Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia.
Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia.
J Am Acad Child Adolesc Psychiatry. 2021 Sep;60(9):1116-1126.e1. doi: 10.1016/j.jaac.2020.11.004. Epub 2020 Nov 13.
To evaluate whether evidence-based depression prevention programs can be optimized by matching youths to interventions that address their psychosocial vulnerabilities.
This randomized controlled trial included 204 adolescents (mean [SD] age = 14.26 [1.65] years; 56.4% female). Youths were categorized as high or low on cognitive and interpersonal risks for depression and randomly assigned to Coping With Stress (CWS), a cognitive-behavioral program, or Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), an interpersonal program. Some participants received a match between risk and prevention (eg, high cognitive-low interpersonal risk teen in CWS, low cognitive-high interpersonal risk teen in IPT-AST), others received a mismatch (eg, low cognitive-high interpersonal risk teen in CWS). Outcomes were depression diagnoses and symptoms through 18 months postintervention (21 months total).
Matched adolescents showed significantly greater decreases in depressive symptoms than mismatched adolescents from postintervention through 18-month follow-up and across the entire 21-month study period (effect size [d] = 0.44, 95% CI = 0.02, 0.86). There was no significant difference in rates of depressive disorders among matched adolescents compared with mismatched adolescents (12.0% versus 18.3%, t = .78, p = .44).
This study illustrates one approach to personalizing depression prevention as a form of precision mental health. Findings suggest that risk-informed personalization may enhance effects beyond a one-size-fits-all approach.
Bending Adolescent Depression Trajectories Through Personalized Prevention; https://www.clinicaltrials.gov/; NCT01948167.
评估基于证据的抑郁预防方案是否可以通过匹配青少年与解决其心理社会脆弱性的干预措施来进行优化。
这是一项随机对照试验，纳入了 204 名青少年（平均[标准差]年龄=14.26[1.65]岁；56.4%为女性）。根据认知和人际抑郁风险，将青少年分为高风险或低风险，并随机分配至应对压力（Coping With Stress，CWS）、认知行为方案，或人际心理治疗-青少年技能训练（Interpersonal Psychotherapy-Adolescent Skills Training，IPT-AST）、人际方案。一些参与者接受了风险与预防的匹配（例如，高认知-低人际风险的青少年在 CWS 中，低认知-高人际风险的青少年在 IPT-AST 中），另一些参与者则接受了不匹配（例如，高认知-高人际风险的青少年在 CWS 中）。结局为抑郁诊断和症状，在干预后 18 个月（共 21 个月）进行评估。
与不匹配的青少年相比，匹配的青少年在干预后 18 个月的随访期内，以及整个 21 个月的研究期间，抑郁症状均显著降低（效应量[d]为 0.44，95%置信区间[CI]为 0.02，0.86）。在匹配的青少年中，与不匹配的青少年相比，抑郁障碍的发生率无显著差异（12.0%比 18.3%，t=-.78，p=.44）。
本研究说明了一种将抑郁预防个性化作为精准心理健康的方法。研究结果表明，风险知情的个性化可能会增强一种一刀切方法之外的效果。
通过个性化预防改变青少年抑郁轨迹；https://www.clinicaltrials.gov/；NCT01948167。
