Longterm Treatment Effects on Juvenile Justice Girls' Depression and Suicide Risk

描述（由申请人提供）：拟议项目的目的是解决在少年司法系统（JJS）中对女孩进行干预的证据基础上的差距。所有的目标都集中在以犯罪为重点的干预在多大程度上破坏了这些高风险女性在成年早期的抑郁症状和自杀风险轨迹。参与者是164名青少年时期参与JJS的女性。这些妇女最初在13-17岁时参加了一项随机对照试验，以测试多维治疗寄养（MTFC, Chamberlain, 2003）与常规治疗（TAU）在减少犯罪和药物滥用方面的有效性。在最初的2年随访期间，对犯罪行为、抑郁症状和自杀念头进行了四次测量。目前正在进行一项研究（R01 DA024672: 2009年2月- 2012年12月），其中将对这些妇女在成年早期（18-28岁）进行多次为期6个月的面对面和电话评估。然而，这个R01的目的并不是针对这些高危妇女的抑郁症状或自杀风险的过程。在目前的应用中，我们利用丰富的现有纵向数据和R01研究的积极评估阶段，提出了MTFC对这些问题的影响的新重点。具体来说，我们建议1)对自杀企图的次数和时间进行终身评估；2)每隔6个月增加R01评估，包括自我报告的自杀想法和行为。其中两项评估将在拟议的研究之前进行，并将得到有限的内部资源的支持；我们要求为三次额外的测量提供资金（每6个月一次），总共对青年期进行五次评估。利用现有和拟议的数据收集，我们将追求三个目标，估计MTFC对青年成年期抑郁症状和自杀风险的影响，并明确间接影响的三个关键机制。在目标1中，我们将使用潜在生长模型来描述青春期和青年期9个时间点的抑郁症状的病程，然后测试干预效果；随机分配到MTFC的女孩与分配到TAU的女孩相比，预计随着时间的推移抑郁症状会减少。目的2检验已证实受MTFC影响的三个领域的变化（Chamberlain et al., 2007; level et al., 2007）是否介导干预对抑郁症状变化的影响；具体来说，MTFC有望通过减少犯罪和少女怀孕/生育以及教育程度来减少成年早期的抑郁症状。目的3检验MTFC对自杀企图的影响，以及这种影响是否通过干预相关的犯罪和抑郁症状的减少而介导。研究结果将为JJS女孩的发展和加强干预提供方向。因此，拟议的研究回应了对创新方法的呼吁，以接触那些没有从现有的抑郁症预防范例中受益的高风险青年（Avenevoli等人，2006）。

DESCRIPTION (provided by applicant): The aims of the proposed project address gaps in the evidence base concerning interventions with girls in the juvenile justice system (JJS). All aims focus on the extent to which a delinquency-focused intervention disrupts depressive symptoms and suicide risk trajectories in young adulthood for these high-risk females. Participants are 164 women who were involved in the JJS as adolescents. The women initially participated at ages 13-17 in a randomized controlled trial to test the effectiveness of Multidimensional Treatment Foster Care (MTFC, Chamberlain, 2003) versus treatment as usual (TAU) at reducing delinquency and drug abuse. Delinquency, depressive symptoms, and suicidal thoughts were measured four times across the original 2-year follow-up period. A study is currently underway (R01 DA024672: February 2009-December 2012) in which in- person and telephone assessments of these women will be conducted across multiple 6-month intervals in young adulthood (18-28 years). The aims of this R01, however, do not address the course of depressive symptoms or suicide risk among these high-risk women. In the present application, we capitalize on rich existing longitudinal data and the active assessment phase in the R01 study to propose a new focus on the effects of MTFC on these problems. Specifically, we propose to 1) conduct a lifetime assessment of the number and timing of suicide attempts; and 2) augment R01 assessments planned at 6-month intervals to include self-reported suicidal thoughts and behaviors. Two of these assessments will occur prior to the proposed study, and will be supported with limited internal resources; we request funding for three additional measurement occasions (at 6-month intervals), for a total of five assessments in young adulthood. Using existing and proposed data collection, we will pursue three aims that estimate MTFC effects on depressive symptoms and suicide risk in young adulthood, and specify three key mechanisms of indirect effects. In Aim 1, we will use latent growth modeling to characterize the course of depressive symptoms across 9 time points in adolescence and young adulthood, and then to test intervention effects; girls randomly assigned to MTFC are expected to show decreases in depressive symptoms over time relative to girls assigned to TAU. Aim 2 tests whether changes in three domains already demonstrated to be impacted by MTFC (Chamberlain et al., 2007; Leve et al., 2007) mediate effects of the intervention on changes in depressive symptoms; specifically, MTFC is expected to reduce depressive symptoms through early adulthood via decreased delinquency and teenage pregnancy/child-bearing, and educational attainment. Aim 3 tests the effects of MTFC on suicide attempts and whether such effects are mediated by intervention-related reductions in delinquency and depressive symptoms. Findings will suggest directions for development and augmentation of interventions for JJS girls. Thus, the proposed study answers calls for innovative approaches to reaching high risk youth who do not benefit from existing depression prevention paradigms (Avenevoli et al., 2006). PUBLIC HEALTH RELEVANCE: Adolescent girls with serious conduct problems are at high risk for depression and suicide. Yet, effective treatments for these problems in this group are lacking. We examine whether a delinquency-focused intervention for girls in the juvenile justice system will reduce depressive symptoms and rates of suicide attempt into young adulthood via changes in delinquency, teen pregnancy rates, and educational attainment.