1/2-Family Cognitive Behavioral Prevention of Depression in Youth and Parents

描述(申请人提供)：抑郁症是一个主要的公共卫生问题，每年影响超过1500万美国成年人，尤其是在育儿年龄的人中。抑郁父母的子女患抑郁症的风险增加，因此是预防性干预的关键目标。在一定程度上受到调查人员先前工作的启发，我现在准备在降低抑郁率方面取得重大进展，方法是采用创新的、以家庭为基础的方法，同时预防高危儿童及其受影响的父母的抑郁症。这种方法的理论基础是：(A)我们的概念模型整合了育儿过程、压力源(尤其是与父母抑郁相关的压力源)和儿童在面临压力时的自我调节能力，(B)抑郁症的家庭性质的强有力证据，(C)以家庭和儿童为重点的抑郁症预防计划的良好结果，(D)证据表明，在成年人中，认知行为疗法(CBT)可以减少抑郁发作及其复发，(E)科学家、临床医生和政策制定者越来越一致地认为需要以家庭为基础的医疗保健模式。这项拟议的为期5年的两点随机对照试验将测试针对患有抑郁症的儿童(9-15岁)及其父母(过去或现在)的家庭抑郁预防(FDP)计划。这种“双重预防”方法是从儿童预防和成人治疗模式中提取的现有循证干预技术的新综合。参与的家庭(N=300)将被随机分为FDP(每周12次+每月3次)或书面信息控制(WI)条件。父母和儿童将在干预前、干预中期和干预后立即以及从基线开始的6个月、12个月、18个月和24个月进行评估。这一单一的综合干预措施旨在预防儿童和父母的抑郁症状和发作，减少相关的障碍，并改善功能(目标1)。我们还将评估FDP相对于WI对照的成本效益(CE)，并以具有里程碑意义的儿童预防和成人抑郁症治疗研究的成本效益(CE)为基准(目标1)。此外，我们将审查中介因素(例如，父母的养育行为；父母的认知；儿童的应对)，并评估儿童和父母的过程和结果之间的双向影响(目标2)。最后，我们将探索干预-结果关系的调节变量[例如，父母抑郁严重程度(目标3)]。

DESCRIPTION (provided by applicant): Depression is a major public health problem affecting over 15 million U.S. adults annually and is especially prevalent in those of parenting age. Offspring of depressed parents are at increased risk of depression and therefore are a critical target for preventive interventions. Informed in part by the investigators' prior work, the field i now poised to make significant advances toward reducing the rate of depression by adopting an innovative, family-based approach to simultaneously preventing depression in at-risk children and in their affected parents. The rationale for this approach is based on (a) our conceptual model that integrates parenting processes, stressors (particularly those associated with parental depression), and children's self-regulatory skills in the face of stress, (b) strong evidence of th familial nature of depression, (c) promising results from family- and child-focused depression prevention programs, (d) evidence that in adults, cognitive-behavioral therapy (CBT) reduces both depressive episodes and their recurrence, and (e) growing consensus among scientists, clinicians, and policymakers on the need for family-based models of healthcare. The proposed 5- year, two-site randomized controlled trial will test a Family Depression Prevention (FDP) program for children (ages 9-15) and their parents with depressive disorders (past or current). This "dual prevention" approach is a novel synthesis of existing evidence-based intervention techniques drawn from child prevention and adult treatment models. Participating families (N=300) will be randomized to either FDP (12 weekly + 3 monthly sessions) or a written information control (WI) condition. Parents and children will be evaluated at pre-, mid-, and immediately post-intervention, and at 6-, 12-, 18-, and 24-months from baseline. This single integrated intervention aims to prevent depressive symptoms and episodes in both children and parents, reduce associated disorders, and improve functioning (Aim 1). We also will assess the cost-effectiveness (CE) of FDP relative to the WI control and benchmarked against the CE of landmark studies in child prevention and adult depression treatment (Aim 1). Additionally, we will examine mediators (e.g., parenting behaviors; parents' cognitions; children's coping) and evaluate bidirectional effects between child and parent processes and outcomes (Aim 2). Finally, we will explore moderators [e.g., parental depression severity (Aim 3)] of the intervention-outcome relation.