预防高危青少年的抑郁症：急性效应的预测因素和调节因素
Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects.
作者信息
Weersing V Robin, Shamseddeen Wael, Garber Judy, Hollon Steven D, Clarke Gregory N, Beardslee William R, Gladstone Tracy R, Lynch Frances L, Porta Giovanna, Iyengar Satish, Brent David A
机构信息
Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego.
University of Michigan, Ann Arbor.
出版信息
J Am Acad Child Adolesc Psychiatry. 2016 Mar;55(3):219-26. doi: 10.1016/j.jaac.2015.12.015. Epub 2016 Jan 18.
OBJECTIVE
To assess predictors and moderators of a cognitive-behavioral prevention (CBP) program for adolescent offspring of parents with depression.
METHOD
This 4-site randomized trial evaluated CBP compared to usual community care (UC) in 310 adolescents with familial (parental depression) and individual (youth history of depression or current subsyndromal symptoms) risk for depression. As previously reported by Garber and colleagues, a significant prevention effect favored CBP through 9 months; however, outcomes of CBP and UC did not significantly differ when parents were depressed at baseline. The current study expanded on these analyses and examined a range of demographic, clinical, and contextual characteristics of families as predictors and moderators and used recursive partitioning to construct a classification tree to organize clinical response subgroups.
RESULTS
Depression onset was predicted by lower functioning (hazard ratio [HR] = 0.95, 95% CI = 0.92-0.98) and higher hopelessness (HR = 1.06, 95% CI = 1.01-1.11) in adolescents. The superior effect of CBP was diminished when parents were currently depressed at baseline (HR = 6.38, 95% CI = 2.38-17.1) or had a history of hypomania (HR = 67.5, 95% CI = 10.9-417.1), or when adolescents reported higher depressive symptoms (HR = 1.04, 95% CI = 1.00-1.08), higher anxiety (HR = 1.05, 95% CI = 1.01-1.08), higher hopelessness (HR = 1.10, 95% CI = 1.01-1.20), or lower functioning (HR = 0.94, 95% CI = 0.89-1.00) at baseline. Onset rates varied significantly by clinical response cluster (0%-57%).
CONCLUSION
Depression in adolescents can be prevented, but programs may produce superior effects when timed at moments of relative wellness in high-risk families. Future programs may be enhanced by targeting modifiable negative clinical indicators of response.
CLINICAL TRIAL REGISTRATION INFORMATION
Prevention of Depression in At-Risk Adolescents; http://clinicaltrials.gov/; NCT00073671.
目的
评估针对父母患有抑郁症的青少年后代的认知行为预防（CBP）项目的预测因素和调节因素。
方法
这项4个地点的随机试验在310名有家族性（父母患抑郁症）和个体性（青少年有抑郁症病史或当前有亚综合征症状）抑郁风险的青少年中，将CBP与常规社区护理（UC）进行了比较。正如Garber及其同事之前所报告的，在9个月的时间里，CBP有显著的预防效果；然而，当父母在基线时患有抑郁症时，CBP和UC的结果没有显著差异。本研究扩展了这些分析，考察了一系列家庭人口统计学、临床和背景特征作为预测因素和调节因素，并使用递归划分构建分类树来组织临床反应亚组。
结果
青少年功能较低（风险比[HR]=0.95，95%置信区间[CI]=0.92-0.98）和绝望感较高（HR=1.06，95%CI=1.01-1.11）可预测抑郁症发作。当父母在基线时患有抑郁症（HR=6.38，95%CI=2.38-17.1）或有轻躁狂病史（HR=67.5，95%CI=10.9-417.1），或者青少年在基线时报告有更高的抑郁症状（HR=1.04，95%CI=1.00-1.08）、更高的焦虑（HR=1.05，95%CI=1.01-1.08）、更高的绝望感（HR=1.10，95%CI=1.01-1.20）或更低的功能（HR=0.94，95%CI=0.89-1.00）时，CBP的优越效果会减弱。发作率因临床反应集群而异（0%-57%）。
结论
青少年抑郁症是可以预防的，但项目在高危家庭相对健康的时期实施可能会产生更好的效果。未来的项目可以通过针对可改变的负面临床反应指标来加强。
临床试验注册信息
高危青少年抑郁症预防；http://clinicaltrials.gov/；NCT00073671。
Zotero 插件