A novel app-based cognitive behavioral therapy intervention for preventing postpartum depression

一种基于应用程序的新型认知行为治疗干预措施，用于预防产后抑郁症

• 批准号: 10478190
• 负责人: Adam Korrick Lewkowitz
• 金额: $ 18万
• 依托单位: WOMEN AND INFANTS HOSPITAL-RHODE ISLAND
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10478190
• 关键词: Affect; American College of Obstetricians and Gynecologists; Area; Behavior; Biometry; Birth; Breast Feeding; Breastfed infant; COVID-19; Cellular Phone; Child; Childbirth; Childhood; Client satisfaction; Cognitive; Cognitive Therapy; Consent; Control Groups; Coping Skills; Data; Depression screen; Development; Diagnosis; Education; Educational Curriculum; Evaluation; Feedback; Focus Groups; Funding; Goals; Group Interviews; Health Insurance; High Risk Woman; Impairment; Individual; Infant Care; Internet; Intervention; Intervention Studies; Interview; K-Series Research Career Programs; Low income; Measures; Medical; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentors; Mentorship; Mothers; Outcome Study; Parenting Education; Perinatal; Perinatal Care; Persons; Phase; Physiological; Postpartum Depression; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Prevalence; Prevention; Preventive; Protocols documentation; Psychology; Questionnaires; Randomized; Randomized Controlled Trials; Recommendation; Recording of previous events; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Risk; Risk Factors; Services; Social support; Symptoms; System; Technology; Testing; Text Messaging; Therapeutic Intervention; Time; Training; Transportation; United States; United States National Institutes of Health; Unmarried; Visit; Woman; acceptability and feasibility; adaptive intervention; aged; antenatal; barrier to care; base; cognitive development; depressive symptoms; design; digital health; efficacy testing; ethnic diversity; experience; falls; feasibility trial; food insecurity; group intervention; health equity; high risk; implementation barriers; improved; improved outcome; innovation; innovative technologies; insight; multidisciplinary; novel; obstetric outcomes; patient oriented; patient oriented research; perinatal mental health; pilot trial; postpartum health; prevent; primary outcome; programs; prototype; racial diversity; randomized trial; recruit; screening; screening guidelines; secondary outcome; smartphone Application; telehealth; tool; trial design; usability; women of color

The prevalence of depression is high after childbirth: rates of postpartum depression (PPD) are as high as 25% among women without prior PPD or depression but with personal or structural risk factors such as being low- income or a women of color, among others. As such, the American College of Obstetricians and Gynecologists recommends screening women for PPD. However, disparities in postpartum mental health care exist: <60% of women attend post-partum visits where PPD screening occurs, and barriers such as lack of transportation or childcare have been shown to not only reduce rates of postpartum visit attendance but to disproportionately affect low-income women or women of color. In addition, the risk of PPD extends beyond 60 days post-partum, when pregnancy-related federal health insurance often expires. Smartphone applications (apps) may increase equity in postpartum mental health by providing long-term access to mental health treatment to most women. Indeed, in the United States, 96% of those aged 18-29 own a smartphone, and medical apps have been shown to improve obstetric outcomes and increase access to mental health services. Though in-person, cognitive behavioral therapy given through the Mothers and Babies Program (MB) has been shown to reduce PPD by 53% among low-income women of color, the effect of app-provided group MB is unclear. The purpose of this Mentored Patient-Oriented Career Development Award (K23) is to enable the candidate to develop a funded research program to optimize postpartum mental health care for low-income women of color via an innovative technology-based intervention that may decrease their rates of PPD. To achieve this goal, training and mentor- ship are proposed in three key areas: 1) Advanced training in mixed methods research, perinatal psychology, digital health, and biostatistics; 2) Mentorship from a multi-disciplinary team of established researchers; and 3) Protected time to perform patient-oriented research on the feasibility of utilizing app-provided MB as a study intervention for low-income women of color with risk factors for PPD. Two study phases are required. First, focus groups and interviews will optimize the study intervention, which contains MB and parenting education (PE). Those in the intervention group will access MB+PE while those in the control group will access PE to encourage app engagement with both study groups. This is because women in both groups will receive bimonthly Edinburgh Postnatal Depression Scales (EPDS) scores from birth to six months postpartum. The primary outcome of the proposed randomized trial is demonstrated feasibility and acceptability of app-based MB, defined via recruitment and app usage (feasibility), and scores on the System Usability Scale and Client Satisfaction Questionnaire (acceptability). Secondary outcomes include EDPS scores. The proposed trial will provide critical insight into a subsequent R01-supported randomized trial designed to examine the effect of app-based MB on PPD among low-income, racially and ethnically diverse women. If effective, app-based MB has great potential for scalability and could increase postpartum mental health equity for most women.

产后抑郁症患病率高：产后抑郁症（PPD）发生率高达25% 没有既往产前抑郁症或抑郁症但有个人或结构性危险因素（例如低血压）的女性 收入或有色人种女性等。因此，美国妇产科学院 建议对女性进行 PPD 筛查。然而，产后心理保健方面存在差异：<60% 女性参加产后检查，进行 PPD 筛查，并克服缺乏交通或交通等障碍 事实证明，托儿服务不仅会降低产后就诊率，而且会不成比例地降低产后就诊率。 影响低收入女性或有色人种女性。此外，产后抑郁症的风险会持续到产后 60 天以上， 与怀孕相关的联邦健康保险经常到期。智能手机应用程序（apps）可能会增加 通过为大多数妇女提供长期获得心理健康治疗的机会，实现产后心理健康的公平。 事实上，在美国，18-29 岁的人群中 96% 拥有智能手机，并且医疗应用程序已被证明 改善产科结果并增加获得心理健康服务的机会。尽管是面对面的、认知的 通过母亲和婴儿计划 (MB) 进行的行为疗法已被证明可以减少 PPD 在低收入有色人种女性中，53% 的人认为应用程序提供的群体 MB 的效果尚不清楚。这样做的目的 以患者为导向的职业发展奖（K23）旨在帮助候选人发展一个受资助的职业发展奖 研究计划旨在通过创新方法优化低收入有色人种女性的产后心理保健 基于技术的干预可能会降低他们的产后抑郁症发生率。为了实现这一目标，培训和指导 - 船舶建议在三个关键领域进行：1）混合方法研究、围产期心理学、 数字健康和生物统计学； 2）由知名研究人员组成的多学科团队的指导；和 3) 有保护的时间来进行以患者为导向的研究，以了解利用应用程序提供的 MB 作为研究的可行性 对有产后抑郁症危险因素的低收入有色人种女性进行干预。需要两个学习阶段。第一的， 焦点小组和访谈将优化研究干预，其中包括MB和育儿教育 （体育）。干预组将接受 MB+PE，而对照组将接受 PE 鼓励应用程序与两个研究小组互动。这是因为两组中的女性都会收到 每两个月一次的爱丁堡产后抑郁量表 (EPDS) 评分，从出生到产后六个月。这 拟议的随机试验的主要结果是证明基于应用程序的可行性和可接受性 MB，通过招聘和应用程序使用（可行性）定义，以及系统可用性量表和客户端的分数 满意度调查问卷（可接受性）。次要结果包括 EDPS 分数。拟议的试验将 为随后 R01 支持的旨在检查效果的随机试验提供重要见解 针对低收入、种族和民族多元化女性的 PPD 基于应用程序的 MB。如果有效，基于应用程序的 MB 具有巨大的可扩展潜力，可以提高大多数女性的产后心理健康公平性。