Evaluating maternal depression among adolescent and adult women in Kenya

评估肯尼亚青少年和成年妇女的孕产妇抑郁情况

• 批准号: 9905969
• 负责人: Anna M Larsen
• 金额: $ 4.46万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-16 至 2022-12-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9905969
• 关键词: 15 year old; 20 year old; Adolescence; Adolescent; Adult; Africa South of the Sahara; Age; Area; Child Health; Childbirth; Clinical; Cluster randomized trial; Cohort Studies; Country; Cross-Sectional Studies; Data; Development; Diagnostic; Educational Background; Emotional; Epidemiology; Equation; Evaluation; Frequencies; Future; Health Professional; High Prevalence; High-Risk Pregnancy; Hormonal; Hormonal Change; Income; Individual; Infant; Infant Health; Intervention; Kenya; Life Cycle Stages; Link; Loneliness; Longitudinal Studies; Low Birth Weight Infant; Marital Status; Maternal Health; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Monitor; Mothers; Performance; Perinatal; Physiological; Positioning Attribute; Postnatal Care; Postpartum Period; Postpartum Women; Pregnancy; Pregnancy in Adolescence; Pregnancy loss; Pregnant Women; Premature Birth; Prevalence; Procedures; Psychosocial Factor; Reporting; Research; Research Personnel; Research Project Grants; Risk; Sample Size; Self Efficacy; Severities; Social support; South Africa; Symptoms; Time; Training; Visit; Woman; adolescent health; adverse childhood events; adverse outcome; age group; antenatal; antepartum depression; cohort; critical period; depressive symptoms; epidemiology study; experience; high risk; improved; infant morbidity/mortality; infant outcome; instrument; intimate partner violence; longitudinal analysis; low and middle-income countries; maternal depression; mental training; neonatal death; novel; parity; perceived stress; perinatal outcomes; peripartum depression; pre-doctoral; pregnant; pregnant teen; prospective; psychosocial; screening; stillbirth; systematic review; tool; young woman

ABSTRACT This F31 project aims to advance understanding of the manifestation and trajectory of maternal depression among adolescent women (age 15-19) compared to adults throughout pregnancy and postpartum, and to develop a risk score to identify pregnancies at high risk for adverse perinatal outcomes. Approximately 13% of peripartum women worldwide report mental health issues, predominantly depression. Adolescence is a period of substantial developmental and hormonal changes which add to physiologic and psychosocial changes in pregnancy. Frequency of depression among adolescent pregnant and postpartum women is up to 30% higher than their adult and non-pregnant counterparts. Perinatal depression among adolescents has not been rigorously characterized in a large-scale, longitudinal study. Almost all adolescent pregnancies (95%) worldwide occur in low- and middle-income countries (LMICs), yet few data exist on maternal depression among adolescents in these settings. A recent systematic review found higher prevalence of maternal depression in LMICs (16% in pregnancy, 20% in postpartum) than in high-income country settings (HICs). Several studies in HICs have linked depression and adolescence to preterm birth and low birthweight, yet critical gaps remain in understanding implications of maternal depression on perinatal outcomes within SSA where the burden of infant morbidity and mortality is highest worldwide. The proposed F31 research project leverages data collected in an ongoing randomized cluster trial (PrIMA Study, R01AI125498, MPI: John-Stewart/Baeten) among adolescent and adult pregnant Kenyan women (≥15 years old) who are followed through 9-months postpartum. We are screening >4000 Kenyan women (median age: 24 years, ~25% age <20 years) longitudinally via antenatal/postnatal care (ANC/PNC) for depressive symptoms. In Aim 1, we will use data from initial ANC, 6 weeks PNC, and 9 months PNC to longitudinally compare maternal depression among adolescent versus adult women, identifying predictors, symptoms, and changes in prevalence and severity to inform future interventions. In Aim 2 we will develop and validate an empiric risk score to predict adverse perinatal outcomes that incorporates depressive score in pregnancy and other maternal factors (e.g., adolescent age). Results from Aim 2 will contribute a clinical prediction tool to inform who may need intensified monitoring to avert adverse perinatal outcomes like preterm birth and low birthweight. This large-scale study to longitudinally compare depression among adolescents and adults from pregnancy through 9 months postpartum will contribute a novel clinical prediction tool using depression score to predict perinatal outcomes. This research plan will provide the F31 candidate rigorous predoctoral training including 1) quantitative analysis of longitudinal data, 2) experience developing and internally validating a risk score, and 3) content-area expertise in maternal depression, an area critical to closing gaps in maternal, adolescent, and child health.

抽象的 这个F31项目旨在提高对母性抑郁症的表现和轨迹的了解 在青春期妇女（15-19岁）与整个怀孕和产后相比 建立风险评分，以识别患有不良围产期结局的高风险的怀孕。大约13％ 全世界的Peripartum妇女报告心理健康问题，主要是抑郁症。青少年是一个时期 实质性发展和马匹变化，增加了生理和社会心理变化 怀孕。青少年怀孕和产后女性抑郁症的频率高达30％ 比他们的成人和非怀孕对应物。青少年的围产期抑郁症并不严格 在大规模的纵向研究中进行了特征。全球几乎所有青少年怀孕（95％） 低收入和中等收入国家（LMIC），但在青少年中几乎没有数据 这些设置。最近的系统评价发现，LMIC中母性抑郁症的患病率更高（16％ 怀孕，产后20％），比在高收入国家环境（HIC）中。关于HIC的几项研究已连接 抑郁症和青少年对早产和低出生体重，但危险的差距仍在理解中 孕产妇抑郁症对SSA内围产期结局的影响，婴儿发病率燃烧 死亡率是全球最高的。拟议的F31研究项目利用了正在进行的 在青少年和成人中，随机聚类试验（Prima研究，R01AI125498，MPI：John-Stewart/Baeten） 孕妇肯尼亚妇女（≥15岁），后期9个月。我们正在筛选 > 4000名肯尼亚妇女（中位年龄：24岁，〜25％<20岁）通过天内/产后护理纵向 （ANC/PNC）用于抑郁症状。在AIM 1中，我们将使用初始ANC，6周PNC和9个月的数据 PNC纵向比较青少年与成年女性的母校抑郁症 预测因素，症状以及患病率和严重程度的变化，以告知未来干预措施。在目标2中，我们将 开发和验证经验风险评分，以预测纳入抑郁症的不良围产期结果 在怀孕和其他母校因素（例如青少年年龄）中得分。 AIM 2的结果将有助于临床 预测工具告知谁可能需要加强监控以避免广告围产期结果（例如早产） 生日和生日低。这项大规模研究以纵向比较青少年和 从怀孕到产后9个月的成年人将使用一种新的临床预测工具 抑郁得分以预测围产期结局。该研究计划将为F31候选人提供严格 术前培训，包括1）纵向数据的定量分析，2）开发和内部经验 验证风险评分和3）遗产抑郁症的内容区域专业知识，这对于缩小差距至关重要 孕产妇，青少年和儿童健康。