2/4-Prevention of Depression: Impact on the Transition to Early Adulthood

2/4-预防抑郁症：对成年早期过渡的影响

• 批准号: 7778185
• 负责人: William R. Beardslee
• 金额: $ 29.35万
• 依托单位: JUDGE BAKER CHILDREN'S CENTER
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-02-03 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7778185
• 关键词: 17 year old; Absenteeism; Acute; Address; Adolescence; Adolescent; Adoption; Adult; Age; Age of Onset; Angiotensins; Anxiety; Area; Behavioral; Benchmarking; Biological; Body mass index; Boston; Candidate Disease Gene; Child; Child Abuse; Chronic; Cognitive; Competence; Costs and Benefits; DNA; Data; Data Collection; Data Coordinating Center; Depressed mood; Depressive disorder; Development; Diet; Disease; Divorce; Doctor of Philosophy; Early Diagnosis; Economics; Education; Effectiveness of Interventions; Employment; Enrollment; Environment; Environmental Risk Factor; Enzymes; Evaluation; Event; Family; Family history of; Family member; Foundations; Funding; Future; Genes; Genetic; Genetic Markers; Genetic Polymorphism; Genetic Risk; Goals; Health; Health Benefit; Health Care Costs; Health Psychology; Health Status; Hostility; Hypertension; Hypotension; Impairment; Incidence; Individual; Individual Differences; Intervention; Intervention Studies; Interview; Knowledge; Lead; Life; Link; Literature; Long-Term Effects; Longitudinal Studies; Measures; Mediating; Medical; Mental Depression; Mental Health; Mental disorders; Methods; Modeling; Molecular; Mood Disorders; Morbidity - disease rate; National Institute of Mental Health; Neurotic Disorders; Occupational; Outcome; Overweight; Parents; Participant; Patient Self-Report; Personality; Physical activity; Population; Prevalence; Prevention; Prevention program; Prevention strategy; Preventive; Preventive Intervention; Procedures; Productivity; Program Development; Progress Reports; Psyche structure; Psychopathology; Psychosocial Factor; Public Health; Randomized; Recording of previous events; Recurrence; Relative (related person); Relative Risks; Reporting; Research; Research Project Grants; Risk; Risk Behaviors; Risk Factors; Role; Sample Size; Sampling; Schools; Severities; Site; Sleep; Smoking; Social Policies; Source; Specific qualifier value; Stress; Subgroup; Substance abuse problem; Suicide; Teenagers; Telephone; Training; Unemployment; Unipolar Depression; Universities; Work; Workplace; Youth; abuse neglect; cardiovascular disorder risk; cardiovascular risk factor; cohort; cost; cost effectiveness; critical period; depressive symptoms; design; disability; disorder prevention; early childhood; economic impact; economic outcome; emerging adult; emerging adulthood; experience; follow-up; genetic analysis; global health; health care service organization; high risk; human capital; improved; indexing; innovation; intervention effect; intervention program; meetings; multi-site trial; next generation; novel; offspring; pediatric trauma; performance site; physical conditioning; prevent; proband; programs; promoter; psychologic; psychosocial; public health relevance; response; serotonin transporter; service intervention; stressor; suicidal risk; therapy development; trait; treatment as usual; treatment effect; young adult

DESCRIPTION (provided by applicant): This A1competitive renewal is one of four collaborative, linked R01s that proposes to examine the long-term effects of a Cognitive Behavioral Program (CBP) for preventing depression provided when adolescents were 13-17 years old. The sample is at high risk by virtue of familial (parental depression) and individual factors (past history of depression and/or current subsyndromal depressive symptoms). In the original study, we successfully enrolled 99% (N=316) of our proposed target recruitment of 320 adolescents, with equal recruitment across the 4 sites. Participants were randomized into either CBP or treatment as usual (TAU), with equally high retention (92%) in both conditions. Results through the 8-month follow-up indicated a significant prevention effect of CBP with regard to depressive episodes (HR=.60, 95% CI, .38-.96; effect size, d=.25), thus replicating and extending the earlier, single site study by Clarke et al., (2001). The aims of the current proposal are to (a) study the longer term impact of CBP on preventing depression during the critical developmental transition to early adulthood, a period of multiple new life challenges and stressors; (b) assess potential biological (e.g., genetic) and psychosocial (e.g., childhood abuse, stressful life events) moderators of response to the intervention; (c) examine the broader impact of the CBP program on sequelae of depression including other mental and medical health problems, health risk behaviors, and impairment in the attainment of developmental competencies; and (d) assess the long-term cost-efficacy of CBP, identify markers of the impact of CBP on key economic outcomes (e.g., workplace productivity), and examine the longer-term economic benefits of preventing or delaying the onset of mood disorders in adolescents with CBP. We will explore the potential role of adolescent depression in mediating these outcomes in young adulthood. These aims are consistent with the areas of highest priority for the NIMH Division of Services and Intervention Research (DSIR) insofar as this project will evaluate the durability and broader effects as well as cost-efficacy of an innovative prevention strategy, will potentially reduce the burden of suicidality by increasing depression-free days, and will both aid in the personalization of the intervention and the identification of new prevention targets through our study of biological and psychosocial moderators of treatment effects. Knowledge gained from this study will be used to identify individuals who are most and least likely to benefit from this prevention program, and will provide an empirical foundation for novel and innovative strategies for the prevention of depression. In our original study, we found that we can prevent depression among at-risk youth, but we do not yet know if this prevention lasts and whether it improves youths' schooling, employment, and relationships with others. The proposed study will be the first to examine whether depression continues to be prevented as these teens become young adults. This study also will identify youth who are most likely to benefit from this program, and will inform us about how to create future prevention programs that help those youth who did not benefit.

描述（由申请人提供）：此 A1 竞争性更新是四个协作、关联的 R01 之一，该 R01 旨在检查 13-17 岁青少年提供的预防抑郁症的认知行为计划 (CBP) 的长期效果。由于家族（父母抑郁）和个人因素（既往抑郁史和/或当前的亚综合征抑郁症状），样本处于高风险。在最初的研究中，我们成功招募了 99% (N=316) 的 320 名青少年，在 4 个地点进行平等招募。参与者被随机分为 CBP 组或照常治疗组 (TAU)，两种情况下的保留率相同 (92%)。 8 个月的随访结果表明 CBP 对抑郁发作具有显着的预防作用（HR=.60，95% CI，0.38-.96；效应大小，d=.25），从而复制和扩展Clarke 等人 (2001) 进行的早期单点研究。当前提案的目的是 (a) 研究 CBP 对在成年早期的关键发展过渡期间预防抑郁症的长期影响，这是一个面临多种新生活挑战和压力源的时期； (b) 评估干预措施反应的潜在生物（例如遗传）和社会心理（例如儿童虐待、压力性生活事件）调节因素； (c) 审查 CBP 计划对抑郁症后遗症的更广泛影响，包括其他精神和医疗健康问题、健康风险行为以及发展能力受损； (d) 评估 CBP 的长期成本效益，确定 CBP 对关键经济成果（例如工作场所生产力）影响的标志，并检查预防或延缓情绪障碍发作的长期经济效益患有 CBP 的青少年。我们将探讨青少年抑郁症在调节成年早期这些结果中的潜在作用。这些目标与 NIMH 服务和干预研究部 (DSIR) 的最优先领域一致，因为该项目将评估创新预防策略的持久性和更广泛的影响以及成本效益，有可能减轻负担通过增加无抑郁天数来减少自杀倾向，并且通过我们对治疗效果的生物和心理社会调节因素的研究，将有助于个性化干预和确定新的预防目标。从这项研究中获得的知识将用于确定最有可能和最不可能从该预防计划中受益的个人，并将为预防抑郁症的新颖和创新策略提供经验基础。在我们最初的研究中，我们发现我们可以预防高危青少年的抑郁症，但我们还不知道这种预防是否能持续下去，以及是否能改善青少年的学业、就业和与他人的关系。拟议的研究将首次检验随着这些青少年成年后是否可以继续预防抑郁症。这项研究还将确定最有可能从该计划中受益的青少年，并将告知我们如何制定未来的预防计划来帮助那些没有受益的青少年。