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

描述(由申请人提供)：儿童期起病抑郁症是一种损害性的、经常反复发作的持续性疾病，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很高，目前的实践参数强调心理社会治疗的初始疗程，以及对青少年抑郁症的广泛研究，但我们目前缺乏评估抑郁障碍儿童的心理社会治疗的随机对照试验。本申请旨在解决有关抑郁症儿童的最佳心理社会治疗策略方面的知识差距。我们提出了一项两点随机对照试验，以评估以家庭为中心的治疗(FFT)的疗效，并与仿照通常的社区护理模式的以个人客户为中心的心理治疗(IP)进行比较。这项申请建立在我们最初的NIMH治疗开发赠款的基础上，并扩展了通过我们开发和手册FFT进行的工作，并进行了初步试验，表明FFT导致抑郁结果、全球功能和父母报告的内在化、外部化和总问题的减少，并通过9个月的治疗后随访持续和加强。FFT采用人际关系模型来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，并致力于建立支持康复的家庭环境，并增强压力抵抗能力和韧性。这种方法可能特别适合抑郁症儿童的发展需求，因为他们对父母的依赖，FFT满足多个家庭成员需求的潜力，以及我们的数据支持抑郁症、功能和其他共生症状的益处。拟议的项目将招收140名患有抑郁症(严重抑郁症和/或恶劣心境障碍)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。在研究开始时、治疗后立即和治疗后9个月的随访中，所有参与者都将接受对临床状态、心理社会和家庭功能的密集评估。我们假设，快速傅立叶变换将与更快地从抑郁中恢复、症状和心理社会功能的更大改善以及相关症状/症状(焦虑和对立障碍)的减少有关。后续评估将检查治疗成果的维持情况。潜在的调节变量(情绪表达，是否存在共病的外化障碍)和调节变量(家庭功能，父母抑郁)将被评估。为了提高外部效度和促进招募大量、多样化的样本，这项研究将在两个地点--波士顿大学和加州大学洛杉矶分校进行。儿童期抑郁症是一种严重的、经常反复发作的持续性疾病，它会影响当前和以后的发展，导致高昂的社会和经济成本，因此开发有效的治疗方法至关重要。以家庭为中心的治疗(FFT)是专门针对抑郁的青春期前儿童及其家庭开发的，它提出了一种了解抑郁症状如何维持的人际模式，强调发展家庭技能/战略以改变人际关系，并致力于建立一个支持康复并增强压力抵抗和复原力的家庭环境。目前应用的目标是进行一项FFT治疗学龄期抑郁症的随机对照试验。 公共卫生相关性：儿童期抑郁症是一种影响当前和以后发展的、经常反复发作的持续性疾病，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)是专门针对抑郁的青春期前儿童及其家庭开发的，它提出了一种了解抑郁症状如何维持的人际模式，强调发展家庭技能/战略以改变人际关系，并致力于建立一个支持康复并增强压力抵抗和复原力的家庭环境。目前应用的目标是进行一项FFT治疗学龄期抑郁症的随机对照试验。

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.