1/2-Preventing Perinatal Depression (PRE-D): Developing Tools and Interventions

1/2-预防围产期抑郁症 (PRE-D)：开发工具和干预措施

• 批准号: 8189777
• 负责人: ROBIN B JARRETT
• 金额: $ 23.78万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8189777
• 关键词: Academic Medical Centers; Address; Affect; Antidepressive Agents; Area; Caring; Clinic; Clinical Psychology; Clinical Trials; Cognitive; Cognitive Therapy; Collaborations; Communication; Communities; Conceptions; Contracts; Databases; Development; Diagnostic; Disease remission; Doctor of Philosophy; Early Diagnosis; Education; Effectiveness; Evaluation; Funding; Future; Goals; Grant; Health Personnel; Improve Access; Infant; Internet; Intervention; Knowledge; Lactation; Link; Major Depressive Disorder; Manuals; Measurement; Medical Education; Medical Informatics; Medicine; Mental Depression; Mental Health; Mental disorders; Methods; Monitor; Mothers; National Institute of Mental Health; Online Systems; Outcome; Patient observation; Patients; Perinatal; Personality; Pharmaceutical Preparations; Phase; Planned Pregnancy; Population; Populations at Risk; Postpartum Period; Pregnancy; Preparation; Prevention; Prevention strategy; Preventive; Preventive Intervention; Primary Health Care; Private Sector; Procedures; Protocols documentation; Provider; Psychiatry; Psychotherapy; Public Health; Randomized; Randomized Controlled Trials; Recording of previous events; Recurrence; Relapse; Research; Research Personnel; Research Support; Risk; Robin bird; Safety; Site; Small Business Innovation Research Grant; Specialist; Staging; Symptoms; System; Technology; Testing; Texas; Time; Training; Treatment Protocols; Trust; Universities; Withdrawal; Woman; Women' s Health; Work; base; child bearing; computerized; depressive symptoms; design; evidence base; experience; high risk; innovation; interdisciplinary collaboration; maternal depression; named group; prevent; primary care setting; programs; psychoeducational; psychosocial; public health priorities; safety testing; single episode major depressive disorder; therapy design; therapy development; tool; tool development; treatment strategy; uptake; web site

DESCRIPTION (provided by applicant): Through two linked applications, this R34 would support: a) collaboration/partnership between a psychotherapy expert (Jarrett) and a perinatal specialist (Brandon) located in an academic medical center, and an expert in web-based education (Shanahan) in the private sector; b) development of an innovative, preemptive, preventive strategy for women at risk for major depressive disorder (MDD) who are planning to conceive or who are within the first 56 days of pregnancy; and c) evaluation of the safety, tolerability, acceptability, and feasibility of the intervention. We propose to initiate a program of research that has the potential to transform the evidence-based choices, access, and uptake of practices available to women with MDD during pregnancy planning and the perinatal period, when they are at high risk for depressive relapse and recurrence. Early innovative, developmental efforts are necessary to provide a proof-of-concept as a prerequisite to future, formal tests in this population, which is often underrepresented in clinical trials. Risk is defined by current remission of MDD and at least one previous episode of definite MDD. We will develop a web-assisted intervention, Preventive Cognitive Therapy (P-CT), to prevent or reduce relapse/recurrence from conception planning through delivery and postpartum. We will also create a Clinician-Assisted Internet Monitoring (C-AIM) system for monitoring depressive symptoms. This R34 and the associated emerging research program address the NIMH priorities to: 1. Develop new and better interventions that incorporate the diverse needs and circumstances of people with mental illnesses. Vulnerable women planning to conceive have limited choices in order to reduce their risk; this research seeks to increase their evidence-based choices by developing P-CT to address the needs of at-risk women. The NIMH has called for studies to address the expansion of existing interventions and treatment development for perinatal mental health problems as described in PA09-174. 2. Chart mental illness trajectories to determine when, where, and how to intervene. We will chart the trajectory of MDD during the perinatal period and provide initial hypotheses on when, where, and how to intervene. Clinician-Assisted Internet Monitoring is designed to promote early detection of MDD, thereby increasing the safety of "watchful waiting" during and after antidepressant medication withdrawal or avoidance. 3. Strengthen the public health impact of NIMH-supported research. Moving perinatal mental health research findings from the academic setting into real-world practice is a public health priority. Using clinician-assisted Internet monitoring of symptoms and web-based preventive psychotherapy in at-risk groups has the potential to increase the availability of care, as well as the potential for dissemination into primary care settings. We predict that both P-CT and C-AIM can be integrated within primary care community clinics, if these constituencies are included in development and contingent upon successful tests of effectiveness. PUBLIC HEALTH RELEVANCE: This two-site collaborative R34 application addresses significant public health issues for women with a history of at least one episode of major depressive disorder (currently in remission) who wish to remain free of antidepressant medications during preparation for conception, pregnancy, and lactation. The risks of maternal depression for the mother and infant during and after pregnancy are well-documented, yet women have few empirically based options to avoid depression at this critical time. The investigators aim to: 1) create a Clinician-Assisted Internet Monitoring system to help women and health care providers evaluate depressive symptoms longitudinally, and 2) develop a non-pharmacological intervention (based on cognitive therapy) delivered by a clinician in a web-based platform to prevent depressive relapse and recurrence. Development of these tools is an important step in responding to a significant public health need in an under-researched, at-risk population. This research will aid in filling the gap in current scientific knowledge concerning the prevention and treatment of perinatal depression.

描述（由申请人提供）：通过两个链接的应用程序，该R34将支持：a）心理治疗专家（Jarrett）和位于学术医疗中心的围产期专家（Brandon）之间的合作/合作伙伴关系，以及在私营部门的基于Web的教育专家（Shanahan）； b）制定计划构想或在怀孕的前56天内有重大抑郁症（MDD）危险的妇女（MDD）的创新，先发制人的预防策略； c）评估干预措施的安全性，耐受性，可接受性和可行性。我们建议启动一项研究计划，该计划有可能改变基于循证的选择，获取和吸收妊娠计划期间MDD妇女可用的实践，并在围产期期间（当时她们处于抑郁症复发和复发的高风险）。早期创新的发展努力对于提供概念验证作为对未来人群的未来正式测试的先决条件，这在临床试验中通常不足。风险是由MDD的当前缓解和至少一个确定MDD的一集来定义的。我们将开发网络辅助干预措施，预防性认知疗法（P-CT），以防止或减少通过分娩和产后从构想计划中复发/复发。我们还将创建一个由临床医生协助的互联网监测（C-AIM）系统来监测抑郁症状。 该R34和相关的新兴研究计划将NIMH的优先事项介绍为：1。开发新的，更好的干预措施，结合了精神疾病患者的各种需求和环境。计划受孕的脆弱妇女有限的选择以降低自己的风险；这项研究试图通过开发P-CT来满足处于危险妇女的需求，以增加基于证据的选择。 NIMH呼吁进行研究，以解决PA09-174中所述的围产期心理健康问题现有干预措施和治疗开发的扩展。 2。绘制精神疾病轨迹，以确定何时，何地和如何干预。我们将在围产期期间绘制MDD的轨迹，并提供有关何时，何时和如何干预的初始假设。临床医生辅助的互联网监测旨在促进对MDD的早期检测，从而提高了在抗抑郁药戒断或避免抗抑郁药期间和之后的“注意等待”的安全性。 3。加强了NIMH支持的研究的公共卫生影响。将围产期心理健康研究结果从学术环境转移到现实世界实践是公共卫生的重点。使用临床医生辅助症状的互联网监测和高危人群的基于Web的预防性心理治疗，有可能增加护理的可用性，并有可能将其传播到初级保健环境中。我们预测，如果这些选区包括在开发中，并且取决于成功的有效测试，则P-CT和C-AIM都可以集成在初级保健社区诊所中。 公共卫生相关性：这项两场协作R34应用程序针对具有至少一集的重度抑郁症（目前处于缓解的妇女）的妇女的重大公共卫生问题，她们希望在准备构想，怀孕和泌乳的准备期间没有抗抑郁药。怀孕期间和后母亲的母亲抑郁症的风险是有据可查的，但在这个关键时刻，妇女几乎没有基于经验的选择来避免抑郁症。研究人员的目的是：1）创建一个由临床医生辅助的互联网监测系统，以帮助妇女和医疗保健提供者纵向评估抑郁症状，2）开发临床医生在基于网络的平台中提供的非药物干预措施（基于认知疗法），以防止抑郁症的复发和复发性。这些工具的开发是应对不足的高风险人群中应对巨大的公共卫生需求的重要一步。这项研究将有助于填补有关预防和治疗围产期抑郁症的当前科学知识的空白。