Integrated Treatment for Comorbid Depression and Obesity in Adolescents

青少年共病抑郁症和肥胖症的综合治疗

• 批准号: 8197554
• 负责人: ELISSA JELALIAN
• 金额: $ 23.21万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-12-01 至 2013-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8197554
• 关键词: Acute; Address; Adherence; Adolescence; Adolescent; Adult; Age; Attention; Audiotape; Behavior Therapy; Belief; Blood Pressure; Body Weight decreased; Child; Childhood; Cholesterol; Clinical; Cognitive Therapy; Combined Modality Therapy; Comorbidity; Confidence Intervals; Control Groups; Data; Depressed mood; Development; Diet Habits; Disease remission; Eating; Education; Emotional disorder; Exercise; Feasibility Studies; Feedback; Female; Gender; Goals; Grant; Guidelines; Health; Individual; Intervention; Interview; Length; Literature; Major Depressive Disorder; Manuals; Medical; Mental Depression; Nature; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Overweight; Parents; Participant; Phase; Physical activity; Pilot Projects; Prevalence; Protocols documentation; Public Health; Randomized; Recruitment Activity; Refractory; Research; Research Personnel; Risk; Running; Sampling; School-Age Population; Series; Staging; Techniques; Teenagers; Testing; Training; Training Programs; Treatment Protocols; United States; Weight; Work; base; depressive symptoms; effective therapy; experience; falls; follow-up; intervention effect; male; meetings; pilot trial; programs; psychosocial; public health relevance; satisfaction

DESCRIPTION (provided by applicant): Lifetime prevalence of major depression is estimated at 28% by age 18 (Lewinsohn et al., 1999), with higher cumulative rates in females (35%) than males (19%). Approximately 17% of children and adolescents in the United States are obese as defined by a BMI above the 95th percentile, with more than 30% falling between the 85th and 95th percentiles (Ogden et al., 2008). Overweight children and adolescents are at increased risk for type 2 diabetes (Pinhas-Hamiel et al., 1996) and overwhelming risk for adult obesity (Guo et al., 1994). There is a substantial percentage of adolescents who are both overweight and depressed with estimates from clinical samples averaging 25%. Treatment of teens with comorbid medical and psychiatric conditions such as overweight/obesity and depression has received little to no attention in the psychosocial treatment research literature. Due to the large number of adolescents who are both depressed and overweight, developing a behavioral treatment that addresses both problems simultaneously has important public health significance. The purpose of this proposal is to combine treatments for depression and overweight to address these co-occurring conditions in one intervention. The long-term objectives of this research are to develop efficient and effective treatments for co-occurring physical and emotional disorders. The research program will be divided into 3 major phases: a development phase (Stage 1a), a pilot study phase (Stage 1b), and a revision phase. During the development phase (Stage 1a), a treatment for overweight teens and CBT treatment for depressed teens will be adapted into one integrated protocol that addresses depression using CBT techniques, an exercise component, and advice regarding healthy eating. As part of this phase, we will adapt existing intervention manuals and therapist training materials, and gain some initial clinical experience with the intervention via an open trial with 6 teens. During the randomized pilot study phase (Stage 1b), the integrated intervention will be compared to a control group receiving CBT treatment for depression alone (N=40 in total). During the pilot phase, the feasibility and acceptability of administering the program will be assessed. In addition, we will compare change in depressed mood at end of treatment and 6 month follow-up periods across the two groups. During the revision phase, the intervention manual will be further developed and refined, based on experiences and observations made during the development and pilot study phases. PUBLIC HEALTH RELEVANCE: The cumulative prevalence of major depression in adolescence is estimated at almost 30%. Similarly, approximately 17% of children and adolescents are obese and another 30% at risk for overweight. 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. The intervention protocol will integrate cognitive-behavioral treatment for depression with exercise plus education about healthy eating to achieve its goals.

描述（由申请人提供）： 18 岁时，重度抑郁症的终生患病率估计为 28%（Lewinsohn 等人，1999 年），女性 (35%) 的累积发病率高于男性 (19%)。美国约 17% 的儿童和青少年肥胖（BMI 高于 95%），超过 30% 的儿童和青少年处于 85% 至 95% 之间（Ogden 等，2008）。超重的儿童和青少年患 2 型糖尿病的风险增加（Pinhas-Hamiel 等，1996），并且成人肥胖的风险极高（Guo 等，1994）。根据临床样本估计，相当大比例的青少年既超重又抑郁，这一比例平均为 25%。在心理社会治疗研究文献中，对患有共病的医疗和精神疾病（例如超重/肥胖和抑郁症）的青少年的治疗几乎没有受到关注。由于大量青少年既抑郁又超重，开发一种同时解决这两个问题的行为疗法具有重要的公共卫生意义。该提案的目的是将抑郁症和超重的治疗结合起来，通过一项干预措施解决这些同时发生的病症。这项研究的长期目标是开发针对同时发生的身体和情绪障碍的高效且有效的治疗方法。研究计划将分为3个主要阶段：开发阶段（阶段1a）、试点研究阶段（阶段1b）和修订阶段。在开发阶段（第 1a 阶段），针对超重青少年的治疗和针对抑郁青少年的 CBT 治疗将被改编成一个综合方案，该方案使用 CBT 技术、锻炼部分和健康饮食建议来解决抑郁症。作为此阶段的一部分，我们将调整现有的干预手册和治疗师培训材料，并通过对 6 名青少年进行公开试验来获得一些初步的干预临床经验。在随机试点研究阶段（第 1b 阶段），综合干预措施将与单独接受抑郁症 CBT 治疗的对照组（总共 N=40）进行比较。在试点阶段，将评估管理该计划的可行性和可接受性。此外，我们将比较两组治疗结束时和 6 个月随访期间抑郁情绪的变化。在修订阶段，将根据制定和试点研究阶段的经验和观察，进一步制定和完善干预手册。 公共卫生相关性：青春期重度抑郁症的累积患病率估计接近 30%。同样，大约 17% 的儿童和青少年肥胖，另外 30% 的儿童和青少年面临超重风险。本研究通过制定一种干预措施，以综合方案解决这两个主要公共卫生问题，从而解决青春期这两个主要公共卫生问题的同时发生。该干预方案将把抑郁症的认知行为治疗与锻炼以及健康饮食教育结合起来，以实现其目标。

项目成果

Cognitive-Behavioral Therapy Plus Healthy Lifestyle Enhancement for Depressed, Overweight/Obese Adolescents: Results of a Pilot Trial.

针对抑郁、超重/肥胖青少年的认知行为疗法加上健康生活方式的增强：试点试验的结果。

• 发表时间: 2019
• 作者: Jelalian, Elissa;Jandasek, Barbara;Wolff, Jennifer C;Seaboyer, Lourah M;Jones, Richard N;Spirito, Anthony
• 通讯作者: Spirito, Anthony