2/2-Brief CBT for Pediatric Anxiety and Depression in Primary Care

2/2-简短 CBT 针对初级保健中的儿科焦虑和抑郁

• 批准号: 8068773
• 负责人: David A. Brent
• 金额: $ 36.45万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-03 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8068773
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DESCRIPTION (provided by applicant): This application describes an interlocking, two-site collaborative R01 to test the effects of a brief cognitive behavioral therapy (BCBT) protocol for youths (age 8-15) presenting with anxiety and/or depression in primary care. Over a five year period, 210 youths (105 per site) will be randomly assigned to (a) BCBT delivered in primary care or (b) enhanced referral to specialty mental health care (SMHC). This application builds on a preliminary study (N=60), in which a pilot version of BCBT was well-accepted by families and clinicians and was more efficacious than referral to SMHC. We now propose to test BCBT against an enhanced SMHC referral model in a larger, more diverse sample to establish its utility as a community-based intervention. Outcomes will be assessed by independent evaluators blind to participant status at 16 and 32 weeks post- randomization (Aim 1). It is hypothesized that BCBT will be superior to enhanced SMHC referral in terms of overall clinical improvement (CGI-I < 2) and change in anxiety (PARS) and depression (CDRS-R) symptoms. Response also will be evaluated on brief self-report measures (SCARED, MFQ), as future community care may need to rely more heavily on these types of assessments. In addition, individual trajectories of participants will be examined to understand predictors of treatment response (Aim 2). It is hypothesized that severity of depression symptoms (youth and/or parent) will predict poorer response across treatments but that the BCBT program will still outperform the enhanced SHMC referral model. The effects of ethnicity also will be explored and use of two sites will allow greater enrollment of Hispanic (San Diego) and African-American (Pittsburgh) families than could be achieved by either in isolation. Targeting depression and anxiety as a unified problem area is innovative and in line with calls for new approaches to conceptualizing comorbidity and treating near neighbor disorders. Availability of an effective BCBT program for internalizing youths is needed as service settings struggle with limited sessions and resources available to train clinicians in multiple protocols. The application is noteworthy in adopting a deployment-focused model and testing this intervention early in its development within a real world context (primary care) and against a plausible public health comparision condition (enhanced SMHC referral) relevant for future treatment dissemination. Primary care has become a de facto site of mental health care delivery, with the possibilities of easier access, earlier identification and treatment, and prevention of chronicity. In line with this focus, data will be collected on the cost-effectiveness of the program (Aim 3) in order to lay the groundwork for future investigations focused on issues of dissemination, implementation, and real world sustainability. Site-unique contributions include expertise in practice-based research (San Diego) and data coordination (Pittsburgh). San Diego will serve as the overall coordinating site for the project. PUBLIC HEALTH RELEVANCE: This study will test whether a brief (12 week) psychological treatment program, based in primary care, can help youths struggling with depression and anxiety. Impact of the program on symptoms and cost-effectiveness will be measured. This will be the first study to assess if anxiety and depression can be treated with one, simple program, and results may help move effective treatments for these serious problems into community practice.

描述（由申请人提供）：本申请描述了一种连锁的、两点协作的 R01，用于测试针对初级保健中出现焦虑和/或抑郁的青少年（8-15 岁）的简短认知行为治疗 (BCBT) 方案的效果。在五年内，210 名青少年（每个地点 105 名）将被随机分配到 (a) 在初级保健中提供 BCBT 或 (b) 加强转诊至专业心理健康护理 (SMHC)。该应用程序建立在一项初步研究 (N=60) 的基础上，其中 BCBT 的试点版本受到家庭和临床医生的广泛接受，并且比转诊至 SMHC 更有效。我们现在建议在更大、更多样化的样本中针对增强型 SMHC 转诊模型测试 BCBT，以确定其作为基于社区的干预措施的效用。结果将由不了解参与者状态的独立评估员在随机分组后 16 周和 32 周进行评估（目标 1）。据推测，就整体临床改善 (CGI-I < 2) 以及焦虑 (PARS) 和抑郁 (CDRS-R) 症状的改变而言，BCBT 将优于增强型 SMHC 转诊。还将根据简短的自我报告措施（SCARED、MFQ）对反应进行评估，因为未来的社区护理可能需要更多地依赖这些类型的评估。此外，还将检查参与者的个人轨迹，以了解治疗反应的预测因素（目标 2）。据推测，抑郁症状的严重程度（青少年和/或父母）将预测治疗效果较差，但 BCBT 计划仍将优于增强型 SHMC 转诊模型。种族的影响也将被探讨，并且使用两个站点将允许更多的西班牙裔（圣地亚哥）和非裔美国人（匹兹堡）家庭入学，而不是单独使用任何一个站点。 将抑郁症和焦虑症作为一个统一的问题领域是创新的，并且符合对概念化共病和治疗近邻疾病的新方法的呼吁。由于服务机构面临着有限的课程和资源，无法对临床医生进行多种协议的培训，因此需要为青少年提供有效的 BCBT 计划。该应用程序值得注意的是，它采用了以部署为中心的模型，并在现实世界背景（初级保健）的早期开发中测试了这种干预措施，并针对与未来治疗传播相关的合理的公共卫生比较条件（增强的 SMHC 转诊）进行了测试。初级保健已成为事实上的精神卫生保健提供场所，具有更容易获得、更早识别和治疗以及预防慢性病的可能性。根据这一重点，将收集有关该计划成本效益的数据（目标 3），以便为未来重点关注传播、实施和现实世界可持续性问题的调查奠定基础。站点独特的贡献包括基于实践的研究（圣地亚哥）和数据协调（匹兹堡）方面的专业知识。圣地亚哥将作为该项目的总体协调地点。 公共卫生相关性：本研究将测试基于初级保健的简短（12 周）心理治疗计划是否可以帮助青少年应对抑郁和焦虑。将衡量该计划对症状和成本效益的影响。这将是第一项评估焦虑和抑郁是否可以通过一个简单的方案来治疗的研究，其结果可能有助于将这些严重问题的有效治疗纳入社区实践。