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Evaluating hypothetical prevention strategies for internalizing symptoms in the general population and at-risk children.
Journal of Consulting and Clinical Psychology ( IF 4.5 ) 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

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).

中文翻译:


评估在普通人群和高危儿童中内化症状的假设预防策略。



目的 特定的可改变因素(例如,屏幕时间 [ST]、睡眠持续时间、身体活动或社交关系)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且往往令人望而却步。使用观察数据模拟随机试验,可以推断对降低一般和高危人群抑郁风险的可改变因素的假设干预。方法 来自青少年脑认知发展 (N = 8,699) 和 R 世代 (N = 3,739) 研究的数据用于可改变因素 (10 岁) 和内化症状 (12-14 岁)。我们 (a) 在目标试验模拟 (TTE) 下测试了每个可改变因素与内化症状的前瞻性关联,以及 (b) 使用 G 公式估计如果实施假设干预对内化症状的潜在影响。在全样本 (普遍预防环境) 和高危青年 (选择性和指示性预防环境) 中进行分析。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)使内化症状减少了 0.10-0.16 个标准差,而遵循更宽松的指南(3-4 小时)使内化症状增加了 0.07-0.09 个标准差。这种变化在适应症(亚临床症状)预防环境中更大,并且对残余混杂因素很强。限制身体活动可降低指定情况下的内化风险,但研究结果并不可靠。 结论 通过因果知情策略,我们证明了在多种预防环境中,许多假设干预措施对降低抑郁风险的可改变因素的潜在影响。(PsycInfo 数据库记录 (c) 2025 APA,保留所有权利)。
更新日期:2025-01-06
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