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.

项目概要 10% 到 20% 的女性在围产期（怀孕至产后一年）患有抑郁症， 尤其是低收入种族/少数民族妇女，但许多人没有获得适当的心理健康 治疗。育儿自我效能感低下和母婴互动受损会导致健康相关问题 负担和负面的孕产妇和儿童结果。然而，这些育儿问题目前并未得到解决 基于初级保健的围产期抑郁症治疗。我们的团队开发，以用户为中心的设计 技术，基于证据的促进第一关系（PFR）育儿干预的简要版本： PFR-B。我们现在建议测试一种全面的围产期抑郁症治疗方法 - 母婴和二元治疗 护理 (MInD) - 包括围产期协作护理中的 PFR-Brief，这是一种基于证据的干预措施 围产期抑郁症。 MInD 将响应初级保健机构中妇女的需求，因为初级保健机构中大多数妇女 服务不足的妇女获得产前护理。通过关注产后恶化的重要调节因素 抑郁症（养育自我效能感下降和母婴互动受损），MInD 有潜力 改善产妇结局，并从长远来看，改善儿童结局。我们项目的具体目标是： 目标 1 在 RCT 中比较 MInD 与普通 CC 以评估抑郁症结果。六十名患有抑郁症的女性 妊娠将被随机分配至 MInD 或普通 CC。我们假设患者被随机分配至 MInD 抑郁症会得到显着改善（通过爱丁堡产后中心测量） 与普通 CC 相比，产后 3 个月和 6 个月的抑郁量表）以及随机分组的患者 根据 Sheehan 残疾量表和 Barkin 指数衡量，MInD 将具有显着更好的功能 与接受常规 CC 的患者相比，母亲的功能情况。目标 2：探索之间的关联 养育自我效能感、二元互动和抑郁来提供中介假设。我们假设 随机分组的女性的养育自我效能感会更高，二元互动也会得到改善 MInD 治疗后将介导随机分组患者之间抑郁结果的差异 MInD 和通常的 CC。目标 3：检查 MInD 与普通 CC 的相对利用率，以及进行 试验、评估负担以及治疗与患者需求的匹配程度。我们将使用混合方法 使用工作联盟清单和深入的患者访谈来比较 MInD 和普通 CC 的策略。 我们假设随机分配至 MInD 的患者将具有更高的治疗利用率（如通过以下指标衡量）： 参加至少 3 次产前 CM 会议和 3 次产后 CM 会议。我们将探讨研究问题：如何 随机分配至 MInD 的患者的治疗经历与 患者被随机分配至普通CC？在该项目结束时，我们的多学科和互补团队将 准备进行 R01 资助的更大规模的混合 I 型有效性实施随机对照试验，以研究 MInD 的有效性并为实施做好准备。