Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts2Judge Baker Children's Center, Boston, Massachusetts.
JAMA Psychiatry. 2013 Nov;70(11):1161-70. doi: 10.1001/jamapsychiatry.2013.295.
Adolescent offspring of depressed parents are at high risk for experiencing depressive disorders themselves.
To determine whether the positive effects of a group cognitive-behavioral prevention (CBP) program extended to longer-term (multiyear) follow-up.
A 4-site randomized clinical trial with 33 months of follow-up was conducted. Recruitment of participants was from August 2003 through February 2006.
The study settings included a health maintenance organization, university medical centers, and a community mental health center.
Three hundred sixteen adolescent (aged 13-17 years) offspring of parents with current and/or prior depressive disorders; adolescents had histories of depression, current elevated depressive symptoms, or both but did not currently meet criteria for a depressive disorder.
The CBP program consisted of 8 weekly 90-minute group sessions followed by 6 monthly continuation sessions. Adolescents were randomly assigned to either the CBP program or usual care (UC).
The primary outcome was a probable or definite episode of depression (Depression Symptom Rating score ≥4) for at least 2 weeks through the month 33 follow-up evaluation.
Over the 33-month follow-up period, youths in the CBP condition had significantly fewer onsets of depressive episodes compared with those in UC. Parental depression at baseline significantly moderated the intervention effect. When parents were not depressed at intake, CBP was superior to UC (number needed to treat, 6), whereas when parents were actively depressed at baseline, average onset rates between CBP and UC were not significantly different. A 3-way interaction among intervention, baseline parental depression, and site indicated that the impact of parental depression on intervention effectiveness varied across sites.
The CBP program showed significant sustained effects compared with UC in preventing the onset of depressive episodes in at-risk youth over a nearly 3-year period. Important next steps will be to strengthen the CBP intervention to further enhance its preventive effects, improve intervention outcomes when parents are currently depressed, and conduct larger implementation trials to test the broader public health impact of the CBP program for preventing depression in youth.
clinicaltrials.gov Identifier: NCT00073671.
抑郁父母的青少年子女自身也面临着患抑郁障碍的高风险。
确定团体认知行为预防（CBP）方案的积极效果是否可以延伸至更长时间（多年）的随访。
这是一项为期 33 个月随访的 4 个地点随机临床试验。参与者的招募工作于 2003 年 8 月至 2006 年 2 月进行。
研究地点包括健康维护组织、大学医疗中心和社区心理健康中心。
316 名青少年（年龄 13-17 岁）为当前和/或既往有抑郁障碍的父母的子女；青少年有抑郁史、当前有抑郁症状升高或两者兼有，但目前不符合抑郁障碍的诊断标准。
CBP 方案由 8 次每周 90 分钟的团体会议和 6 次每月的延续性会议组成。青少年被随机分配到 CBP 方案或常规护理（UC）组。
主要结局是通过第 33 个月随访评估，抑郁症状评定量表（Depression Symptom Rating score）≥4 分至少 2 周的可能或确定的抑郁发作。
在 33 个月的随访期间，CBP 组的青少年发作抑郁发作的次数明显少于 UC 组。基线时父母的抑郁情况显著调节了干预效果。当父母在入组时没有抑郁时，CBP 优于 UC（需要治疗的人数，6），而当父母在基线时处于活跃抑郁状态时，CBP 和 UC 之间的平均发作率没有显著差异。干预、基线时父母的抑郁情况和地点之间的 3 向交互表明，父母抑郁对干预效果的影响在各地点之间有所不同。
与 UC 相比，CBP 方案在近 3 年的时间内显著持续地预防了高危青少年抑郁发作。下一步重要的是加强 CBP 干预，以进一步增强其预防效果，改善当父母当前抑郁时的干预结果，并开展更大规模的实施试验，以检验 CBP 方案预防青少年抑郁的更广泛的公共卫生影响。
clinicaltrials.gov 标识符：NCT00073671。
