Cognitive Behavioral Program for the Prevention of Depression in At-Risk Adolescents: Isolating the Effects of Dose.

Autor:	Dickerson JF; Kaiser Permanente Center for Health Research., Clarke G; Kaiser Permanente Center for Health Research., Weersing VR; Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego., Lynch FL; Kaiser Permanente Center for Health Research., Hollon SD; Department of Psychology, Vanderbilt University., Brent D; Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine., Beardslee W; Department of Psychiatry, Children's Hospital Boston and Judge Baker Children's Center., Gladstone TRG; Wellesley Centers for Women, Wellesley College., Porta G; Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine., DeBar L; Kaiser Permanente Center for Health Research., Brooks N; Kaiser Permanente Center for Health Research., Garber J; Department of Psychology and Human Development, Vanderbilt University.
Jazyk:	angličtina
Zdroj:	American journal of epidemiology [Am J Epidemiol] 2024 Jun 20. Date of Electronic Publication: 2024 Jun 20.
DOI:	10.1093/aje/kwae131
Abstrakt:	The current study estimated effects of intervention dose (attendance) of a cognitive behavioral prevention (CBP) program on depression-free days (DFD) in adolescent offspring of parents with a history of depression. As part of secondary analyses of a multi-site randomized controlled trial, we analyzed the complete intention-to-treat sample of 316 at-risk adolescents ages 13-17. Youth were randomly assigned to the CBP program plus usual care (n=159) or to usual care alone (n=157). The CBP program involved 8 weekly acute sessions and 6 monthly continuation sessions. Results showed that higher CBP program dose predicted more DFDs, with a key threshold of approximately 75% of a full dose in analyses employing instrumental variable methodology to control multiple channels of bias. Specifically, attending at more than 75% of acute phase sessions led to 45.3 more DFDs over the 9-month period post randomization, which accounted for over 12% of the total follow-up days. Instrument sets were informed by study variables and external data including weather and travel burden. In contrast, conventional analysis methods failed to find a significant dose-outcome relation. Application of the instrumental variable approach, which better controls the influence of confounding, demonstrated that higher CBP program dose resulted in more DFDs. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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