A RANDOMIZED CONTROLLED TRIAL OF PCIT-ED FOR PRESCHOOL DEPRESSION

PCIT-ED 治疗学前抑郁症的随机对照试验

基本信息

批准号：
8683248
负责人：
JOAN L. LUBY
金额：
$ 66.92万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-06-17 至 2018-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8683248
关键词：
Acute Address Adult Affect Aftercare Age Behavior Therapy Brain Characteristics Child Childhood Chronic Clinical Competence DSM-IV Data Depressed mood Depressive disorder Development Diagnostic Disease Disease remission Early Intervention Education Educational process of instructing Emotional Emotions Epidemiologic Studies European Family history of Goals Hydrocortisone Impairment Intelligence Intervention Investigation Learning Measures Mediating Mediator of activation protein Mental Depression Mental disorders Moods National Institute of Mental Health Nursery Schools Outcome Parent-Child Relations Parenting behavior Parents Pharmaceutical Preparations Population Prevalence Prevention Psychotherapy Public Health Randomized Randomized Controlled Trials Regulation Relapse Reporting Research School-Age Population Severities Site Stress Symptoms Techniques Testing Training Waiting Lists active method base child depression depressive symptoms design disturbance in affect early onset effective intervention effective therapy efficacy testing follow-up meetings novel prevent public health relevance skills teacher therapy design trait treatment effect treatment response trend trial comparing

项目摘要

DESCRIPTION (provided by applicant): A Randomized Controlled Trial of PCIT-ED for Preschool Depression Data from several independent research groups have demonstrated that the onset of DSM-IV depressive disorders may occur as early as the preschool period. A stable and specific symptom constellation, family history of related disorders, characteristic alterations in stress cortisol reactivity as well as homotypic continuity with depression at school age provide strong support for the principle that preschool depression represents an early onset form of the later childhood disorder. Epidemiological studies from both U.S. and European sites estimate the prevalence rate of preschool onset depression (PO-MDD) at 1-2%, the same rate found in school- aged children. New data from our lab suggest that depressed preschoolers display alterations in functional brain activity similar to that found in adult depression. These brain changes were detected both during an acute preschool episode and later at school age, even after the depressive episode remitted. These findings taken together underscore the need for treatment of MDD during the preschool period. However, because PO-MDD has only recently been recognized, investigations of treatments remain uncharted. The need for effective treatments for PO-MDD go beyond the important goal of helping affected preschoolers but may also have implications for earlier and potentially more effective interventions in this chronic and relapsing disorder. Based on the large effect sizes reported in early interventions in several preschool disorders, an early intervention for PO-MDD, Parent Child Interaction Therapy Emotion Development (PCIT-ED) was developed and pilot tested. PCIT-ED is an expansion of PCIT, a well-known, widely used and proven effective treatment for preschool disruptive disorders. To address early disturbances of mood and affect, a novel ED module was added based on empirical data in emotion development. The ED module targets parent emotion learning skills with the goal of training the parent to serve as a more effective emotion teacher and coach to the child. The goal of the ED module is to enhance the child's capacity for emotion recognition and regulation or "emotional competence." A pilot randomized controlled trial of PCIT-ED was conducted demonstrating feasibility and promise of efficacy. Following these findings, this application proposes a large scale well powered RCT of PCIT-ED for PO-MDD compared to a wait list control after which subjects will receive the active treatment. The aim is to rigorously test the efficacy of PCIT-ED, to estimate accurate effect sizes and to investigate mediators and moderators of treatment response.

描述（由申请人提供）：来自多个独立研究小组的PCIT-ED的随机对照试验表明，DSM-IV抑郁症的发作可能早在学龄前时期就可能发生。稳定且特定的症状星座，相关疾病的家族史，特征改变在压力皮质醇的反应性以及学龄前抑郁的同种异体连续性中提供对学龄前抑郁症的原则的强烈支持代表了后来儿童疾病的早期出现形式。来自美国和欧洲遗址的流行病学研究估计，学龄前抑郁症（PO-MDD）的患病率为1-2％，与学龄儿童相同。来自实验室的新数据表明，抑郁的学龄前儿童表现出与成人抑郁症相似的功能性脑活动的改变。即使在抑郁症发生后，在急性学龄前情节和后来的学龄前都发现了这些大脑变化。这些发现共同强调了在学龄前期间对MDD进行治疗的必要性。但是，由于PO-MDD直到最近才得到认可，因此对治疗的调查仍然没有医院。对PO-MDD进行有效治疗的需求超出了帮助影响学龄前儿童的重要目标，但也可能对早期且可能更有效的干预措施产生影响复发障碍。基于早期干预措施中几种学龄前疾病的较大效应大小，开发了PO-MDD的早期干预，父母的儿童互动疗法情绪发展（PCIT-ED）（PCIT-ED）并进行了测试。 PCIT-ED是PCIT的扩展，PCIT是一种众所周知的，广泛使用且经过证实的有效治疗方法，可用于学龄前破坏性疾病。为了解决情绪和情感的早期干扰，基于情绪发展中的经验数据添加了一个新颖的ED模块。 ED模块以父母的情感学习能力为目标，目的是训练父母作为更有效的情感老师和孩子的教练。 ED模块的目标是增强孩子的情感识别和调节或“情感能力”的能力。进行了PCIT-ED的随机对照试验，证明了可行性和疗效的希望。在这些发现之后，与等待列表控制相比，该应用程序提出了PO-MDD的大型PCIT-ED的大型RCT，然后受试者将获得主动治疗。目的是严格测试PCIT-ED的功效，以估算准确的效应大小并研究治疗反应的介体和主持人。