Prevention of Depression in Maltreated and Nonmaltreated Adolescents

说明(由申请人提供)：研究一直表明，虐待儿童使儿童更容易出现精神病态疾病，包括严重的抑郁障碍(MDD；Cicchetti&Watino，2006年；Thompson，2005年；Widom等人，2007年)。有虐待史的青少年变得抑郁或自杀的可能性是没有虐待史的青少年的三倍(Brown等人，1999年)。由于青春期是抑郁障碍出现的高峰期，也是女孩的抑郁率开始超过男孩的发育期，因此为抑郁症状加重的青春期女孩提供预防性干预尤为重要。此外，由于对抑郁症潜在过程的研究已经开始阐明基于虐待的存在的不同途径(Heim等人，2008年)，对有或没有虐待病史的亚综合征抑郁症青春期女孩的预防性干预的评估解决了预防文献中的一个关键缺口。随着对虐待和忽视儿童的生物后果的认识不断增加(Watts-English等人，2006年)，将多层次分析的观点纳入预防干预措施的设计和评估变得越来越重要。这项拟议的研究旨在扩大对有和没有虐待病史的青春期女孩的抑郁症进行有效预防干预的知识。这项研究将利用发展精神病理学框架，对350名低收入、不同种族和文化的青春期女孩进行评估，以评估青少年人际心理疗法(IPT-A)预防抑郁症的效果。在这些有抑郁症状的青少年中，有140人将有虐待儿童的历史，140人在人口统计学上是相似的，但没有虐待史。在每组中，一半将被随机分配到IPT-A，另一半将被分配到持续时间相当的强化护理。另一组70名未受虐待的无症状女孩将作为比较，以确定抑郁症组的心理和神经生物学功能如何与无症状青少年组的情况相似。这项研究将采用多层次分析的方法，通过在基线、治疗中期、治疗后和一年的随访中检查遗传、神经内分泌、认知和人际领域，评估IPT-A在减轻虐待和非虐待青春期女孩抑郁症状和预防MDD方面的有效性。受虐待和未受虐待的青少年抑郁的致病过程网络中的群体差异将与结果相关。此外，还将研究干预过程中涉及的潜在机制，包括神经内分泌调节、认知过程和人际关系的变化。此外，分析将确定遗传差异是否会影响IPT-A在减少受虐待和未受虐待女孩的抑郁症状方面的有效性。

DESCRIPTION (provided by applicant): Research has consistently demonstrated that child maltreatment places children at heightened risk for the emergence of psychopathology, including major depressive disorders (MDD; Cicchetti & Valentino, 2006; Thompson, 2005; Widom et al., 2007). Adolescents with maltreatment histories have been found to be three times more likely to become depressed or suicidal than adolescents without histories of maltreatment (Brown et al., 1999). Because adolescence represents a peak time for the emergence of depressive disorders, as well as a developmental period during which rates of depression for girls begin to exceed those of boys, the provision of preventive intervention for adolescent girls with elevated depressive symptoms is particularly important. Moreover, because studies examining processes underlying depression have begun to elucidate differential pathways based on the presence of maltreatment (Heim et al., 2008), the evaluation of a preventive intervention for subsyndromal depressed adolescent girls with or without histories of maltreatment addresses a critical gap in the prevention literature. As increased knowledge on the biological consequences of child abuse and neglect has emerged (Watts-English et al., 2006), it is increasingly important to incorporate a multiple- levels-of-analysis perspective into the design and evaluation of preventive interventions. The proposed research seeks to extend knowledge on an efficacious preventive intervention for depression in adolescent girls with and without histories of maltreatment. The investigation will utilize a developmental psychopathology framework with 350 low-income ethnically and culturally diverse adolescent girls to evaluate the efficacy of Interpersonal Psychotherapy for Adolescents (IPT-A) for preventing depression. 140 of these adolescents with depressive symptoms will have histories of child maltreatment and 140 will be demographically comparable but without maltreatment history. Within each group, half will be randomly assigned to IPT-A and half to enhanced care with comparable duration. An additional group of 70 nonmaltreated nonsymptomatic girls will serve as a comparison for to determining how psychological and neurobiological functioning in the depressive groups may approximate that seen in a nonsymptomatic group of adolescents. The investigation will apply a multiple- levels-of-analysis approach to evaluate IPT-A efficacy in decreasing depressive symptoms and preventing MDD in maltreated and nonmaltreated adolescent girls through examining genetic, neuroendocrine, cognitive, and interpersonal domains at baseline, mid-treatment, post-treatment, and at one-year follow-ups. Group differences in the network of causative processes in depression for maltreated and nonmaltreated adolescents will be examined in relation to outcomes. Additionally, potential mechanisms involved in the intervention process will be examined, including changes in neuroendocrine regulation, cognitive processes, and interpersonal relations. Additionally, analyses will determine whether genetic differences moderate the efficacy of IPT-A in reducing depressive symptomatology in maltreated and in nonmaltreated girls.