预防抑郁症的改变机制：一项针对高中过渡时期的有针对性的学校预防试验。
Mechanisms of Change in the Prevention of Depression: An Indicated School-Based Prevention Trial at the Transition to High School.
机构信息
University of Washington School of Medicine, Seattle; Seattle Children's Hospital, WA.
University of Washington School of Medicine, Seattle; Seattle Children's Hospital, WA.
出版信息
J Am Acad Child Adolesc Psychiatry. 2020 Apr;59(4):541-551. doi: 10.1016/j.jaac.2019.05.031. Epub 2019 Jun 20.
OBJECTIVE
Depression represents a major public health concern, and prevalence increases significantly during adolescence. The high school transition may exacerbate the risk of depression for youth with pre-existing vulnerability. The High School Transition Program (HSTP) is a brief, skills-based intervention that has demonstrated efficacy in preventing depression in adolescents. The current study aimed to evaluate the theorized mechanisms of change of the HSTP intervention by testing a multiple mediation model including school attachment (SA) and self-esteem (SE) as two mediators of treatment outcomes.
METHOD
Students (N= 497; 61.5% girls) with elevated depressive symptoms, identified for the intervention program via an eighth-grade screening, were randomized to a brief intervention (n = 247) or the HSTP (n = 233) from 2003 to 2008. Participants completed measures at five time points. The first assessment occurred at the start of the second semester of eighth grade and the last assessment occurred at the end of ninth grade. A multiple mediation model tested whether SA and SE contributed to changes in depression for youth in the HSTP.
RESULTS
The mediation model, including contemporaneously assessed SE and SA, was not supported. There was evidence of sequential mediation, such that students who participated in the HSTP intervention reported higher SA, which in turn predicted improved SE, and in turn contributed to amelioration of depressive symptoms.
CONCLUSION
The HSTP intervention ameliorated depressive symptoms by targeting factors specific to the school transition (ie, SA). Results suggest youth at risk for depression may benefit from prevention efforts that enhance students' capacity to effectively manage identified environmental stressors, such as school transitions.
CLINICAL TRIAL REGISTRATION INFORMATION
Middle School to High School Transition Project: Depression and Substance Abuse Prevention; https://clinicaltrials.gov/; NCT00071513.
目的
抑郁是一个主要的公共卫生问题，其发病率在青少年时期显著增加。高中过渡时期可能会使原本脆弱的青少年面临更大的抑郁风险。高中过渡项目（HSTP）是一种基于技能的短期干预措施，已被证明可有效预防青少年抑郁。本研究旨在通过测试一个包含学校依恋（SA）和自尊（SE）作为两个中介的多重中介模型，来评估 HSTP 干预的理论变化机制，以此作为治疗结果的中介。
方法
通过八年级的筛查，确定了有较高抑郁症状的学生（N=497；61.5%为女生）需要参加干预项目，他们被随机分配到一个简短的干预组（n=247）或 HSTP 组（n=233），时间从 2003 年到 2008 年。参与者在五个时间点完成了评估。第一个评估在八年级第二学期开始时进行，最后一个评估在九年级末进行。一个多重中介模型测试了 HSTP 中的 SA 和 SE 是否对青少年的抑郁变化有贡献。
结果
包括同时评估的 SE 和 SA 的中介模型没有得到支持。有顺序中介的证据，即参加 HSTP 干预的学生报告了更高的 SA，这反过来又预测了 SE 的改善，而 SE 的改善又有助于改善抑郁症状。
结论
HSTP 干预通过针对与学校过渡相关的特定因素（即 SA）来改善抑郁症状。结果表明，有抑郁风险的青少年可能受益于预防措施，这些措施可以增强学生有效管理确定的环境压力源（如学校过渡）的能力。
临床试验注册信息
从中学到高中过渡项目：抑郁和药物滥用预防；https://clinicaltrials.gov/；NCT00071513。
Zotero 插件