CARE Intervention for Depressed Mothers & Their Infants

对抑郁母亲的 CARE 干预

• 批准号: 6867298
• 负责人: June Andrews Horowitz
• 金额: $ 34.76万
• 依托单位: BOSTON COLLEGE
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-03-15 至 2008-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6867298
• 关键词: behavior therapy; child rearing; clinical research; counseling; education evaluation /planning; health education; human subject; human therapy evaluation; infant human (0-1 year); mother child interaction; nursing intervention; patient oriented research; postpartum depression; women' s health

DESCRIPTION (provided by applicant): Postpartum depression, (PPD), a commonly experienced childbirth complication, jeopardizes mothers' ability to interact responsively with their infants. Onset during the critical period of the first months of infants' lives threatens the maternal-infant relationship and adversely affects infant development. Despite the clinical significance of the problem, limited information exists on the treatment of maternal-infant relational disturbances associated with PPD. The overall goal of this randomized clinical trial is to mitigate negative effects of PPD on infants' development by promoting responsive interaction between depressed mothers and their infants. The specific aim is to test the efficacy of the relationship-focused Communicating And Relating Effectively (CARE) intervention in increasing maternal-infant relational effectiveness, increasing infant clarity of cues and responsiveness to parent, and reducing parenting stress for the treatment group at 3-months, 6-months, and 9-months after delivery. This proposed study builds on preliminary studies that: (a) demonstrated the feasibility of screening women for postpartum depression, and (b) tested the efficacy of a coaching intervention delivered by nurses to promote responsiveness between depressed mothers and their infants. In this study, the CARE intervention is designed to teach depressed mothers to recognize and interpret Infants' engagement and disengagement cues, and to coach mothers to alter withdrawn and intrusive maternal-infant interactive behaviors that are associated specifically with PPD. Nurses will screen approximately 1,500 postpartum women for PPD, randomly assign a minimum of 116 eligible participants to either the treatment or control group, and confirm depression status with a diagnostic interview. Using a repeated measures design, data will be collected at 6-weeks, and 3, 6, and 9 months postpartum. Standardized instruments will evaluate depression symptoms and parenting stress; blind coding of videotaped maternal-infant interaction will measure maternal-infant relational effectiveness and infant behavioral responses. The CARE intervention will be conducted during home visits at 6-weeks, and 2, 3, 4, 6 months postpartum by teaching mothers to interpret their infants' behavioral cues and to respond effectively. R-ANOVA and R-MANOVA will be used to test the study hypotheses and to answer the research question. Outcomes are expected to contribute to knowledge of evidence-based nursing practice models for the treatment of maternal-infant relational problems associated with PPD.

描述（由申请人提供）：产后抑郁症，（PPD）是一种常见的分娩并发症，危害了母亲与婴儿的反应性互动的能力。在婴儿生命的头几个月的关键时期，发作威胁着产妇的关系，并对婴儿的发育产生不利影响。尽管该问题具有临床意义，但有关与PPD相关的孕产妇关系干扰的治疗的信息有限。这项随机临床试验的总体目的是通过促进抑郁母亲及其婴儿之间的反应性相互作用来减轻PPD对婴儿发育的负面影响。具体的目的是测试以关系为中心的沟通和有效相关的（护理）干预措施，以提高产妇的关系有效性，提高婴儿的提示和对父母的反应性，并减少三分之一，6个月和9个月后治疗组的育儿压力。这项拟议的研究以初步研究为基础：（a）证明了筛查女性为产后抑郁症的可行性，并且（b）测试了护士提供的教练干预措施以促进沮丧的母亲及其婴儿之间的反应能力的疗效。在这项研究中，护理干预措施旨在教会沮丧的母亲认识和解释婴儿的互动和脱离接触线索，并指导母亲改变与PPD专门相关的撤离和侵入性的孕妇互动行为。护士将在PPD中筛查大约1,500名产后女性，随机将至少116名合格参与者分配给治疗或对照组，并通过诊断访谈确认抑郁状态。使用重复的措施设计，将在6周以及产后3、6和9个月内收集数据。 标准化仪器将评估抑郁症状和育儿压力；录像带的孕产妇互动的盲目编码将衡量产妇的关系有效性和婴儿行为反应。护理干预措施将在6周的家庭访问期间，产后2、3、4、6个月，通过教母亲解释婴儿的行为提示并有效地做出反应，从而进行。 R-Anova和R-Manova将用于检验研究假设并回答研究问题。预计结果将有助于循证护理实践模型的知识，以治疗与PPD相关的孕产妇关系问题。