Department of Psychology, University of Illinois at Urbana-Champaign, 603 E Daniel St, Champaign, IL, 61820, USA.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Abnorm Child Psychol. 2018 Oct;46(7):1521-1533. doi: 10.1007/s10802-018-0401-2.
Despite interest in psychosocial vulnerabilities to depression, little is known about reliable and valid individualized risk profiles that can be used to match individuals to evidence-based interventions for depression. This study investigated well-established cognitive and interpersonal vulnerabilities to depression among youth to discern an evidence-based risk classification approach which is being used in a personalized depression prevention randomized clinical trial. Data were drawn from a general community sample of adolescents (N = 467; ages 10-16, mean 13.14, SD = 1.62; 57% females) who were followed prospectively for 3 years. Youth completed measures of cognitive (negative cognitive style, dysfunctional attitudes, rumination) and interpersonal (support and conflict with peers and parents, excessive reassurance seeking, social competence, co-rumination) risks to depression, and then were followed longitudinally for onset of depression. Principal axis factor analyses showed that three latent factors--cognitive vulnerability, interpersonal support, and interpersonal conflict--optimally represented the structure of these risk factors. Clinically practical and meaningful cutoffs, based on tertile cut-off scores on cognitive and interpersonal risk measures, were used to categorize youth into relatively balanced high and low cognitive and interpersonal risk groups. These risk classification groups exhibited validity (AUC > 0.70) by predicting prospective onsets of depressive episodes at 18-months follow-ups. These findings demonstrate a reliable and valid approach to synthesize psychosocial vulnerabilities to depression, specifically cognitive and interpersonal risks. Results are discussed in terms of using these risk classifications profiles to test personalized prevention of depression during adolescence.
尽管人们对抑郁的心理社会脆弱性很感兴趣，但对于可靠和有效的个体风险特征知之甚少，这些特征可以用于将个体与针对抑郁的循证干预措施相匹配。本研究调查了青少年中已确立的认知和人际脆弱性，以确定一种基于证据的风险分类方法，该方法正在一项针对青少年的个性化抑郁预防随机临床试验中使用。数据来自一般社区青少年样本（N=467；年龄 10-16 岁，平均 13.14，标准差 1.62；57%为女性），他们前瞻性地随访了 3 年。青少年完成了对抑郁的认知（消极认知风格、功能失调态度、反刍）和人际（与同伴和父母的支持和冲突、过度寻求保证、社交能力、共同反刍）风险的测量，然后进行了抑郁发病的纵向随访。主成分因子分析表明，三个潜在因素——认知脆弱性、人际支持和人际冲突——最佳地代表了这些风险因素的结构。基于认知和人际风险测量的三分位截断分数，使用临床实用且有意义的截断值将青少年分为相对平衡的高认知和低认知风险组和人际风险组。这些风险分类组通过预测 18 个月随访时抑郁发作的前瞻性发病，表现出有效性（AUC>0.70）。这些发现证明了一种可靠和有效的综合抑郁心理社会脆弱性的方法，特别是认知和人际风险。讨论了使用这些风险分类来测试青少年时期个性化预防抑郁的问题。
