This grant application is for the Mentored Clinical Scientist Development Award (K08). The objective is to train the applicant to be an independent researcher in combined drug and family treatments of adolescent depression. This career goal evolved out of a desire to understand why most controlled studies have failed to show drug efficacy in youth depression. Developing effective treatments for this disorder is an important priority because of its increasing prevalence, serious morbidity, frequent recurrence, significant mortality, and huge cost to society. The research study will test the hypothesis that family stressors contribute to poor drug response in depressed adolescents. Its primary specific aim is to see how parental expressed emotion (EE) affects drug efficacy in treatment of adolescent depression. A marker of excessive parental criticism and emotional overinvolvement, high EE is associated with relapse in some adolescent psychiatric disorders. The study will compare response rates to fluoxetine of depressed adolescent outpatients from high and low EE families. The Career Development Plan will develop the applicant's skills in 1) use of instruments diagnosing youth depression and family dysfunction; 2) design of studies examining impacts of family stressors on drug efficacy; 3) design and performance of drug studies; 4) interventions for high EE families; 5) data analysis; and 6) reporting of study data to the scientific community. Methods of career development include: 1) the proposed study; 2) the primary mentorship of Dr. Martin Reite with consultation from other UCHSC faculty; 3) consultation with experts in drug and family treatments of adolescent depression; 4) formal coursework; 5) attendance at scientific meetings; and 6) data preparation for submission to professionally referred journals.
