Intervention to Prevent Peer Violence & Depressive Symptoms Among At-Risk Adolescents

项目摘要 青少年同伴暴力和抑郁症状是常见的，相互关联的问题，主要的长期 发展后果。预防这些问题的可行的、易于传播的干预措施是一种 公共卫生势在必行。现有的多阶段预防性干预措施耗时， 高风险的年轻人无法获得。急诊室（艾德）访问是一个潜在的接触点， 没有其他途径获得预防性干预措施的高危青年。教育署发起的简短干预和文本- 信息干预在减少暴力和抑郁症状方面显示出希望， 比现有干预措施覆盖面更广，传播能力更强。该研究项目建议建立在我们的 先前的工作，以确定最有效和最吝啬的ED发起的干预，以减少同伴暴力 和抑郁症状的风险。我们提出了一个创新的，严格的析因临床试验 之前试点的两部分干预措施具有高度可接受性和有效性信号。我们将招收800名 青少年（13-17岁）因任何原因向艾德报告过去一年的同伴暴力和目前的暴力行为。 轻度到中度的抑郁症状一个主要的创新是，我们将使用2x2析因随机试验， 测试整体干预效果，并确定干预成分的最佳组合。 参与者将在基线时随机分配至1）短暂艾德干预（BI）（20分钟CBT-和 艾德访视期间的动机访谈干预）或无BI;以及2）文本（自动化的、定制的、双- 艾德访问后，一种“推动式”短信课程开始了，强化了认知重新评价、情感 调节，和自我效能技能）或无文本。反映了我们的试点RCT结果和其他人的研究，文本 在7天没有显示改善迹象的参与者（基于他们的每日文本情绪评估）将 在第7天重新随机分配，继续标准文本干预，或额外接受LiveText（a 更密集的微辅导与文本干预）。我们将衡量同伴暴力的改善， 抑郁症状，以及通过经验证的自我报告在2、4、8和12个月时的潜在效应介质 措施和病历审查。我们打算确定：（a）iDOVE（BI +文本）和每种 其组成部分（BI单独，文本单独），与对照组（无BI，无文本）相比，对同伴暴力， 抑郁症状;（B）使用LiveText自适应地增加强度是否改善了 早期没有改善迹象的参与者;（c）潜在调解人和调解人的作用 干预效果意义：如果所有或部分干预成分显示有效， 干预可能对同伴共存的共同青少年状况产生巨大的潜在影响， 暴力和抑郁症状。该项目还将告知对潜在干预的理解 机制，特别是适应性技术为基础的干预措施，符合NIH的目标。

PROJECT SUMMARY Adolescent peer violence and depressive symptoms are common, inter-related problems with major long-term developmental consequences. Accessible, easy-to-disseminate interventions to prevent these problems are a public health imperative. Existing multi-session preventive interventions are time-consuming and generally unavailable to the highest-risk youth. Emergency departments (ED) visits are a potential engagement point for at-risk youth without other access to preventive interventions. ED-initiated brief interventions and text- messaging interventions show promise in reducing violence and depressive symptoms, and may have greater reach and greater disseminability than existing interventions. This research project proposes to build on our prior work, to determine the most potent and parsimonious ED-initiated intervention for reducing peer violence and depressive symptoms among at-risk youth. We are proposing an innovative, rigorous factorial clinical trial of a previously piloted two-part intervention with high acceptability and a signal of efficacy. We will enroll 800 adolescents (age 13-17) presenting to the ED for any reason who report past-year peer violence and current mild-to-moderate depressive symptoms. A major innovation is that we will use a 2x2 factorial randomized trial to both test overall intervention efficacy, and determine the optimal combination of intervention components. Participants will be randomized at baseline to 1) Brief ED Intervention (BI) (a 20 minute CBT- and motivational interviewing intervention during the ED visit) or No BI; and 2) Text (an automated, tailored, two- way “pushed” text-message curriculum started after the ED visit, reinforcing cognitive reappraisal, emotional regulation, and self-efficacy skills) or No Text. Reflecting our pilot RCT findings and others' research, Text participants who do not show signs of improvement at 7 days (based on their daily Text mood assessment) will be re-randomized at day 7 to either continue standard Text intervention, or to additionally receive LiveText (a more intensive micro-counseling with a text interventionist). We will measure improvements in peer violence, depressive symptoms, and potential mediators of effect at 2, 4, 8, and 12 months through validated self-report measures and medical record review. We intend to determine: (a) the effect of iDOVE (BI + Text) and of each of its components (BI alone, Text alone), as compared to controls (no BI, no Text) on peer violence and depressive symptoms; (b) whether adaptively increasing intensity with LiveText improves efficacy for participants with early signals of no improvement; (c) the role of potential mediators and moderators of intervention efficacy. SIGNIFICANCE: If all or part of the intervention components show efficacy, this intervention could have great potential impact on the co-existing, common adolescent conditions of peer violence and depressive symptoms. This project will also inform understanding of underlying intervention mechanisms, particularly for adaptive technology-based interventions, in correspondence with NIH objectives.