Evaluating hypothetical prevention strategies for internalizing symptoms in the general population and at-risk children.

IF 4.5 1区心理学 Q1 PSYCHOLOGY, CLINICAL Journal of consulting and clinical psychology Pub Date : 2025-01-06 DOI:10.1037/ccp0000912

Lorenza Dall'Aglio, Jeremy A Labrecque, Isabel Schuurmans, Yingzhe Zhang, Nicole Creasey, Marina Wilson, Chris J Kennedy, Ryan L Muetzel, Jordan W Smoller, Henning Tiemeier, Karmel W Choi

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Abstract

Objective: 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.

Method: Data from the Adolescent Brain Cognitive Development (N = 8,699) and the Generation R (N = 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).

Results: 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 SDs while following more lenient guidelines (3-4 hr) increased them by 0.07-0.09 SDs, 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.

Conclusions: 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).

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评估一般人群和高危儿童内化症状的假设预防策略。

目的：特定的可改变因素（如屏幕时间、睡眠时间、身体活动或社会关系）是降低成人抑郁风险的目标。然而，对青少年的研究缺乏因果推理的实施，因为预防试验成本高昂，而且往往令人望而却步。用观察性数据模拟随机试验，可以对降低一般人群和高危人群抑郁风险的可改变因素的假设干预进行推断。方法：利用青少年大脑认知发展（N = 8,699）和R世代（N = 3,739）研究的数据来确定可改变因素（10岁）和内化症状（12-14岁）。我们(a)在目标试验模拟（TTE）下测试了每个可修改因素与内化症状的前瞻性关联，(b)使用g公式估计实施假设干预措施对内化症状的潜在影响。在全样本（普遍预防设置）和高危青年（选择性和指示性预防设置）中进行了分析。结果：首先，在TTE下，只有ST与内化症状相关。其次，在普遍预防环境中，与现有指南（2小时）相比，遵循更严格的ST指南（0-1小时）可使内化症状减少0.10-0.16个标准差，而遵循更宽松的指南（3-4小时）可使内化症状增加0.07-0.09个标准差。这种变化在指征（亚临床症状）预防设置中更大，并且对残留混淆具有稳健性。在指定的环境中，限制身体活动降低了内化风险，但研究结果并不可靠。结论：通过因果信息策略，我们证明了在多种预防设置中，许多假设干预措施对降低抑郁风险的可修改因素的潜在影响。（PsycInfo Database Record (c) 2025 APA，版权所有）。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.