Treatment of Youth Comorbid Conduct Problems and Depression

青少年共病行为问题和抑郁症的治疗

• 批准号: 8114137
• 负责人: Anthony Spirito
• 金额: $ 21.15万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8114137
• 关键词: 14 year old; Accounting; Acute; Address; Adherence; Adolescence; Adolescent; Adoption; Affect; Aftercare; Attention; Audiotape; Behavior; Behavior Therapy; Behavioral; Caring; Child; Clinic; Clinical; Clinical Trials; Cognitive; Cognitive Therapy; Communities; Comorbidity; Competence; Confidence Intervals; Consumer Satisfaction; Data; Decision Making; Depressed mood; Development; Diagnosis; Disease; Educational process of instructing; Effectiveness; Family; Feasibility Studies; Feedback; Future; Goals; Grant; Guidelines; Individual; Intervention; Length; Literature; Maintenance; Major Depressive Disorder; Manuals; Measures; Mental Depression; Mental Health; Meta-Analysis; Modeling; Odds Ratio; Outcome; Outpatients; Parenting behavior; Parents; Participant; Patients; Phase; Pilot Projects; Population; Prevalence; Problem Solving; Problem behavior; Process; Protocols documentation; Psychopathology; Public Health; Randomized; Randomized Controlled Trials; Recruitment Activity; Regulation; Relative (related person); Research; Risk; Sampling; Selection for Treatments; Series; Staging; Substance abuse problem; Suicide; Suicide attempt; Surveys; Symptoms; Techniques; Testing; Therapeutic Studies; Time; Training; Training Programs; Treatment Protocols; Treatment outcome; Work; Youth; anti social; base; clinically significant; community setting; emotion regulation; follow-up; functional disability; innovation; intervention effect; pilot trial; post intervention; programs; psychosocial; public health relevance; satisfaction; skills; skills training; standard care; therapy development; treatment adherence; treatment as usual; treatment effect; treatment strategy; willingness

DESCRIPTION (provided by applicant): Studies of comorbidity between depression and conduct problems suggest that each of these disorders is associated with increased risk for the other. Despite the strong association between these disorders, integrated treatments that target these co-occurring problems in youth have not been tested. The importance of treating this comorbid presentation is heightened by the elevated risk for negative outcomes in adolescents with both disorders including suicide, substance abuse, and antisocial behavior. The primary purpose of this proposal is to develop a family based cognitive behavioral treatment protocol for youths with comorbid conduct problems and depression. This intervention is based on developmental psychopathology research and integrates existing cognitive behavioral techniques in an innovative fashion using an adaptive treatment strategy and a set of decision rules to enhance the delivery of the protocol in a community setting. The protocol will teach problem solving, cognitive restructuring, affect regulation skills, and parenting techniques needed to remediate skill deficits that underlie these disorders. The resultant product will be an 18-session manual, comprised of individual sessions, family sessions, and parent training sessions, that will be delivered over the course of six months. The integrated treatment allows for ongoing attention to both disorders and a synthesis of treatment principles. There are four primary aims in this project: 1) conduct stage 1a work to develop the manualized cognitive behavioral therapy protocol for young adolescents diagnosed with conduct problems and co- occurring depression; 2) to test the treatment protocol with 6 families through an open pilot trial to assess the manual for clarity, completeness, and feasibility; 3) conduct a small pilot randomized controlled trial to examine feasibility, treatment adherence, and reductions in symptoms of conduct problems and depression; and 4) develop and refine decision rules used to guide selection of treatment modules. In addition, this project will explore potential process variables that may account for treatment effects. To accomplish these aims, thirty 11- 14 year olds with comorbid conduct problems and depression will be assigned to the experimental condition or treatment as usual in a community care setting. The treatment manual will be revised using an iterative approach. Outcome will be assessed at post-acute treatment, postmaintenance treatment, and 6 months post- treatment. The long-term objective of this research is to yield a more effective yet feasible outpatient treatment approach for youth with comorbid conduct problems and depression. PUBLIC HEALTH RELEVANCE: The cumulative prevalence of major depression in adolescence is estimated at almost 30%. Similarly, approximately 16% of children and adolescents are diagnosed with conduct problems. This study addresses the co-occurrence of these two major public health issues in adolescence by developing an intervention that addresses both problems in an integrated protocol.

描述（由申请人提供）：抑郁和行为问题之间合并症的研究表明，这些疾病中的每一种都与对方的风险增加有关。尽管这些疾病之间有着密切的关联，但针对这些青年人同时发生问题的综合治疗方法尚未得到测试。在患有两种疾病（包括自杀，药物滥用和反社会行为）的青少年的负面结果风险中，治疗这种合并表现的重要性提高了。该提案的主要目的是为有合并症的行为问题和抑郁症的年轻人制定基于家庭的认知行为治疗方案。该干预措施基于发展心理病理学研究，并使用自适应治疗策略和一组决策规则以创新的方式整合了现有的认知行为技术，以增强协议在社区环境中的交付。该协议将教授解决问题，认知重组，影响调节技能以及为补救这些疾病构成的技能缺陷所需的育儿技巧。由此产生的产品将是18条课程的手册，由个人会议，家庭会议和家长培训课程组成，将在六个月的时间内进行。综合治疗允许对疾病的持续关注和治疗原则的综合。该项目有四个主要目标：1）进行1A阶段的工作，以为诊断出​​患有行为问题和抑郁症的年轻青少年制定手动认知行为疗法方案； 2）通过开放试验试验与6个家庭测试治疗方案，以评估该手册，以确保清晰，完整性和可行性； 3）进行一项小型飞行员随机对照试验，以检查行为问题和抑郁症状的可行性，治疗依从性和减少； 4）制定和完善用于指导治疗模块选择的决策规则。此外，该项目将探索可能解释治疗效果的潜在过程变量。为了实现这些目标，在社区护理环境中，有30-11-14岁的有合并行为问题和抑郁症的孩子将被分配给实验状况或治疗。该处理手册将使用迭代方法进行修订。结果将在急性后治疗，维护后治疗和治疗后6个月进行评估。这项研究的长期目标是为合并症的行为问题和抑郁症的年轻人提供一种更有效但可行的门诊治疗方法。 公共卫生相关性：青春期严重抑郁症的累积患病率估计为30％。同样，大约16％的儿童和青少年被诊断出患有行为问题。这项研究通过开发一种解决综合协议中这两个问题的干预措施，解决了青春期这两个主要公共卫生问题的同时出现。