The "Wings" Depressive Symptom Intervention for Latina Mothers

针对拉丁裔母亲的“翅膀”抑郁症状干预

• 批准号: 8084197
• 负责人: LINDA BEEBER
• 金额: $ 12.53万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8084197
• 关键词: Achievement; Address; Age; Aggressive behavior; Area; Behavioral; Case Management; Child; Chronic; Clinic; Clinical; Clinical Trials; Collection; Communities; County; DSM-IV; Data; Data Collection; Destinations; Development; Disease; Early treatment; Economics; Eligibility Determination; Emotional; Enrollment; Exposure to; Extended Family; Family; Head Start Program; Home environment; Immigration; Infant; Infant Development; Intervention; Intervention Studies; Interview; Language; Language Disorders; Latina; Latino; Learning; Link; Low income; Maintenance; Measures; Mental Depression; Mental Health; Mental Health Services; Methods; Modeling; Modification; Mothers; North Carolina; Nurse Psychotherapist; Outcome; Parenting behavior; Parents; Participant; Peer Group; Population; Protein Structure Initiative; Protocols documentation; Psychiatric Nursing; Psychotherapy; Questionnaires; Randomized; Recruitment Activity; Recurrence; Research Project Grants; Safety; Sales; Schools; Screening procedure; Self Efficacy; Services; Social support; Societies; Staging; Stress; Structure; Symptoms; Testing; Toddler; Wing; Work; center for epidemiological studies depression scale; clinically significant; coping; depressive symptoms; design; effective intervention; experience; improved; instrument; interpersonal conflict; intervention program; method development; post intervention; pressure; prevent; programs; public health relevance; randomized trial; social; stressor; training project; treatment as usual

DESCRIPTION (provided by applicant): Limited English Proficiency (LEP) Latina mothers of infants and toddlers are confronted with chronic economic hardship and immigration-related stressors. As high as 64% experience clinically significant depressive symptoms, which limit their ability to offer developmental support to their infant or toddler. Infant/toddler exposure to maternal depressive symptoms has been linked to language deficits and persistent developmental lags, and in older children, conduct disorders and social aggression. Many "new destination" areas for Latinos in the US have inadequate bilingual mental health services and LEP Latina mothers cannot get treatment. The "Wings" intervention to reduce depressive symptoms had a significant impact in 80 Latina LEP mothers in Early Head Start (EHS). To prepare for a larger trial of the intervention, this study will finalize refinements to the intervention and test the feasibility, acceptability and safety of selected methods and protocols. The intervention is a 10-session, in-home modification of Interpersonal Psychotherapy (IPT) delivered by English-speaking advanced practice psychiatric nurses paired with bilingual, project-trained community interpreters. It is designed to help mothers reduce depressive symptoms, cope with stress, increase social support and parent more effectively. Refinements to the intervention that will be finalized include strategies to resolve interpersonal conflict and promote familismo [family unity], additional parenting guidance that supports Latino values of respeto [respectfulness] and educacisn [responsible actions], the addition of post- intervention maintenance sessions (PIMs) to prolong the reduction of symptoms and emphasis on helping mothers connect to existing community agencies to access peer and group social support. This study will also test protocols for a case management/control condition and a pre-enrollment mental health assessment; determine the feasibility of recruitment, screening and enrollment protocols and the administration of instruments not used in previous studies. Finally, the study will evaluate feasibility, acceptability and safety of the revised methods in 20 Latina mothers who score 16 or greater on the Center for Epidemiological Studies Depression Scale (CES-D) and who have infants or toddlers between 6 weeks and 36 months old recruited from community agencies. Participants will be randomized to the intervention or to a case management/control condition and measured over three collection points (baseline, 12 weeks and 6 months). Spanish versions of the Hamilton Rating Sale for Depression (HRSD) will be used along with other measures (PSI; CBCL; Ages and Stages Questionnaires - Social-Emotional; HSI-I, ARSMA-II, social support and self-efficacy). This study will support a larger randomized trial, and ultimately the integration of the "Wings" intervention into community clinics, early intervention programs and Latino-serving agencies. PUBLIC HEALTH RELEVANCE: The development of infants and toddlers may be harmed by exposure to depressive symptoms in their mother. This project will determine whether a short-term, in-home, intervention to help Spanish-speaking Latina mothers reduce their depressive symptoms is feasible and safe and whether the methods needed to test it on a larger scale can be carried out. Ultimately, by improving the mental health of these mothers, their infants and toddlers' development and adaptation to society will be enhanced.

描述（由申请人提供）：英语水平有限（LEP）的拉丁裔婴儿和幼儿母亲面临着长期的经济困难和与移民相关的压力。高达 64% 的人经历过临床上显着的抑郁症状，这限制了他们为婴儿或幼儿提供发育支持的能力。婴儿/幼儿接触母亲抑郁症状与语言缺陷和持续发育迟缓有关，而在年龄较大的儿童中，则与行为障碍和社交攻击有关。美国许多拉丁裔“新目的地”地区的双语心理健康服务不足，LEP 拉丁裔母亲无法获得治疗。减少抑郁症状的“Wings”干预对 80 名处于早期启蒙 (EHS) 阶段的拉丁裔 LEP 母亲产生了显着影响。为了准备更大规模的干预试验，本研究将最终完善干预措施，并测试所选方法和方案的可行性、可接受性和安全性。该干预措施是对人际心理治疗 (IPT) 进行 10 次家庭改良，由讲英语的高级执业精神科护士与经过项目培训的双语社区口译员配合进行。它旨在帮助母亲减轻抑郁症状、应对压力、增加社会支持和更有效地为人父母。将最终确定的干预措施的完善包括解决人际冲突和促进家庭团结的策略、支持拉丁裔尊重和教育价值观的额外育儿指导、增加干预后维护课程（ PIM）以延长症状的缓解时间，并强调帮助母亲与现有的社区机构建立联系，以获得同伴和团体的社会支持。这项研究还将测试病例管理/控制条件和入组前心理健康评估的方案；确定招募、筛选和登记方案以及先前研究中未使用的仪器管理的可行性。最后，该研究将评估 20 名拉丁裔母亲的修订方法的可行性、可接受性和安全性，这些母亲在流行病学研究中心抑郁量表 (CES-D) 上得分为 16 分或以上，且婴儿或幼儿年龄在 6 周至 36 个月之间从社区机构招募。参与者将被随机分配到干预组或病例管理/对照条件组，并在三个收集点（基线、12 周和 6 个月）进行测量。西班牙语版本的汉密尔顿抑郁症评级 (HRSD) 将与其他指标（PSI、CBCL、年龄和阶段问卷 - 社会情感、HSI-I、ARSMA-II、社会支持和自我效能）一起使用。这项研究将支持更大规模的随机试验，并最终将“Wings”干预纳入社区诊所、早期干预计划和拉丁裔服务机构。 公共卫生相关性：婴儿和幼儿的发育可能会因母亲的抑郁症状而受到损害。该项目将确定帮助讲西班牙语的拉丁裔母亲减轻抑郁症状的短期家庭干预是否可行且安全，以及是否可以进行更大规模测试所需的方法。最终，通过改善这些母亲的心理健康，她们的婴幼儿的发育和社会适应能力将得到加强。