Stress Reactivity and Cognitive Vulnerability for Depression in Adolescence

描述(申请人提供)：严重抑郁障碍(MDD)是最常见的精神疾病，估计终生患病率为25%2。此外，MDD是世界上导致残疾和过早死亡的第四大原因3。重要的是，研究表明，抑郁症的一年患病率在儿童时期相对较低，但从青春期早期到青春期晚期显著增加，高达6-7倍。这些趋势使研究人员研究了抑郁症的发展先兆，希望确定与首次发病有关的风险因素。在他们对青少年MDD研究现状的回顾中，Kovacs和Lopez-Duran1评论了理解早期生活经验在青少年MDD病因和病程中多方面等效性的重要性。 抑郁症。这项研究建议检验两个经验性支持的风险因素之间的关系：压力反应性和认知脆弱性(CV)。在不同程度上，这些因素在整个发展过程中都得到了审查，然而，这些文献出人意料地是分开的，这可能导致识别和治疗处于危险中的青年的选择性干预战略表现令人失望。重要的是，S需要一种综合的方法来捕捉个体风险、环境影响及其随后对抑郁结果的预测之间的复杂关联。这项研究提出了第一步来理解在显著的发育时期中CV和应激反应之间的关系，并建议利用正在进行的NIMH资助的R01资助，该资助旨在了解从青春期前到青春期晚期的抑郁的发展和过程，在人口统计学上不同的样本。本研究的主要目的是：(1)考察CV和应激反应的发展前因，(2)评估这两个危险因素对抑郁的联合作用，以及(3)检验CV是否可以预测应激反应。此外，本研究还将探讨应激反应是否在简历和抑郁之间起中介作用，以及性别和种族差异在这些危险因素的影响中是否存在明显差异。由于青春期标志着抑郁症发病率的急剧增加，7-8这项研究建议包括一个不同种族的青年社区样本，这些样本已经在NIMH资助的一项正在进行的研究中进行了评估，并将进行前瞻性的跟踪调查。在下一次访问这项研究时，参与者将完成简历、生活经历和诊断性访谈的测量，以及一项心理社会压力任务，通过该任务将评估他们的生物(神经内分泌和自主神经)反应。这项研究有可能提供一个更完整的发展前置因素和危险因素的社会压力反应性，CV，和MDD的发展提供更完整的理解。鉴于MDD的高患病率和高负担，需要进行研究以了解在MDD发展过程中起作用的原因。这项研究的结果可能有助于改善青年中的预防计划、早期干预策略和治疗结果。

DESCRIPTION (provided by applicant): Major Depressive Disorder (MDD) is the most common mental illness, with estimated lifetime prevalence of 25%2. In addition, MDD is the fourth leading cause of disability and premature death worldwide3. Importantly, research suggests that the one-year prevalence rates of depression are relatively low in childhood, but dramatically increase, as much as six-fold, from early to late adolescence6-7. These trends have led researchers to examine the developmental antecedents to depression in hopes of identifying risk factors associated with the first onset of disorder. In their review of the state f research on juvenile MDD, Kovacs and Lopez-Duran1 commented on the importance of understanding the multifaceted equifinality of early life experiences in the etiology and course of depression. This study proposes to examine the relationship between two empirically supported risk factors: stress reactivity and cognitive vulnerabilities (CV). To varying degrees, these factos have been examined throughout development~ yet, these bodies of literature have been surprisingly separate, which may contribute to the disappointing performance of selective intervention strategies to identify and treat youth at risk1. Importantly, an integrative approach s necessary to capture the complex association between individual risk, environmental influences, and their subsequent prediction of depressive outcomes. This study proposes a first step in understanding the relationship between CV and stress reactivity in a salient developmental time period and proposes to take advantage of an ongoing NIMH funded R01 grant that is targeted at understanding the development and course of depression from pre- adolescence through late-adolescence in a demographically diverse sample. The primary aims of the proposed study are to (1) examine the developmental antecedents of CV and stress reactivity, (2) evaluate the combined role of these two risk factors for depression, and (3) examine whether CV predicts stress reactivity. In addition, this study will explore whether stress reactivity mediates the relationship between CV and depression and whether gender and racial differences are evident in the effects of these risk factors. Because adolescence marks a period of dramatic increase in rates of depression, 7-8 this study proposes to include a racially diverse community sample of youth that have been assessed in an ongoing NIMH funded study and will be followed prospectively. At their next visit for the study, participants will complete measures of CV, life experiences and diagnostic interviews, and a psychosocial stress task whereby their biological (neuroendocrine and autonomic nervous) responses will be assessed. This study has the potential to provide a more complete understanding of developmental antecedents and risk factors involved in social stress reactivity, CV, and the development of MDD. Given the high prevalence and burden of MDD, research is needed to understand the causal factors at play in the development of MDD. Results from this study may help to improve prevention programs, early intervention strategies, and treatment outcomes among youth.