Prevention of Depression in Maltreated and Nonmaltreated Adolescents

描述（由申请人提供）：研究一直表明，虐待儿童使儿童处于出现精神病理学（包括重度抑郁症）的高风险中（MDD; Cicchetti & Valentino，2006; Thompson，2005; Widom等人，2007年）。已经发现，有虐待史的青少年比没有虐待史的青少年更有可能变得抑郁或自杀（Brown等人，1999年）。由于青春期是抑郁症出现的高峰期，也是女孩抑郁症发病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，由于研究抑郁症的潜在过程已经开始阐明基于虐待存在的不同途径（Heim等人，2008年），对有或无虐待史的亚综合征抑郁少女的预防性干预措施进行了评价，解决了预防文献中的一个关键空白。随着对虐待和忽视儿童的生物后果的认识的增加，2006年），将多层次分析视角纳入预防性干预措施的设计和评价越来越重要。拟议的研究旨在扩大知识的有效预防干预抑郁症的青春期女孩和没有虐待的历史。这项调查将利用一个发展心理病理学框架，与350个低收入的种族和文化多样的青春期女孩，以评估青少年人际心理治疗（IPT-A）预防抑郁症的疗效。这些有抑郁症状的青少年中有140人有虐待儿童的历史，140人在人口统计学上具有可比性，但没有虐待历史。在每组中，一半将被随机分配到IPT-A组，另一半将被随机分配到持续时间相当的强化护理组。另外一组70名未受虐待的无症状女孩将作为比较，以确定抑郁组的心理和神经生物学功能如何接近无症状青少年组。本研究将采用多水平分析方法，通过在基线、治疗中期、治疗后和1年随访时检查遗传、神经内分泌、认知和人际关系领域，评价IPT-A在减少受虐待和未受虐待青春期女孩抑郁症状和预防MDD方面的疗效。小组的差异，在网络的原因过程中，在抑郁症的虐待和nonmaltreated青少年将检查有关的结果。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调节IPT-A在减少受虐待和未受虐待女孩的抑郁症方面的疗效。 公共卫生相关性：将受虐待的青少年与人口结构相似的青少年进行比较的调查发现，虐待和忽视会增加随后出现精神病理学（包括抑郁症）的风险。拟议的调查将采用多层次分析方法，通过在基线、治疗中期、治疗后、一年随访时检查遗传、神经内分泌、认知和人际关系领域，评估青少年人际心理治疗（IPT-A）在减少低收入文化多样性虐待和非虐待青春期女孩抑郁症状和预防重性抑郁症方面的疗效，抑郁症状将在18个月的随访中进一步评估。由于缺乏与虐待有关的抑郁症的循证预防干预措施，以及利用干预效果的多层次分析，向有和没有儿童虐待史的低收入文化多样性女孩提供和评估IPT-A特别重要和创新，具有非常高的公共卫生意义。

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. PUBLIC HEALTH RELEVANCE: Investigations comparing maltreated youth with demographically similar youth have found that abuse and neglect increase risk for the development of subsequent psychopathology, including depression. The proposed investigation will apply a multiple- levels-of-analysis approach to evaluating the efficacy of Interpersonal Psychotherapy for Adolescents (IPT-A) efficacy in reducing depressive symptoms and preventing Major Depressive Disorder in low-income culturally diverse maltreated and nonmaltreated adolescent girls through examining genetic, neuroendocrine, cognitive, and interpersonal domains at baseline, mid-treatment, post-treatment, at a one-year follow-up, and depressive symptoms will be further assessed at an 18-month follow-up. Given the paucity of evidence-based preventive interventions for depression associated with maltreatment, and the utilization of a multiple-levels-of-analysis of intervention effects, the provision and evaluation of IPT-A to low-income culturally diverse girls with and without histories of child maltreatment is particularly important and innovative and possesses very high public health significance.