Detection and Care for Depression in the Peripartum

围产期抑郁症的检测和护理

• 批准号: 8282928
• 负责人: JAMES C COYNE
• 金额: $ 39.24万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-19 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8282928
• 关键词: Accounting; Adherence; Affect; African American; Antidepressive Agents; Attention; Attitude; Belief; Caring; Characteristics; Child Development; Clinical; Data; Decision Making; Depressed mood; Detection; Disadvantaged; Discipline of obstetrics; Disease remission; Documentation; Effectiveness; Enabling Factors; Epidemiology; Family; Fetal Development; Goals; Health Personnel; Health Services; Health Services Research; Health system; High Risk Woman; Infant Development; Insurance; Insurance Coverage; Interview; Investigation; Learning; Level of Evidence; Low income; Major Depressive Disorder; Measures; Medicaid; Medical; Mental Depression; Mental Health; Mental Health Services; Methods; Modeling; Monitor; Observational Study; Outcome; Participant; Patients; Perinatal; Population; Postpartum Period; Predisposing Factor; Pregnancy; Prenatal care; Process; Protocols documentation; Provider; Qualitative Research; Recommendation; Recording of previous events; Recruitment Activity; Relapse; Research; Research Methodology; Research Personnel; Risk; Sampling; Services; Site; Social Network; Social support; Symptoms; System; Time; Treatment outcome; United States; United States National Center for Health Statistics; Unmarried; Visit; Woman; Work; abstracting; base; clinical research site; depressive symptoms; design; experience; follow-up; health care service utilization; help-seeking behavior; high risk; informant; maternal depression; meetings; motherhood; pregnant; prenatal; psychologic; response; social; uptake

Detection and Care for Depression in the Perinatal Period Major depressive disorder (MDD) among women in pregnancy and the postpartum can have profoundly negative implications for women; fetal, infant, and child development; and the larger family. This mixed method study examines the detection and treatment of depression in a sample of high-risk women recruited during their first prenatal visit at one of two prenatal care sites chosen for diversity. One site serves a predominately white, married, insured population and the other a predominately African-American, unmarried, Medicaid population. The overarching goal is to identify influences on access and barriers to care for MDD in pregnancy and postpartum. Such influences include not only institutional, financial, provider, and practical issues, but often overlooked factors such as personal and cultural attitudes about depression, engagement with the medical system, competing priorities, and difficulties maintaining a focus on personal mental health during pregnancy and early motherhood, particularly for disadvantaged women. The research involves identifying a group of approximately 1600 women at high risk for MDD based on history of MDD, treatment for MDD, or current depressive symptomatology. These women will be assessed twice in pregnancy and twice postpartum for emergence of MDD. When these women meet criteria for MDD, they will be entered into a treatment monitoring protocol. This protocol involves systematically assessing symptom level, evidence of help-seeking, the detection of depression and offering of treatment by health providers, interactions with the health system, and the initiation of treatment and follow up care for depression. A targeted and purposively selected subsample of these women will also receive qualitative interviews to provide a more nuanced, comprehensive understanding of their responses to the quantitative assessments. Finally, a sample of maternal care providers will be interviewed to understand the provider's perspective on the process of identifying and obtaining treatment of depression. Results will show how design, implementation, and uptake and effective use of enhancements of care for depression in the perinatal period must be based on a realistic understanding of the full range of factors affecting the accessibility and acceptability of care and how these factors vary with the circumstances of women. This project examines the rates of detection of depression, quality of treatment received and outcomes achieved, and moderating factors of these in more than 1600 high-risk women recruited during their first prenatal visit. Results will show how design, implementation, and, importantly, uptake and effective use of enhancements of care for depression in the peripartum must be based on a more realistic understanding of the full range of factors affecting the accessibility and acceptability of care and how these factors vary with the circumstances of women.

围产期抑郁症的检测和护理 妊娠期和产后妇女可能患有重度抑郁症 (MDD) 对女性产生深远的负面影响；胎儿、婴儿和儿童的发育； 和更大的家庭。这项混合方法研究检验了以下疾病的检测和治疗： 在第一次产前检查期间招募的高危妇女样本中存在抑郁症 因多样性而选择的两个产前护理地点。一个站点主要服务于白人， 已婚、参保人口和其他主要是非洲裔美国人、未婚、 医疗补助人口。总体目标是确定对访问和访问的影响 妊娠期和产后 MDD 护理的障碍。这样的影响不仅包括 制度、财务、提供者和实际问题，但经常被忽视的因素，例如 作为对抑郁症的个人和文化态度、对医疗的参与 系统、相互竞争的优先事项以及保持关注个人心理的困难 怀孕和早期孕产期间的健康，特别是弱势妇女。 该研究涉及确定一组大约 1600 名具有高风险的女性。 MDD 基于 MDD 病史、MDD 治疗或当前抑郁症 症状学。这些女性将在怀孕期间接受两次评估，并在怀孕期间接受两次评估。 产后MDD的出现。当这些女性符合MDD标准时，她们会 进入治疗监测方案。该协议系统地涉及 评估症状水平、寻求帮助的证据、抑郁症的检测和 卫生服务提供者提供的治疗、与卫生系统的互动以及 抑郁症治疗的开始和后续护理。有针对性和有目的的 这些女性的选定子样本还将接受定性访谈，以提供 更细致、更全面地了解他们对定量分析的反应 评估。最后，将对孕产妇护理人员进行抽样调查 了解提供商对识别和获取过程的看法 治疗抑郁症。结果将展示如何设计、实施和采用以及 必须有效地加强对围产期抑郁症的护理 基于对影响可达​​性的各种因素的现实理解 护理的可接受性以及这些因素如何随妇女的情况而变化。该项目检查抑郁症的检出率和接受治疗的质量 1600 多个高风险国家中所取得的成果以及这些成果的调节因素 在第一次产前检查期间招募的妇女。结果将展示如何设计、 实施，并且重要的是采用和有效利用加强护理 围产期抑郁症必须基于对全面的更现实的理解 影响护理的可及性和可接受性的一系列因素以及这些因素如何 因素因妇女的具体情况而异。