Reducing Depressive Symptoms in Physically Ill Youth

减少患有身体疾病的青少年的抑郁症状

• 批准号: 7774398
• 负责人: David R DeMaso
• 金额: $ 67.53万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-03-01 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7774398
• 关键词: 17 year old; Abdominal Pain; Academic Medical Centers; Adherence; Adolescent; Aftercare; Age; Anxiety; Area; Attention; Awareness; Behavior; Behavior Therapy; Behavioral; Boston; Cardiac; Caring; Child; Childhood; Chronic; Chronic Disease; Clinical; Cognitive; Cognitive Therapy; Collaborations; Communication; Communities; Control Groups; Crohn' s disease; Data; Data Analyses; Depressed mood; Development; Disease; Doctor of Philosophy; Dose; Educational process of instructing; Effectiveness; Emotional; Empathy; Enrollment; Family; Female; Funding; Future; Gastroenterologist; Gender; Goals; Grant; Health; Hygiene; Individual; Inflammation; Inflammatory Bowel Diseases; Intervention; Learning; Life; Literature; Maintenance; Major Depressive Disorder; Measures; Medical; Medical center; Mental Depression; Modeling; Moods; Morbidity - disease rate; Neurologic; Operative Surgical Procedures; Outcome; Pain; Parents; Participant; Patients; Pediatric Hospitals; Perception; Pharmaceutical Preparations; Population; Prevalence; Prevention; Procedures; Psychiatric therapeutic procedure; Psychiatrist; Public Health; Quality of life; Randomized; Recording of previous events; Recruitment Activity; Relaxation; Research; Research Design; Research Personnel; Research Project Grants; Risk; Risk Factors; Role; Sample Size; Sampling; Severities; Severity of illness; Shapes; Site; Sleep; Sleep Disorders; Sleep disturbances; Social Functioning; Social support; Steroids; Supportive care; Symptoms; Testing; Therapeutic; Time; Ulcerative Colitis; Universities; Work; Youth; arm; base; clinically relevant; clinically significant; coping; cytokine; daily functioning; data integrity; data management; depressive symptoms; design; experience; group intervention; health related quality of life; illness perceptions; improved; medication compliance; meetings; microbial alkaline proteinase inhibitor; peer; physical conditioning; prevent; primary outcome; randomized trial; reconstruction; response; self esteem; skills; social skills; success; therapy design; treatment effect; treatment trial

DESCRIPTION (provided by applicant): Youth with inflammatory bowel disease (IBD) have high rates of depression and difficulty with daily functioning compared to age-matched peers without physical illness. Additionally, the medications used to treat IBD, specifically steroids, may induce depression, cause sleep problems, and adversely impact health-related quality of life (HRQOL). We will investigate the effects that cognitive behavioral therapy (CBT) with a physical narrative focus has on the child's emotional state and several health-related factors (e.g., HRQOL, medication adherence, IBD severity) in children and adolescents 9 -17 years of age with IBD and clinically significant depression. Participants will be randomized to either CBT designed for youth with IBD or supportive non-directive therapy (SNDT). Individuals in the CBT group will learn new cognitive strategies (i.e., reconstruction of personal physical illness narratives, coping strategies, and social skills) and alternate behaviors (i.e., positive activities, family communication, sleep hygiene, relaxation) to improve emotional (mood) and health (HRQOL, adherence, IBD severity) functioning. Participants in the time and attention control group of SNDT will receive social support and information about depression. Both groups will have parent (family) sessions provided at the beginning, middle and end of the study. For CBT these sessions will seek to improve family understanding and communication about the physical illness and the skills being taught to the patient; for (SNDT) we will provide non-directive support. The goals of this study are to assess the efficacy of the CBT versus SNDT on emotional (reducing symptoms of depression) and physical health (HRQOL, medication adherence; IBD severity) outcomes. Secondary analyses will assess changes in IBD course, pain, sleep, and illness perceptions with treatment. The relationship between health outcomes and depression will also be examined in exploratory manner. Putative moderators (e.g., anxiety, steroid use, and pubertal status) of CBT effects on depression and HRQOL will be explored. This will be the first study to explore the effects of CBT on physical health outcomes over and above the effects attributable to changes in depression in a pediatric IBD population. This approach represents an important paradigm shift in using a behavioral intervention, integrated into medical treatment, to target both emotional and physical health problems. Two sites will be used to obtain the targeted sample size of 112 per intervention group. A benefit of this research is a better understanding of both the emotional and physical health effects of chronic illness in youth and will serve to help other similar pediatric populations. The University of Pittsburgh Medical Center (UPMC)/Children's Hospital Pittsburgh and Harvard University/Children's Hospital Boston plan to collaborate on this 5 year project. This project will investigate the effects of CBT on depression and physical health-related outcomes in children and adolescents with IBD. This will be the first study that will also explore the effects of CBT on physical health outcomes over and above the effects attributable to changes in depression. A benefit of this research is that public awareness will be increased regarding both the emotional and physical health effects of chronic illness in youth and will server to help other similar pediatric populations.

描述（由申请人提供）：与没有身体疾病的年龄匹配的同龄人相比，患有炎症性肠病（IBD）的青年抑郁率和难度很高。此外，用于治疗IBD的药物，特别是类固醇，可能引起抑郁，导致睡眠问题，并对与健康相关的生活质量（HRQOL）产生不利影响。我们将调查具有物理叙事重点的认知行为疗法（CBT）对儿童的情绪状态和与健康相关的几个因素（例如，HRQOL，药物依从性，IBD严重性）对9 -17岁的IBD和IBD年龄9 -17岁的IBD和临床显着的抑郁症的影响。参与者将被随机分配为为IBD青年设计或支持性非指导疗法（SNDT）设计的CBT。 CBT小组中的个人将学习新的认知策略（即对个人身体疾病叙事，应对策略和社交技能的重建）以及替代行为（即积极的活动，家庭交流，睡眠卫生，放松），以改善情绪（情绪）和健康（HRQOL，HRQOL，ADHERCE，IBD，IBD严重性）的功能。 SNDT时间和注意力控制组的参与者将获得有关抑郁症的社会支持和信息。两组将在研究的开始，中间和结尾都提供父母（家庭）会议。对于CBT，这些课程将寻求提高家庭疾病的家庭理解和沟通以及向患者教授的技能；对于（SNDT），我们将提供非指导性支持。这项研究的目标是评估CBT与SNDT对情绪（减少抑郁症状）和身体健康（HRQOL，药物依从性； IBD严重程度）的功效。次要分析将评估IBD课程，疼痛，睡眠和治疗的疾病看法的变化。健康结果与抑郁症之间的关系也将通过探索方式进行检查。将探索CBT对抑郁症和HRQOL影响的推定主持人（例如，焦虑，类固醇使用和青春期状态）。这将是第一个探索CBT对身体健康结果的影响的研究，而不是儿科IBD人群抑郁症的变化所带来的影响。这种方法代表了使用行为干预措施（集成到医疗中）的重要范式转变，以针对情绪和身体健康问题。每个干预组的目标样本量将用于获得两个地点。这项研究的一个好处是更好地理解慢性疾病在青年中的情绪和身体健康影响，并将有助于帮助其他类似的儿科人群。匹兹堡大学医学中心（UPMC）/匹兹堡儿童医院和哈佛大学/波士顿儿童医院计划在这项5年项目中合作。该项目将调查CBT对IBD儿童和青少年的抑郁症和身体健康相关结果的影响。这将是第一项研究，还将探讨CBT对抑郁症变化的影响之外的CBT对身体健康结果的影响。这项研究的一个好处是，公众意识将对青年人的慢性疾病的情感和身体健康影响提高，并且会帮助其他类似的儿科人群。