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.

在围产期发现和护理抑郁症 怀孕和产后妇女中的重度抑郁症（MDD）可以 对妇女具有深远的负面影响；胎儿，婴儿和儿童发育； 还有更大的家庭。这项混合方法研究检查了对的检测和处理 在第一次产前访问期间招募的高风险妇女样本中的抑郁症 为多样性选择的两个产前护理网站。一个站点以白色为主， 已婚，被保险人口，另一个主要是非裔美国人，未婚， 医疗补助人口。总体目标是确定对访问和的影响 怀孕和产后护理MDD的障碍。这种影响不仅包括 机构，财务，提供商和实际问题，但常常被忽视的因素 作为关于抑郁的个人和文化态度，与医疗互动 系统，竞争优先级以及保持专注于个人心理的困难 怀孕期间和早期孕产期间的健康，特别是对于处境不利的妇女。 该研究涉及确定大约1600名高风险的女性 MDD基于MDD史，MDD治疗或当前抑郁症 症状学。这些妇女将在怀孕和两次评估两次 MDD出现的产后。当这些妇女符合MDD的标准时，她们将 进入治疗监测方案。该协议系统涉及 评估症状水平，寻求帮助的证据，抑郁症的检测和 卫生提供者提供治疗，与卫生系统的互动以及 启动治疗并跟踪抑郁症。有针对性的 这些女性选定的子样本还将接受定性面试，以提供 对他们对定量的反应更细微，全面地理解 评估。最后，将对孕产妇护理提供者进行采访 了解提供商在识别和获得的过程中的观点 抑郁症的治疗。结果将显示设计，实施和吸收方式以及 在围产期有效利用对抑郁症的护理增强必须是 基于对影响可访问性的全部因素的现实理解 以及护理的可接受性以及这些因素如何随妇女的情况而变化。该项目检查了抑郁症的检测率，接受的治疗质量 在1600多种高风险中，达到的结果和调节因素的调节因素 妇女在第一次产前访问期间招募。结果将显示如何设计， 实施，重要的是，采取和有效地利用了护理的增强 围栏中的抑郁必须基于对全部的更现实的理解 影响护理的可访问性和可接受性以及这些因素的范围 因素随妇女的情况而异。