A Dyadic Approach to Perinatal Depression Treatment in Primary Care

初级保健中围产期抑郁症治疗的二元方法

• 批准号: 10343820
• 负责人: Amritha Subray Bhat
• 金额: $ 23.33万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-15 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10343820
• 关键词: Address; Affect; Aftercare; Antidepressive Agents; Attention; Belief; Caring; Child; Child Rearing; Consultations; Data; Depressed mood; Discipline of obstetrics; Education; Equipment and supply inventories; Evidence based intervention; Evidence based treatment; Feedback; Funding; Future; Health; Hybrids; Impairment; Improve Access; Infant; Intervention; Interview; Low income; Measures; Mediating; Mediator of activation protein; Mental Depression; Mental Health; Mental Health Services; Methodology; Methods; Minority Women; Moods; Mother-Child Relations; Mothers; National Institute of Mental Health; Outcome; Parents; Patients; Perinatal; Pilot Projects; Postpartum Depression; Postpartum Period; Pregnancy; Prenatal care; Primary Health Care; Procedures; Protocols documentation; Provider; Randomized; Reporting; Research; Risk; Role; Sampling; Self Efficacy; Severities; Symptoms; Techniques; Testing; Time; Variant; Woman; Work; antenatal; antepartum depression; base; collaborative care; depressive symptoms; disability; dyadic interaction; effectiveness study; effectiveness-implementation RCT; evidence base; experience; feasibility testing; help-seeking behavior; human centered design; improved; indexing; maternal depression; maternal outcome; medical specialties; motherhood; multidisciplinary; perinatal period; peripartum depression; pilot test; prenatal; prevent; primary care setting; programs; racial and ethnic; recruit; response; social stigma; uptake; user centered design

Project Summary Ten to 20% of women have depression in the perinatal period (pregnancy through one year postpartum), especially low income racial /ethnic minority women, yet many do not receive appropriate mental health treatment. Low parenting self-efficacy and impaired mother - infant interactions contribute to health-related burden and negative maternal and child outcomes. Yet these parenting issues are not addressed in current primary care-based perinatal depression treatments. Our team has developed, with user centered design techniques, a brief version of the evidence based Promoting First Relationships (PFR) parenting intervention: PFR-B. We now propose to test a comprehensive perinatal depression treatment - Maternal Infant and Dyadic Care (MInD) - that includes PFR-Brief in perinatal collaborative care, an evidence based intervention for perinatal depression. MInD will be responsive to the needs of women in primary care settings where most underserved women obtain prenatal care. By focusing on important mediators of worsened postpartum depression (decreased parenting self-efficacy and impaired mother-infant interaction), MInD has the potential to improve maternal outcomes, and in the long run, child outcomes. Our project specific aims are: Aim 1 To compare MInD vs. usual CC in a RCT to assess depression outcomes. Sixty women with depression in pregnancy will be randomly assigned to MInD or usual CC. We hypothesize that patients randomized to MInD will experience significantly better improvement in depression (measured by the Edinburgh Postpartum Depression Scale) at 3 months and 6 months postpartum compared to usual CC and that patients randomized to MInD will have significantly better functioning as measured by Sheehan Disability Scale and Barkin Index of Maternal Functioning compared to patients receiving usual CC. Aim 2: To explore the association between parenting self-efficacy, dyadic interaction and depression to inform a mediational hypothesis. We hypothesize that parenting self-efficacy will be greater and dyadic interaction will be improved in women randomized to MInD post treatment and will mediate differences in depression outcomes between patients randomized to MInD and usual CC. Aim 3: To examine relative utilization of MInD vs usual CC, feasibility of conducting the trial, assessment burden and perceived match of treatment to patient need. We will use a mixed methods strategy using the Working Alliance Inventory and in-depth patient interviews to compare MInD and usual CC. We hypothesize that patients randomized to MInD will have higher utilization of treatment as measured by attendance at least 3 antenatal and 3 postpartum CM sessions. We will explore the research question: How do the treatment experiences of patients randomized to MInD compare with the treatment experiences of patients randomized to usual CC? At the end of this project our multidisciplinary and complementary team will be poised to conduct an R01 funded, larger Hybrid Type I effectiveness-implementation RCT to study the effectiveness of MInD and prepare for implementation.

项目摘要 十到20％的妇女在围产期（产后一年怀孕）患有抑郁症， 尤其是低收入的种族 /族裔少数民族妇女，但许多人没有获得适当的心理健康 治疗。低育儿的自我效能感和母亲受损 - 婴儿互动有助于与健康有关 负担和负面的母亲和儿童成果。然而，这些育儿问题当前尚未解决 基于初级保健的围产期抑郁疗法。我们的团队以用户为中心的设计发展了 技术，基于证据的简短版本促进第一关系（PFR）育儿干预： PFR-B。我们现在建议测试全面的围产期抑郁症治疗 - 孕产妇和二元 护理（思维） - 包括围产期协作护理中的pfr -brief，这是基于证据的干预措施 围产期抑郁症。头脑将在大多数的初级保健环境中响应女性的需求 服务不足的妇女获得产前护理。通过专注于产后恶化的重要介体 抑郁（育儿自我效能减少和母亲互动受损）具有潜力 从长远来看，要改善产妇的结果。我们的项目具体目标是：目标1 比较思维与常规CC在RCT中评估抑郁症结果。六十名患有抑郁症的妇女 怀孕将被随机分配给脑海或常规CC。我们假设患者随机脑海 抑郁症的改善将显着改善（由爱丁堡产后衡量 抑郁量表）与通常的CC相比，产后3个月零6个月，患者随机分组 想到 与接受常规CC的患者相比，孕产妇的功能。目标2：探索 育儿自我效能，二元相互作用和抑郁症，以告知中介假设。我们假设 育儿的自我效能感将更大，而随机分配给女性的二元相互作用将得到改善 心理治疗后，将介导随机分配到的患者之间的抑郁症结局差异 心灵和通常的CC。目标3：检查思维的相对利用与通常的CC，进行的可行性 试验，评估负担和感知治疗与患者需求的匹配。我们将使用混合的方法 使用工作联盟库存和深入的患者访谈来比较思维和通常的CC的策略。 我们假设患者随机脑海将具有较高的治疗利用率 参加至少3个产前和3个产后CM会议。我们将探讨研究问题： 与随机心态的患者的治疗经历相比 患者随机使用CC？在这个项目的结尾，我们的多学科和补充团队将 准备进行R01资助的较大的I型I型有效性 - 实现RCT来研究 思维的有效性并为实施做准备。