弹性。本申请的目的是进行FFT治疗抑郁学龄青年的随机对照试验。

DESCRIPTION (provided by applicant): Childhood-onset depression is an impairing and often recurrent and persistent disorder that impacts current and later development resulting in high personal, social, and economic costs. Despite the costs of early-onset depression, the emphasis in current practice parameters on an initial course of psychosocial treatment, and extensive research on adolescent depression, we currently lack randomized controlled trials evaluating psychosocial treatments for children with depressive disorders. The present application aims to address this gap in knowledge regarding optimal psychosocial treatment strategies for children suffering from depressive disorders. We propose a 2-site randomized controlled trial to evaluate the efficacy of Family Focused Treatment (FFT), as compared to an individual client-centered psychotherapy (IP) modeled after "usual" community care. This application builds on and extends work conducted through our initial NIMH treatment development grant in which we developed and manualized the FFT and carried out a preliminary trial demonstrating that the FFT resulted in significant improvements in depression outcomes, global functioning, and reductions in parent reported internalizing, externalizing, and total problems, with gains persisting and strengthening by the 9-month post-treatment follow-up. FFT adopts an interpersonal model for understanding how depressive symptoms are maintained, emphasizes developing family skills/strategies for altering interpersonal processes, and works on building a family environment that supports recovery and enhances stress resistance and resilience. This approach may be particularly appropriate to the developmental needs of depressed children, given their dependence on parents, the potential of FFT to address the needs of multiple family members, and our data supporting benefits on depression, functioning, and other co-occurring symptoms. The proposed project will enroll 140 children (ages 8-12) with depressive disorders (major depression and/or dysthymic disorder). Children will be randomly assigned to receive a 14-week trial of either FFT or IP. At study entry, immediately post-treatment, and at a 9-month post-treatment follow-up all participants will undergo intensive evaluation of clinical state and psychosocial and family functioning. We hypothesize that FFT will be associated with quicker recovery from depression, greater improvement in symptoms and psychosocial functioning, and reduction in associated symptoms/syndromes (anxiety and oppositional disorders). Follow-up evaluations will examine maintenance of treatment gains. Potential moderating (Expressed Emotion, presence of comorbid externalizing disorder) and mediating (family functioning, parental depression) variables will be evaluated. To enhance external validity and facilitate recruitment of a large, diverse sample, the study will be conducted at two sites -- Boston University and UCLA. Childhood-onset depression is an impairing and often recurrent and persistent disorder that impacts current and later development resulting in high social and economic costs, and development of efficacious treatments is of critical importance. Family-Focused Treatment (FFT), developed to specifically target depressed pre- adolescents and their families, presents an interpersonal model for understanding how depressive symptoms are maintained, emphasizes developing family skills/strategies for altering interpersonal processes, and works on building a family environment that supports recovery and enhances stress resistance and resilience. The goal of the current application is to conduct a randomized controlled trial of FFT for the treatment of depressed school-aged youth. PUBLIC HEALTH RELEVANCE: Childhood-onset depression is an impairing and often recurrent and persistent disorder that impacts current and later development resulting in high social and economic costs, and development of efficacious treatments is of critical importance. Family-Focused Treatment (FFT), developed to specifically target depressed pre- adolescents and their families, presents an interpersonal model for understanding how depressive symptoms are maintained, emphasizes developing family skills/strategies for altering interpersonal processes, and works on building a family environment that supports recovery and enhances stress resistance and resilience. The goal of the current application is to conduct a randomized controlled trial of FFT for the treatment of depressed school-aged youth.