Brief, Primary Care CBT for Unmedicated Depressed Youth

针对未接受药物治疗的抑郁青少年的简短初级保健 CBT

• 批准号: 7048023
• 负责人: GREGORY N CLARKE
• 金额: $ 69.1万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-01 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7048023
• 关键词: adolescence (12-20); antidepressants; behavioral /social science research tag; child mental health service; child psychology; clinical research; clinical trials; cognitive behavior therapy; cost effectiveness; developmental psychology; early /brief intervention /therapy; health services research tag; human subject; human therapy evaluation; major depression; managed care; mental disorder chemotherapy; mental disorder diagnosis; patient oriented research; primary care physician; therapy compliance

Substantial numbers of depressed adolescents either decline antidepressant medication or quickly discontinue such medications before benefits are expected. Recent controversies regarding the safety of SSRI anti-depressants are likely to increase medication refusal. More than half of depressed adolescents identified in primary care prefer psychosocial treatments, compared to.20% who prefer medication. Among the psychotherapy alternatives to medication, CBT has the strongest research support. We have already developed a collaborative care CBT model that we evaluated in a previous primary care trial. However, this previous trial did not specifically examined its effects in the absence of medication treatment. Therefore, we propose to conduct a two-arm, randomized, efficacy-effectiveness trial in a Health Maintenance Organization (HMO), comparing a treatment as usual (TAD) control condition to TAU plus brief, individual, collaborative care CBT. We will enroll 240 youth ages 12 to 18 who, during this depressive episode, have either declined anti-depressant medication or who received a single dispense of anti-depressant medication but quickly discontinued. All enrolled cases will be reassessed periodically throughout a 24-month follow-up period. The primary clinical outcome is recovery from the index episode of major depression, assessed via LIFE/K-SADS diagnosis. Secondary outcomes include continuous depression symptomatology; depression response; rates of new, recurrent episodes of major depression in the follow-up period; improvements in psychosocial function; clinical improvement; reduction in depressionrelated dysfunction; parent/youth attitudes regarding treatment. We will also examine incremental costeffectiveness of CBT compared to TAU from the HMO, family, and societal perspectives. We will conduct exploratory analyses of mediation and moderation of depression treatment outcomes, and employ data from the TAU control condition to estimate the usual outcomes for depressed youth who refuse/discontinue antidepressant medication. Finally, we will examine how provider, parent and youth barriers, attitudes and beliefs moderate outcomes, as well as possibly change over time as a function of participation in this program. The validation of a primary care model for brief CC-CBT may prove to be a significant benefit to the sizeable numbers of depressed youth identified in primary care, and who elect not to try antidepressant medication or quickly discontinue an initial trial.

大量抑郁青少年要么拒绝服用抗抑郁药物，要么很快就停止服用抗抑郁药物。 在预期获益之前停止使用此类药物。最近关于安全性的争议 SSRI 抗抑郁药可能会增加拒绝用药的情况。超过一半的人抑郁 在初级保健中发现的青少年更喜欢心理社会治疗，而 20% 的青少年更喜欢心理社会治疗 药物。在药物治疗的心理治疗替代方案中，CBT 拥有最强有力的研究支持。 我们已经开发了一种协作护理 CBT 模型，我们在之前的初级护理中对其进行了评估 审判。然而，之前的试验并没有专门检查其在没有药物治疗的情况下的效果 治疗。因此，我们建议进行一项双组、随机、疗效-效果试验 健康维护组织 (HMO)，将照常治疗 (TAD) 控制条件与 TAU 进行比较 加上简短、个人、协作护理 CBT。我们将招募 240 名 12 至 18 岁的青少年，在此期间 抑郁发作，拒绝服用抗抑郁药物或接受单次配药 抗抑郁药物，但很快就停药了。所有登记的案例将定期重新评估 在整个 24 个月的随访期内。主要临床结果是从指数发作中恢复 重度抑郁症，通过 LIFE/K-SADS 诊断进行评估。次要结果包括持续 抑郁症症状学；抑郁反应；重度抑郁症新发、复发的发生率 随访期；心理社会功能的改善；临床改善；减少抑郁相关的 功能障碍；家长/青少年对治疗的态度。我们还将研究增量成本效益 从 HMO、家庭和社会角度比较 CBT 与 TAU 的差异。我们将进行 对抑郁症治疗结果的中介和调节进行探索性分析，并采用来自 TAU 控制条件来估计拒绝/停止治疗的抑郁青少年的通常结果 抗抑郁药物。最后，我们将研究提供者、家长和青少年的障碍、态度如何 和信念会调节结果，并且可能会随着时间的推移而随着参与的函数而变化 在这个节目中。 短期 CC-CBT 初级保健模型的验证可能会被证明对 在初级保健中发现了大量抑郁青少年，他们选择不尝试抗抑郁药物 药物治疗或迅速停止初始试验。