Dall'Aglio Lorenza, Labrecque Jeremy A, Schuurmans Isabel, Zhang Yingzhe, Creasey Nicole, Wilson Marina, Kennedy Chris J, Muetzel Ryan L, Smoller Jordan W, Tiemeier Henning, Choi Karmel W
Department of Child and Adolescent Psychology and Psychiatry, Erasmus MC, University Medical Center Rotterdam, Sophia Children's Hospital.
Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam.
J Consult Clin Psychol. 2025 Apr;93(4):252-266. doi: 10.1037/ccp0000912. Epub 2025 Jan 6.
Specific modifiable factors (e.g., screen time [ST], sleep duration, physical activity, or social connections) are targets for reducing depression risk in adults. However, research in adolescents lacks causal inference implementations, as prevention trials are costly and often prohibitive. Emulating randomized trials with observational data enables inference regarding hypothetical interventions on modifiable factors that reduce depression risk, in general and at-risk populations.
Data from the Adolescent Brain Cognitive Development ( = 8,699) and the Generation R ( = 3,739) studies were leveraged for modifiable factors (age 10) and internalizing symptoms (age 12-14). We (a) tested prospective associations of each modifiable factor with internalizing symptoms under target trial emulation (TTE) and (b) used G-formula to estimate the potential effects on internalizing symptoms if hypothetical interventions were implemented. Analyses were conducted in the full sample (universal prevention setting) and at-risk youth (selective and indicated prevention setting).
First, under TTE, only ST associated with internalizing symptoms. Second, in the universal prevention setting, adhering to more stringent ST guidelines (0-1 hr) decreased internalizing symptoms by 0.10-0.16 s while following more lenient guidelines (3-4 hr) increased them by 0.07-0.09 s, compared to existing guidelines (2 hr). Such changes were greater in the indicated (subclinical symptom) prevention settings and robust to residual confounding. Restricting physical activity reduced internalizing risk in the indicated setting, but findings were not robust.
With a causally informed strategy, we demonstrated the potential effects of numerous hypothetical interventions on modifiable factors for depression risk reduction, across multiple preventive settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
特定的可改变因素（如屏幕使用时间[ST]、睡眠时间、体育活动或社交联系）是降低成年人抑郁症风险的目标。然而，青少年研究缺乏因果推断的实施，因为预防试验成本高昂且往往难以开展。利用观察数据模拟随机试验能够推断出针对可改变因素的假设干预措施对降低抑郁症风险的影响，无论是在一般人群还是高危人群中。
利用青少年大脑认知发展研究（n = 8699）和Generation R研究（n = 3739）的数据，分析可改变因素（10岁时）与内化症状（12 - 14岁时）之间的关系。我们（a）在目标试验模拟（TTE）下测试每个可改变因素与内化症状的前瞻性关联，（b）使用G公式估计如果实施假设干预措施对内化症状的潜在影响。分析在全样本（普遍预防环境）和高危青少年（选择性和指示性预防环境）中进行。
首先，在TTE下，只有屏幕使用时间与内化症状相关。其次，在普遍预防环境中，与现有指导方针（2小时）相比，遵循更严格的屏幕使用时间指导方针（0 - 1小时）可使内化症状减少0.10 - 0.16标准差，而遵循更宽松的指导方针（3 - 4小时）则使其增加0.07 - 0.09标准差。在指示性（亚临床症状）预防环境中，这种变化更大，并且对残余混杂因素具有稳健性。在指示性环境中限制体育活动可降低内化风险，但结果并不稳健。
通过因果关系明确的策略，我们证明了多种假设干预措施对降低抑郁症风险的可改变因素的潜在影响，涵盖了多种预防环境。（PsycInfo数据库记录（c）2025美国心理学会，保留所有权利）
