A National Research Consortium 国家性研究

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CATCH-IT Intervention-Overview of Past Clinical Trial Results

Behavioral Vaccine Trial 行为疫苗测试 College of Medicine, University

Bell, MD, Director, Center for Juvenile Research and Tracy

Wellesley College, USA Chief, Section, General Pediatrics and

1 CATCH-IT Intervention-Overview of Past Clinical Trial Results and Future Planned Trials CATCH-IT 干預模組过去测试结果与未来测试计划概述 A Behavioral Vaccine Trial 行为疫苗测试 College of Medicine, University of Illinois at Chicago Benjamin Van Voorhees, MD, MPH, Carl Bell, MD, Director, Center for Juvenile Research and Tracy Gladstone, Ph.D. Wellesley College, USA Chief, Section, General Pediatrics and Adolescent Medicine Visiting Associate Professor of Pediatrics Director, TIKES Center A National Research Consortium 国家性研究 1

2 CATCH-IT Research Collaborations and Anticipated Affiliations CATCH-IT研究合作与相关机构 CATCH-IT 的定义 C-Competent 有才能称职的 A-Adulthood 成年人 T-Transition 过渡期 C-Cognitive 认知 H-Humanistic 人文 I-Interpersonal 人际(关系) T-Training 训练 2

CATCH-IT History CATCH-IT历史 2004 Phase 1 Clinical Trial 第一阶段临床试验 2007 Phase 2 Clinical Trial 第二阶段 2007 2011 Phase 3 Clinical Trials (2) 2011 第3阶段 2015 Phase 4 Clinical Trial 2015 第4阶段 Other

3 CATCH-IT History CATCH-IT历史 2004 Phase 1 Clinical Trial 第一阶段临床试验 2007 Phase 2 Clinical Trial 第二阶段 Phase 3 Clinical Trials (2) 2011 第3阶段 2015 Phase 4 Clinical Trial 2015 第4阶段 Other trials 其他测试 2013 Advanced technology Phase 2 Clinical Trial (预计2013年) 使用更先进技术的第二阶段临床实验 Hong Kong Phase 1 Clinical Trial 年香港第一阶段测试 Word-wide Phase 4 Clinical Trial 2017 世界性第四阶段临床实验 3

4 Grant Support 1. Centers for Disease Control, Prevention Research Centers, Grant #U48/CCU (2002) 2. National Association for Research on Schizophrenia and Affective Disorders Young Investigator Award (2004) 3. Robert Wood Johnson Foundation Depression in Primary Care Value Grant (2005) 4. K-08National Institute of Mental Health Physician Scientist Career Development Award (2006) 5. RWJ Foundation Finding Answers Grant (2010) 6. 1 R01 MH A1 Primary Care Internet-Based Depression Prevention for Adolescents (CATCH-IT) (2011) 7. P20MH A1 Technology Assisted intervention for Treatment and Prevention of Depression Mentors and Appreciation Carl Bell, MD University of Illinois Mark Reinecke, Ph.D. Northwestern University Patrick Corrigan, Ph.D. Illinois Institute of Technology David Meltzer, Ph.D. University of Chicago Daniel Ford, MD, MPH Johns Hopkins University Usha Raj, MD University of Illinois Chicago 4

5 Disclosures Mevident, Inc Received $ 4,000 to assist in revising version of CATCH-IT for schools Prevail Health Solutions, Inc. Social Kinetics, Inc Chinese International School, Hong Kong University of Hong Kong Alberta Medical Association Dalhousie University Hong Kong Government, SA, PRC Depression-Major Problem and Limitations of Current Treatment-only Model 抑郁症现阶段治疗的主要问题与局限 25% incidence by age 24 25%患病发生于24岁前 80% recurrence 80%复发 SA/tobacco use and suicide 物质滥用与自杀 Impaired productivity/education 生产/学习力下降 2-fold increased mortality at all ages 全年龄层患病率2倍 Treatment alone will eliminate < 20% of total disease burden 治疗只减低20%以下的负担 Kessler RC, Walters EE. Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the National Co-morbidity Survey. Depress Anxiety. 1998;7(1):

6 Advantages for Primary Care-Based Delivery 医疗机关为主的传递 Access to at-risk population 可与危险群接触 Established role in prevention 为防治要角 Easy distribution 分布简单 Culturally acceptable 文化上可接受 Low cost 低价 Endorsed by multiple organizations 多机构使用 Kessler RC, Avenevoli S, Ries Merikangas K. Mood disorders in children and adolescents: an epidemiologic perspective. Biol Psychiatry. Jun ;49(12): Joffe A, Radius S, Gall M. Health counseling for adolescents: what they want, what they get, and who gives it. Pediatrics. Sep 1988;82(3 Pt 2): Kronn DF, Sapru A, Satou GM. Management of hypercholesterolemia in childhood and adolescence. Heart Dis. 2000;2(5): Could early primary care intervention reduce morbidity? 早期干預是否可减低病症 Potential to intervene before first episode 有可能在第一次抑郁期前成功干預 Reduce lifetime burden 減低一生中負擔 Attenuate secondary damage to development 控制發展中的次級傷害 Reduce risk of other disorders linked to depression 降低與抑鬱症相關疾病風險 Kessler RC, Avenevoli S, Ries Merikangas K. Mood disorders in children and adolescents: an epidemiologic perspective. Biol Psychiatry. Jun ;49(12): Joffe A, Radius S, Gall M. Health counseling for adolescents: what they want, what they get, and who gives it. Pediatrics. Sep 1988;82(3 Pt 2): Kronn DF, Sapru A, Satou GM. Management of hypercholesterolemia in childhood and adolescence. Heart Dis. 2000;2(5):

CATCH-IT History 2004 Phase 1 Clinical Trial 2004年第一階段臨床實驗 2007 Phase 2 Clinical Trial 2011 Phase 3 Clinical Trials (2) 2011 Hong Kong Phase 1 Clinical Trial (Dr.

7 CATCH-IT History 2004 Phase 1 Clinical Trial 2004年第一階段臨床實驗 2007 Phase 2 Clinical Trial 2011 Phase 3 Clinical Trials (2) 2011 Hong Kong Phase 1 Clinical Trial (Dr. Chim will discuss) 2013 Advanced technology Phase 2 clinical trial Anticipated 2015 Phase 4 Clinical Trial Anticipated Word-wide Phase 4 clinical trial 2017 But, we have few solutions for the every day dilemmas of families, children and teens that increase risk of mental disorders 降低日常家庭兒童與青少年風險的方式 7 7

Intervention Sequence 干預措施 Primary Care Primary Care Initial Interview 初次面談 Web-based Introduction To website/ Depression Prevention 網頁/抑鬱防治節少 Cognitive Behavioral

8 Intervention Sequence 干預措施 Primary Care Primary Care Initial Interview 初次面談 Web-based Introduction To website/ Depression Prevention 網頁/抑鬱防治節少 Cognitive Behavioral Training 認知行為訓練 Interpersonal Training 人際關係訓練 Primary Care Self-evaluation Treatment Option Education Primary Care Interview 研究後面談自我評估治療選擇教育第一模組結束後將問受試者參與原因(動機) 8

9 Key Lessons Learned 關鍵教訓 Reduce drop-out rate 降低樣本丟失率 Need coaching phone calls 需要指導電話 manage negative affect while online- otherwise 以其他方式處理負面情感 Increase engagement 提升吸引力 Need lively stories and engaging graphics 需要吸引人的故事 Improved data capture 資料採集資料 Track time on line 追蹤上線時間 Improved theoretical model based on risk factors 以流行病學提升理論模組 CATCH-IT History 2004 Phase 1 Clinical Trial 2007 Phase 2 Clinical Trial 第2階段臨床測試 2011 Phase 3 Clinical Trials (2) 2011 Hong Kong Phase 1 Clinical Trial (Dr. Chim will discuss) 2013 Advanced technology Phase 2 clinical trial Anticipated 2015 Phase 4 Clinical Trial Anticipated Word-wide Phase 4 clinical trial

10 Key Lessons Learned Improved theoretical model using epidemiology 以流行病學提升理論模組 Focus on activation of behavior 著重於行為激活 Reduce drop-out rate 減低丟失率 Increase engagement 增加吸引力 Need lively stories and engaging graphics 需要引人注目的圖文 Do study in actual primary care practice 在機構現場測驗 Ecological Framework of Depression Pathogenesis 內至外為個人家庭學校同/伴社會抑鬱症治病的環境架構 17 危險與保護因子抑鬱情感抑鬱症 Van Voorhees, et al, JAH,

11 New Theory: Developmental-Ecological Model 新理論發展-環境模組 CATCH-IT 介入點個人學校社會 17 Van Voorhees, et al, JAH, 2008 Key Lessons Learned Improved theoretical model using epidemiology Focus on activation of behavior 行為激活的聚焦 Reduce drop-out rate Increase engagement Need lively stories and engaging graphics Do study in actual primary care practices 11

12 Effective Components use Evidence-Based Manuals mapped to Ecology of Risk 有效因子使用特殊針對環境危險因子的循證準則 Clarke GN. The adolescent coping with stress class: leader Manual. Portland, OR: Kaiser Permanent Center for Health Research; Jacobson NS MC, Dimdjian S. Behavioral Activation Treatment for Depression: Returning to Contextual Roots. Clinical Psychology: Science and Practice. Fall 2001;8(3). Stuart S, O'Hara MW, Gorman LL. The prevention and psychotherapeutic treatment of postpartum depression. Arch Women Ment Health. 2003;6 (Suppl 2):S Epub 2003 Aug Effective Components 有效因子 Epidemiology Theoretical Model Brain/Clinical Psychology Vulnerability/ Protection Behavior Implementation Behavior Goals Low motivation/depressed mood Trans-theoretical Model of Change Motivational Interviewing Increase self-efficacy Individual Coping (CBT) Cognitive Behavioral Psychotherapy Positive, realistic view self/situations/problem solve actively Community 社群 Behavioral Activation and Resiliency 行為激活與復原力 Internet Instructional Design and Vicarious Learning Theory 網絡指令設計與替代學習理論增加愉悅/有意義的活動 Increase pleasant/meaningful activities School/Peer Interpersonal Psychotherapy Strengthen peer relations/problem solve Family Family Systems Strengthen parenting skills/understanding 12

13 Key Lessons Learned Improved theoretical model using epidemiology Focus on activation of behavior Reduce drop-out rate 降低丟失率 Increase engagement Need lively stories and engaging graphics Do study in actual primary care practices Reduce Drop-Out: Social Marketing Strategy 降低丟失率社會行銷策略 Marketing Strategy/Behavior Model (Formation) Don t Mis s Out Bec aus e of Mood 別因心情錯過治療重要性與準備 Importanc e and readines s Internet Priv ac y and Res ilienc y and Autonomy 網絡匿 Conv enience 復原力名性與與自主性便利性自我效能 Self-effic ac y 信任 Endors ed by nurs e and phy s ic ian 醫護人員支持 Beliefs / Attitudes toward Interv ention Perc eiv ed Soc ial Norms 社會標準覺察 PCP Interview, Nurse discussion and Social Worker Calls Parent engagement by all Baseline Motivation Adolescent Motivation (Effectiveness) Post-study Motivation 主治醫面談護士討論社工聯繫 Van Voorhees, et al, 2009 全體家長參與 13

14 Nurse Social Marketing 行銷培養 The CATCH-IT intervention is for adolescents who want to prevent down moods that make them miss out. Pioneered by leading universities, the CATCH-IT Internet site helps teens build resiliency against down moods at their own convenience in complete privacy. 宣傳重點為防止抑鬱情感自主性匿名性 Key Lessons Learned Improved theoretical model using epidemiology Focus on activation of behavior Reduce drop-out rate Increase engagement 吸引目光 Need lively stories and engaging graphics Do study in actual primary care practices 14

15 Motivational Framework: Engaging with Lively Medium 激勵架構接觸更生動的媒介 CATCH-IT Motivational Interview Components Goals Mood Cost-benefit of doing something CATCH-IT overview Cost- benefits of CATCH-IT Contract 15

16 CATCH-IT Internet Components What you will learn Review Lesson Stories Skill builders Feedback Wrap-up Doing Goals Rewards Visit CATCH-IT site 16

17 Next, we need to hold their attention.. 保持住使用者的注意 Say some more Say some more And control negative affect 並調整負面情感 17

Vicarious Learning Theory-Stories 替代學習理論以他人經驗記取教訓 Key Lessons Learned Improved theoretical model using epidemiology Focus on activation of

18 Vicarious Learning Theory-Stories 替代學習理論以他人經驗記取教訓 Key Lessons Learned Improved theoretical model using epidemiology Focus on activation of behavior Reduce drop-out rate Increase engagement Need lively stories and engaging graphics Do study in actual primary care practices 實地研究 18

19 What to say here? Study Done in Primary Care Sites Screened >1,200 adolescents (14-21) in primary care Key Lessons Learned Improved theoretical model using epidemiology Focus on activation of behavior Reduce drop-out rate Increase engagement Need lively stories and engaging graphics Do study in actual primary care practices Determine what is the form of physician engagement needed to maximize adolescent participation 實地研究可以體驗到提升參與感所需的醫護人員互動種類 19

20 Maximize Physician/Minimize Cost 最大投資報酬 Primary Care Motivational Interview 15 minutes 激勵 15分鐘 Brief Advice 1-2 minutes 簡短建議 1-2 分鐘 Primary Care Individual 個人層級 Coping (BA/CBT) Family 家庭層級 (Beardslee/ Gladstone) Primary Care Interview post 研究後面談 School/Peer 學校層級 (IPT) Community/ Resiliency 社群等級與復原人力與時間 Primary Care Interview pre 研究前面談 Internet-based Van Voorhees BW, Ellis J, Stuart S, Fogel J and Ford DE, 2004, Pilot study of a primary care-based depression prevention intervention for late adolescents. Canadian Child and Adolescent Psychiatry Review, 14 (2), Video example of motivational interview 20

21 Study Design and Recruitment 設計募集隨機分配 Motivation PCP Motivational Interview Social worker motivational phone calls N=43 Brief Advice PCP Brief Advice No motivational Phone calls N=40 主治醫師建議主治醫師激勵 103 eligible and 84 enrolled and randomized (1 dis-enrolled) 103人符合標準 84加入 1人取消 All Adolescents have access to Internet program and receive Safety Phone Calls 所有個案皆有網絡使用權與接收到安全電話 6 week follow-up with Full Motivational Interview 6 week follow-up with Brief Advice Diverse Sample 多樣化樣本 Characteristic 特性 Motivational (N=43) 激勵 Brief Advice (N=40) 建議 17.1 (2.1) 17.2 (2.1) Male 45% 59% Female 55% 41% 59% 60% African American非裔美国人 19% 32% Asian American 亚裔美国人 7% 3% Hispanic 西裔美国人 12% 2% 其他 2% 3% Mean Age 平均年齡 Gender 性別 Ethnicity 種族 White 白人 Other 24 21

22 Fidelity and Dose Characteristic Motivational 激励 (N=43) Brief Advice 建议 (N=40) PCP Interview Motivational Interview 3.50 (0.63) Fidelity Rating Scale激励效度 0.90 (0.37)*** Interview Length (minutes) 面谈时间 1.8 (0.45)*** 6.0 (1.8) Adolescent Internet Site Participation 参与测量 Percentage Visiting the Internet Site 参观网页 90% 78% Time on Internet Site 网页上花费时间 (111) 93.7 (123) ** Numbers Characters Typed in 输入字元 3225 (3022) 1824 (2305) ** ***p-value < 0.001, **p-value < 0.01 Van Voorhees, et al, 2008 Children s Hospital of the University of Illinois * Center for Epidemiologic Studies Depression Scale (CES-D) comparison for both groups baseline to 120 weeks P-value> CATCH-IT CES-D10 Score Motivational Brief CATCH-IT 干預在激勵組與建議組兼有立即效果 baseline 6 weeks 12 weeks 24 weeks 52 weeks 120 weeks Time 22

23 Prevalence of Any Depressive Disorder 任何種類抑鬱症的普及性 Percentage of adolescents with any Depressive Disorder (McMemars baseline to follow-up not sig for either group; chi squared 52 week motivational brief baseline 6 weeks 12 weeks 24 weeks 52 weeks 激勵組一年後追蹤仍有顯著降低 Percentage (%) group comparison p-value=0.15) Time Reduction in Self Harm Thoughts 自殘意念減低 Percentage (%) 組 2一年後追蹤仍有顯著降低 Percentage of adolescents with thoughts of self harm over time (McMemars p-value=0.05 for entire cohort baseline versus 12 weeks; chi squared 52 week group comparison p-value=0.13) Motivational Brief Baseline 6 weeks 12 weeks 24 weeks 52 weeks -10 Time Van Voorhees, et al, 2008, partial 23

24 Reduced Depressive Episode by 12 Months 12個月後追蹤與抑鬱期的減少 Cumulative Prevalence of Clinically Significant Depressive Episodes at 12 Months (p-value comparison < 0.013) Percentage Depressive Disorder 抑鬱症百分比 Motivational Brief Group 12個月後抑鬱期出現的累積 Van Voorhees, et al, 2008, partial?? Protective and Vulnerability Factors Pre/Post Outcomes Summarized 保護與危險因子的總結 Factor Domains MI 激勵 YES 5/6 BA 建議 MARGINAL 1/6 Family Social support family 家庭支持 YES 2/3 MARGINAL 1/3 School/community 學校/社區 YES 2/3 MARGINAL 1/3 Individual 個人層級 24

25 Adverse or Other Events One adolescent with gun shot wound, later killed in bystander shooting Two adolescents assaulted One unplanned pregnancy One suicide attempt at one week One completed suicide at 20 weeks Iraq War deployment Unplanned pregnancies Key Lessons Learned Broaden effective components Improve motivational framework Improve implementation structure 25

26 CATCH-IT History 2004 Phase 1 Clinical Trial 2007 Phase 2 Clinical Trial 2011 Phase 3 Clinical Trials (2) 2011 Hong Kong Phase 1 Clinical Trial (Dr. Chim will discuss) 2013 Advanced technology Phase 2 clinical trial Anticipated 2015 Phase 4 Clinical Trial Anticipated Word-wide Phase 4 clinical trial R01 MH A1 Promoting Adolescent Health Study (PATH) Practice Training Presentation Tracy Gladstone, Ph.D. Senior Research Scientist Wellesley Centers for Women, Wellesley College Children s Hospital Boston 26

27 = 27

Effective Components 有效要素 Epidemiology 流行病 Theoretical Model 理论模块 Brain/Clinical Psychology 脑部/临床心理学 Vulnerability危险因子/ Protection保护因子 Behavior 行为 Implementation 实行 Behavior Goals 行为目标 Low

28 Effective Components 有效要素 Epidemiology 流行病 Theoretical Model 理论模块 Brain/Clinical Psychology 脑部/临床心理学 Vulnerability危险因子/ Protection保护因子 Behavior 行为 Implementation 实行 Behavior Goals 行为目标 Low motivation/ depressed mood 低动力/抑郁心境 Trans-theoretical Model of Change 跨理论转换模块 Motivational Interviewing 激励面谈 Increase self-efficacy 自我效能提升 Individual Coping (CBT) Cognitive Behavioral Psychotherapy 认知行为治疗 Community 社群 Behavioral Activation and Resiliency 行为激活与复原 School/Peer 学校/同伴 Interpersonal Psychotherapy 人际精神治疗 Family 家庭 Family Systems Strengthen parenting skills/ understanding 加强亲护/理解家庭系统 Internet Instructional Design and Vicarious Learning Theory 学习理论 Positive, realistic view self/ situation/problem solve actively 正面现实的观察/环境/主動问题解决能力 Increase pleasant/meaningful activities 增加愉悦/有意义的活动 Strengthen peer relations/problem solve 增强同伴关系与问题解决能力 28

29 Health Education 29

30 Module Module Content Behavioral Target 1 2 AVOIDING ACCIENTAL INJURY NUTRITION FACTS AND MYTHS Safety behaviors Healthy diet 3 HEALTHY EATING ON THE GO Healthy diet 4 HEALTHY TEETH AND GUMS Dental health 5 Calcium and Vit D consumption 6 BENEFITS OF CALCIUM AND VITAMIN D ENVIRONMENTAL HEALTH 7 FOODBORNE ILLNESSES Reducing exposure 8 PROTECTION AGAINST SEASONAL ILLNESSES 9 MENINGOCOCCAL MENINGITIES VACCINATION 10 BICYCLE AND VEHICLE SAFETY MEASURES Increase bike safety 11 FIRE SAFETY IN THE HOME Increase fire safety 12 Increase vaccination 13 HUMAN PAPILOMA VIRUS VACCINATION ALLERGIES 14 LEARNING ABOUT MOOD Awareness of when to seek treatment Reducing exposure Minimizing exposure 30

Chicago Jennifer Froemel, LCPC, Family Service and Mental Health Center of Cicero

31 Chicago Urban Resiliency Building Evaluation Study Karen Taylor-Caldwell, MD University of Illinois Benjamin Van Voorhees, MD, MPH, University of Illinois, Chicago Jennifer Froemel, LCPC, Family Service and Mental Health Center of Cicero Mary Johnson, MSW, Corazon Community Services TJ Crawford, BA, Positive Influences CURB Study Design 31

32 CURB Design 32

33 CATCH-IT History 2004 Phase 1 Clinical Trial 2007 Phase 2 Clinical Trial 2011 Phase 3 Clinical Trials (2) 2011 Hong Kong Phase 1 Clinical Trial (Dr. Chim will discuss) 2013 Advanced technology Phase 2 clinical trial Anticipated 2015 Phase 4 Clinical Trial Anticipated Word-wide Phase 4 clinical trial 2017 Advanced Technology Figure 1: Intervention and Behavior Change Process Virtual Humans Induction/ Maintenance Motivational Program Constructed social networks Booster Motivational Mobile sensing Adolescent Internet Program Parent Internet 1 2 Peer and School Family Individual Coping/ Depressed Mood 3 Major Depression Incidence 4 Social Capital Functional Status /Developmental Progress 33

34 CATCHIT Proposed World WideResearch Consortium (Arabic, Chinese, English, Spanish) (N=5,000 Trial) Chinese Language and cultural Adaptation (2007 present) North American Spanish cultural adaptation ( ) Arabic cultural adaptation and Translation ( ) 67 Conclusions Long-term efficacy/effectiveness studies needed Must address needs of adolescents in many environments May need cultural adaptation even in same society Complex modeling of outcomes will be needed in addition to clinical trial between group outcomes 34

35 Thanks and Special Acknowledgments Intervention Development Justin Ellis Josephine Landsback Micah Prochaska Karoline Dmokowska Sachiko Kuwabara Rebecca Garza Katy Keller Elise Johnson Brendan Sweeney Internet Site Programming Don Saner Nicholas Shank Tim Holper Bret Westphal Justin Ellis Dave Paunesku Elise Johnson Priscilla Arias Monika Marko Rachel Landau Clinical Epidemiology: Anirban Basu, Ph.D., Joshua Fogel, Ph.D. Conceptual Model of Revised CATCH-IT Intervention Add content on risk factors for urban youth Epidemiology review Van Voorhees, et al,

Conceptual Model of Revised CATCH-IT Intervention Ethnically matched video introduction to material on line Van Voorhees, et al, 2011 Conceptual

36 Conceptual Model of Revised CATCH-IT Intervention Ethnically matched video introduction to material on line Van Voorhees, et al, 2011 Conceptual Model of Revised CATCH-IT Intervention Shorten text More realistic stories Hip hop cultural theme in art Community engagement Van Voorhees, et al,

37 Advanced technology Phase 2 clinical trial 1. Constructed social networks 2. Virtual Humans 3. Mobile Sensing Van Voorhees, et al, 2011 Qualitative Analysis: Themes and Time Summary: Value of Coping Skills and Challenges of Using them C A T C H -IT C ha n g e C op ing B e fo re C A T C H -IT H e a lt h C A T CH - IT E x pe rie nce R e la tio n ship s C op ing B e fo re C A T C H -IT H e a lt h Jo bs/ Fina nc e s B od y I m a g e Co m m u nic a tion In t e rv e n tio n Un de rsta nd ing De p re s sion C A T CH - IT E x pe rie nce R e la tio n ship s C A T C H -IT C ha n g e Co m m u nic a tion P re In t e rv e n tio n Un de rsta nd ing De p re s sion C A T C H -IT C ha n g e B od y I m a g e C op ing B e fo re C A T C H -IT H e a lt h Jo bs/ Fina nc e s B od y I m a g e Co m m u nic a tion Po stin t e rv e n tio n Un de rsta nd ing De p re s sion C A T CH - IT E x pe rie nce R e la tio n ship s Jo bs/ Fina nc e s 37

38 Process Evaluation: Co-MorbidityNo Materials Targeting these symptoms Co-Morbid Symptoms Any Anxiety Percent Sample Baseline 55% Any Substance Abuse 30% Any Conduct Disorder (mostly truancy) 79% 11, IV Slide (SSP&title) 38

39 Sample Characteristics: Demographics 樣本特色人口統計 Characteristic Mean Age Number of Participants 20 平均年齡 Mean CES-D Score 13 Gender Male Female 7 7 男女 Ethnicity 種族 White 白人 African American 黑人 Hispanic 西裔 Acceptability: Performance 可接受度表現 Web Site Usage 網頁使用 Measure of Use 使用測量 Total time on site 在線時間 Total modules completed 模組完成率 Measure (SD) 平均 (標準差) (66.8) minutes 7.2 (3.9) modules- out of a total of 11 11項模組中完成7.2項 39

40 Acceptability: Reasons for Not Completing the Intervention 接受度干預未完成原因技術問題 1 疾病 Completers 1 Anxious Feelings 無動力 1 Intervention Insufficient for Current Problem 干預不能 1 解決問題完成者 Lack of Motivation 8 Medical Illness 2 Technical Problem 焦慮 Evidence for Benefit: Pre/Post Change in Risk Factors 利益的證明危險因子前後改變 Score 介入後介入前 Pre-intervention Post-Intervention 0 Depressive Symptoms (CES-D) 抑鬱症狀 Dysfunctional Thinking (ATQ) Social Support (SSQ-6) 失能思考社會支持 40

Inclusion/Exclusion Criteria: Adolescents 納入/剃除標準 Inclusion: 納入 Sub-threshold depression 未達診斷標準抑鬱 Age 14-21 Exclusion:

41 Inclusion/Exclusion Criteria: Adolescents 納入/剃除標準 Inclusion: 納入 Sub-threshold depression 未達診斷標準抑鬱 Age Exclusion: 剔除 Major depression (PCP discretion) 重症抑鬱 Other primary mental disorders 其他主要精神疾患 Suicidal intention 自殺意念 Study Design 41

Effective Components 有效要素 Epidemiology 流行病 Theoretical Model 理论模块 Brain/Clinical Psychology 脑部/临床心理学 Vulnerability危险因子/ Protection保护因子

Motivational Interviewing 激励面谈 Increase self-efficacy 自我效能提升 Individual Coping (CBT) Cognitive Behavioral Psychotherapy 认知行为治疗 Community 社群

parenting skills/ understanding 加强亲护/理解家庭系统 Internet Instructional Design and Vicarious Learning Theory 学习理论 Positive, realistic view self/

42 Effective Components 有效要素 Epidemiology 流行病 Theoretical Model 理论模块 Brain/Clinical Psychology 脑部/临床心理学 Vulnerability危险因子/ Protection保护因子 Behavior 行为 Implementation 实行 Behavior Goals 行为目标 Low motivation/ depressed mood 低动力/抑郁心境 Trans-theoretical Model of Change 跨理论转换模块 Motivational Interviewing 激励面谈 Increase self-efficacy 自我效能提升 Individual Coping (CBT) Cognitive Behavioral Psychotherapy 认知行为治疗 Community 社群 Behavioral Activation and Resiliency 行为激活与复原 School/Peer 学校/同伴 Interpersonal Psychotherapy 人际精神治疗 Family 家庭 Family Systems Strengthen parenting skills/ understanding 加强亲护/理解家庭系统 Internet Instructional Design and Vicarious Learning Theory 学习理论 Positive, realistic view self/ situation/problem solve actively 正面现实的观察/环境/主動问题解决能力 Increase pleasant/meaningful activities 增加愉悦/有意义的活动 Strengthen peer relations/problem solve 增强同伴关系与问题解决能力 42

Uncertainty of Measurement Application to Laboratory Medicine 鏡檢組蔡雅雯 2014/09/09

Uncertainty of Measurement Application to Laboratory Medicine 鏡檢組蔡雅雯 2014/09/09 Objectives Definitions Methodology Equation of Measurement Uncertainty Measurement Uncertainty Goal Examples Uncertainty