From the Department of Psychiatry, the Department of Radiology, and the Department of Psychological and Brain Sciences, Washington University in St. Louis.
Am J Psychiatry. 2018 Nov 1;175(11):1102-1110. doi: 10.1176/appi.ajp.2018.18030321. Epub 2018 Jun 20.
Clinical depression in children as young as age 3 has been validated, and prevalence rates are similar to the school-age disorder. Homotypic continuity between early and later childhood depression has been observed, with alterations in brain function and structure similar to those reported in depressed adults. These findings highlight the importance of identifying and treating depression as early as developmentally possible, given the relative treatment resistance and small effect sizes for treatments later in life. The authors conducted a randomized controlled trial of a dyadic parent-child psycho-therapy for early childhood depression that focuses on enhancing the child's emotional competence and emotion regulation.
A modified version of the empirically tested parent-child interaction therapy with a novel "emotion development" module (PCIT-ED) was compared with a waiting list condition in a randomized controlled trial in 229 parent-child dyads with children 3-6.11 years of age. Both study arms lasted 18 weeks.
Children in the PCIT-ED group had lower rates of depression (primary outcome), lower depression severity, and lower impairment compared with those in the waiting list condition (Cohen's d values, >1.0). Measures of child emotional functioning and parenting stress and depression were significantly improved in the PCIT-ED group.
The findings from this randomized controlled trial of a parent-child psychotherapy for early childhood depression suggest that earlier identification and intervention in this chronic and relapsing disorder represents a key new pathway for more effective treatment. Manualized PCIT-ED, administered by master's-level clinicians, is feasible for delivery in community health settings.
3 岁以下儿童的临床抑郁症已得到验证，其患病率与学龄期疾病相似。在早期和后期儿童抑郁症之间观察到同型连续性，大脑功能和结构的改变与报告的成年抑郁症相似。这些发现强调了尽早识别和治疗抑郁症的重要性，因为在生命后期治疗的相对抗性和治疗效果较小。作者对早期儿童抑郁症的亲子心理治疗进行了一项随机对照试验，该治疗侧重于增强儿童的情绪能力和情绪调节。
在一项针对 229 对 3-6.11 岁儿童的父母-儿童双元随机对照试验中，对经过实证检验的亲子互动治疗进行了改良版本，并增加了一个新颖的“情感发展”模块（PCIT-ED），与等待名单条件进行了比较。两个研究组的持续时间均为 18 周。
与等待名单组相比，PCIT-ED 组的儿童抑郁率（主要结局）、抑郁严重程度和损伤程度较低（Cohen's d 值，>1.0）。PCIT-ED 组儿童的情绪功能和育儿压力及抑郁程度均有显著改善。
这项针对早期儿童抑郁症的亲子心理治疗的随机对照试验结果表明，在这种慢性和复发性疾病中更早地识别和干预代表了更有效治疗的一个新的关键途径。由硕士级临床医生实施的手册化 PCIT-ED 可在社区卫生环境中进行推广。
