Psychiatric outcomes of children at high- and low-risk for depression: follow up

抑郁症高风险和低风险儿童的精神结局：随访

• 批准号: 8212267
• 负责人: MARIA KOVACS
• 金额: $ 64.54万
• 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: 2010-03-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8212267
• 关键词: 16 year old; 18 year old; Accounting; Adolescence; Adolescent; Adult; Affect; Affective; Age; Alcohol or Other Drugs use; Area; Attention; Biological; Bipolar Disorder; Cardiac; Characteristics; Child; Childhood; Chronic; Clinical; Cognitive; Cognitive Science; Conduct Disorder; Depressive disorder; Development; Disease; Documentation; Early Diagnosis; Elements; Endogenous depression; Enrollment; Environment; Evaluation; Family; Family Characteristics; Family Study; Feasibility Studies; Functional disorder; Generations; Grouping; Heterogeneity; Hospitalization; Impaired cognition; Incidence; Individual Differences; Inpatients; Intake; Intervention; Laboratories; Life; Link; Literature; Major Depressive Disorder; Measures; Mediating; Mental Depression; Mental disorders; Methodology; Modeling; Modification; Mood Disorders; National Institute of Mental Health; Neurocognitive; Neuropsychological Tests; Neuropsychology; Onset of illness; Outcome; Parents; Performance; Persons; Phenotype; Physiological; Predictive Value; Prevalence; Prevention; Probability; Process; Protocols documentation; Psychopathology; Public Health; Questionnaires; Recording of previous events; Recurrence; Relative (related person); Research; Research Design; Rest; Risk; Risk Factors; Sampling; Severities; Source; Staging; Statistical Models; Strategic Planning; Suicide attempt; System; Task Performances; Techniques; Testing; Time; Youth; aged; base; childhood onset depression; cognitive change; cognitive neuroscience; cost; data reduction; depressive symptoms; design; disability; disorder control; disorder risk; early onset; executive function; flexibility; follow-up; high risk; improved; indexing; information processing; innovation; neurocognitive test; neuropsychological; novel; offspring; predictive modeling; prevent; proband; programs; prospective; psychologic; psychosocial; public health relevance; response; sex; successful intervention; transmission process; trend

DESCRIPTION (provided by applicant): In this revised re-submission of our study of children at familial risk for depression (and controls), we have responded to the concerns of the IRG and revised our protocol accordingly. As we explicate, cognitive flexibility has been regarded as one component of executive function, which can be indexed as the ability to re- focus/shift attention and rapidly change cognitive sets in response to environmental demands. We now link our index of cognitive (in)flexibility to traditional cognitive risk factors for depression, and also incorporate an index of physiological flexibility, namely cardiac vagal control (CVC). Parental depression is a significant risk factor for major depressive disorder (MDD) in juveniles and also increases the odds of comorbid non-affective disorders. In the tradition of psychiatric high-risk family studies, we propose to examine combinations of selected personal characteristics as predictors of MDD and conduct and/or substance use-related disorders in juveniles at familial risk for depression. The personal characteristics include parental clinical (e.g., severity of mood disorder history) and child neurocognitive attributes (impaired cognitive flexibility). Cognitive flexibility as an executive function will be assessed both by traditional neuropsychological tests and their novel modifications which incorporate emotionally distracting features. As our Primary Aims, we will test hypotheses about the how the confluence of child and parent factors affect risk of MDD and non-affective disorders in offspring. Our sample will consist of n= 250 youths, including offspring of proband parents (who themselves had childhood-onset mood disorder) and offspring of control parents with no history of major psychiatric disorders. As our Secondary Aims, we will explore the relations of 2 traditional cognitive risk factors (ruminative response style and negative attributional style) to cognitive inflexibility, and the extent to which physiologic inflexibility (reflected in dysfunctional CVC) adds incremental information to our predictive model involving neurocognitive-clinical variables. Offspring will be 8-to-16-years old at initial assessment and 10-to- 18-years old at follow-up; this age range covers the transition into and across adolescence, which is the high risk period for MDD incident (new onset) cases and conduct/substance use related disorders. The feasibility of this study is underscored by the fact that we have access to a unique and well-maintained sample of families that had been ascertained as part of a prior Program Project on depression. Our study: a) is innovative because it integrates developmental and neurocognitive perspectives in the context of a high-risk family design and targets a cognitive process that may underlie a range of information processing biases in depression, b) has great public health significance because depression is both a personally devastating condition and a leading cause of disability worldwide, which may possibly be prevented or forestalled based on a better understanding of person-specific risk factors/mechanisms, and c) is timely because it reflects several components of NIMH's Strategic Objectives for research on mental disorders. PUBLIC HEALTH RELEVANCE: Although parental depression increases the odds of depression and other (non-mood) psychiatric disorders in young offspring, not all children who are at such familial risk become affected. We will therefore investigate whether certain parental clinical characteristics and child neuropsychological characteristics (impaired cognitive flexibility) predict major depressive disorder (MDD) and conduct/substance use-related disorders in 10-18 year-old offspring at familial risk for depression. In this study, cognitive flexibility refers to the ability to re-focus/switch attention and to rapidly change cognitive sets in response to environmental demands; it will be assessed both by traditional neuropsychological tests and novel modifications of such tests which incorporate emotionally distracting features. We also will examine how cognitive (in)flexibility relates to more traditional cognitive risk factors for depression and whether including an index of physiologic (in)flexibility will improve our predictive models. Our study: a) is innovative because it integrates developmental psychopathology and neurocognitive perspectives in the context of a high-risk family design and targets a cognitive process that may underlie information processing biases in depression, b) has considerable public health significance because a better understanding of person-specific risk factors/mechanisms may pave the way for targeted prevention of depression, which is both personally devastating and a leading cause of disability worldwide, and c) is timely because it reflects NIMH's Strategic Objectives for research on mental disorders.

描述（由申请人提供）：在对我们对处于抑郁症（和控制措施）家庭风险的儿童的研究中，我们已经回应了IRG的关注点，并相应地修订了我们的协议。当我们阐明时，认知灵活性被视为执行功能的一个组成部分，可以将其索引为重点/转移注意力并迅速改变认知集以响应环境需求的能力。现在，我们将我们的认知灵活性指数与抑郁症的传统认知风险因素联系起来，还纳入了生理灵活性指数，即心脏迷走神经控制（CVC）。父母抑郁症是重度抑郁症（MDD）在少年中的重要危险因素，也增加了合并症非影响疾病的几率。在精神科高危家庭研究的传统中，我们建议将选定的个人特征作为MDD和行为和/或物质使用相关的疾病的组合，以抑郁症的家族风险。个人特征包括父母临床（例如情绪障碍史的严重程度）和儿童神经认知属性（认知灵活性受损）。认知灵活性作为执行功能将通过传统的神经心理学测试及其新颖的修饰进行评估，这些神经心理学测试融合了情感上的特征。作为我们的主要目的，我们将检验有关子女因素和父母因素的汇合处如何影响MDD和后代无情感疾病的风险的假设。我们的样本将包括n = 250名年轻人，包括父母的后代（他们自己患有童年情绪障碍）和没有主要精神疾病史的控制父母的后代。作为次要目的，我们将探讨2种传统的认知风险因素（反省性反应样式和负面归因方式）与认知僵化性的关系，以及在我们的预测模型中增加了涉及神经认知能力插入式可插入性变量的预测模型的生理不灵活性（反映在功能障碍的CVC中）。后代在初步评估时将为8至16岁，随访时为10至18岁；该年龄范围涵盖了青春期的过渡，这是MDD事件（新发作）病例的高风险时期和相关疾病的行为/药物使用。这项研究的可行性强调了一个事实，即我们可以使用作为先前关于抑郁症计划项目的一部分确定的独特且维护良好的家庭样本。 Our study: a) is innovative because it integrates developmental and neurocognitive perspectives in the context of a high-risk family design and targets a cognitive process that may underlie a range of information processing biases in depression, b) has great public health significance because depression is both a personally devastating condition and a leading cause of disability worldwide, which may possibly be prevented or forestalled based on a better understanding of person-specific risk factors/mechanisms, and c）及时，因为它反映了NIMH关于精神障碍研究的战略目标的几个组成部分。 公共卫生相关性：尽管父母抑郁症增加了年轻后代的抑郁症和其他（非MOOD）精神疾病的几率，但并非所有处于家族风险的孩子都受到影响。因此，我们将研究某些父母的临床特征和儿童神经心理学特征（认知灵活性受损）是否可以预测10 - 8年历史的后代的主要抑郁症（MDD）和与抑郁症风险的行为/物质使用相关疾病。在这项研究中，认知灵活性是指重新聚焦/转移注意力并响应环境需求而迅速改变认知集的能力。它将通过传统的神经心理学测试和此类测试的新颖修改来评估，这些测试结合了情感上的特征。我们还将研究认知灵活性如何与更传统的抑郁症认知风险因素有关，以及包括生理（IN）灵活性指数是否会改善我们的预测模型。我们的研究：a）具有创新性，因为它在高风险的家庭设计的背景下整合了发展性心理病理学和神经认知的观点，并针对一个认知过程，该过程可能是抑郁症中信息处理的基础，b）具有相当大的公共健康意义，因为对人的特定风险因素/机制的理解可能会造成抑郁症的特定方式，并且会导致抑郁症的特定方式，并促进抑郁症的范围，这是造成抑郁症，这一损害的局限性，这是一种领导，这是抑郁症的范围。之所以及时，是因为它反映了NIMH关于精神障碍研究的战略目标。