Discovering Tailoring Variables in Childhood Mental Health Treatment Research

描述（由申请人提供）：儿童精神疾病通常需要临床医生做出个性化的治疗决定。在儿童和青少年心理健康（CAMH）研究和实践的一个令人兴奋的趋势中，人们对制定个性化决策规则（IDR）的兴趣和意识越来越强。IDR使用社会人口统计学信息、病史、合并症、家庭/人际关系测量或生物标志物作为输入，然后推荐后续治疗的类型、方式和强度或交付作为输出。IDR为个性化医疗提供了一个框架：个性化程度的增加与IDR中用作输入的有用信息（定制变量）的数量成比例。开发用于治疗精神疾病儿童的IDR是干预研究的重要“下一步”。大规模的临床试验已经为许多常见的CAMH疾病建立了有效的干预措施。然而，尽管有一个强大的证据基础，治疗是有效的平均，很少有人知道哪些儿童或多或少可能受益于一种治疗或另一种。在深入发展报告能够发挥其潜力之前，在如何利用现有数据协助其发展方面仍有许多方法上的工作要做。制定有效的IDR的关键步骤是确定定制变量， 用作输入。定制变量是特殊类型的预处理措施，可以确定哪种治疗最适合谁。现有的方法没有明确（a）确定哪些措施是最有用的（剪裁变量选择），或（B）联合收割机，他们在一个最佳的方式（剪裁变量特征建设）。本研究的具体目标是：目标1（方法）。开发和评估（a）定制变量选择和（B）定制变量特征构建的框架，以实现CAMH治疗的个体化。新方法将用于解决以下科学问题：人口统计学、疾病的严重程度和持续时间、合并症、父母的精神病理学、心理社会环境（包括家庭和同伴关系、生物学）用于定制治疗？(b)我们如何将它们联合收割机结合起来以指导治疗决策（例如，个体心理治疗、药物治疗或其组合）？目标2（应用）：通过将其应用于儿童/青少年焦虑多模式研究随机试验数据来说明和评估该方法，以构建用于选择SSRI，CBT或SSRI+CBT治疗焦虑症儿童的IDR。我们将应用新的方法来确定变量和特征，以确定哪些儿童或多或少可能从SSRI，CBT或SSRI+CBT组合中受益。结果将被用来构建一个建议的儿童焦虑症的IDR。我们将比较IDR与SSRI（所有人）与CBT（所有人）与SSRI+CBT（所有人）的平均症状和严重程度结局的差异。 本研究将为CAMH的研究人员提供一个新的工具来构建IDR。这项研究对公共卫生产生了重大影响，因为它旨在开发工具，为患有精神健康障碍的儿童和青少年提供个性化治疗。这是国家心理健康研究所的一个高度优先研究领域。

DESCRIPTION (provided by applicant): Childhood psychiatric conditions often require that clinicians make individualized treatment decisions. In an exciting trend in child and adolescent mental health (CAMH) research and practice, there is growing interest and awareness in developing individualized decision rules (IDRs). IDRs use sociodemographic information, illness history, comorbidities, family/interpersonal measures, or biomarkers as inputs and then recommend the type, modality, and intensity or delivery of subsequent treatment(s) as outputs. IDRs provide a framework for personalized medicine: the level of personalization increases in proportion to the amount of useful information (tailoring variables) used as inputs in an IDR. The development of IDRs for the treatment of children with mental illness is an important "next step" in interventions research. Large scale clinical trials have established efficacious interventions fr many of the common CAMH disorders. However, despite a strong evidence base for treatments that are effective on average, little is known about which children are more or less likely to benefit from one treatment or another. Before IDRs can fulfill their potential, much methodological work remains to be done regarding how to use currently available data to assist in their development. A key step in developing effective IDRs is identifying tailoring variables to use as inputs. Tailoring variables are special types of pre-treatment measures that pinpoint which treatment is best for whom. Existing methods do not explicitly (a) identify which measures are most useful (tailoring variable selection), or (b) combine them in an optimal fashion (tailorin variable feature construction). The specific aims of this study are: Aim 1 (Methods). To develop and evaluate a framework for (a) tailoring variable selection and (b) tailoring variable feature construction for individualizing CAMH treatment. The new method will be used to address scientific questions such as: (a) What are the most important measures (e.g., demographic, severity and duration of illness, comorbidity, parental psychopathology, psychosocial environment including family and peer relationships, biological) to use for tailoring treatment? (b) How do we combine them in order to guide treatment decisions (e.g., individual psychotherapy treatment, medication, or their combination)? Aim 2 (Application): To illustrate and evaluate the method by applying it to the Child/Adolescent Anxiety Multimodal Study randomized trial data to construct an IDR for choosing between SSRI, CBT, or SSRI+CBT for children with anxiety disorders. We will apply the new methodology to identify variables and features pinpointing children who are more or less likely to benefit from SSRI, CBT, or combined SSRI+CBT. Results will be used to construct a proposed IDR for pediatric anxiety disorders. We will compare how average symptom and severity outcomes differ on the IDR vs SSRI for all vs CBT for all vs SSRI+CBT for all. This study will provide researchers in CAMH with a novel tool for building IDRs. This study has significant public health impact because it aims to develop tools to personalize treatment for children and adolescents with mental health disorders. This is a high-priority area of research for the National Institute of Mental Health.