Elevating Voices, Addressing Depression, Toxic Stress and Equity in Group Prenatal Care (EleVATE GC)

提高声音、解决抑郁症、有毒压力和团体产前护理中的公平性 (EleVATE GC)

基本信息

批准号：
10882583
负责人：
Ebony Boyce Carter
金额：
$ 15.93万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-21 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10882583
关键词：
Address Adverse event Affect African American Anxiety Anxiety Disorders Appointment Area Birth Rate Caring Chronic Disease Clinic Collaborations Data Diagnosis Discipline of obstetrics Disease Management Enrollment Equity Event Exposure to Face Health High Risk Woman Individual Insurance Coverage Intervention Life Low Birth Weight Infant Low income Medicaid Mental Depression Mental Health Mental Health Services Minority Women Modeling Mood Disorders Neonatal Outcome Patients Perinatal Population Postpartum Depression Practical Robust Implementation and Sustainability Model Pregnancy Pregnant Women Premature Birth Prenatal care Provider Psyche structure Psychosocial Stress Recording of previous events Research Personnel Resources Risk Services Site Stigmatization Stress System Testing Time Trauma Underserved Population United States Voice Woman adverse pregnancy outcome antepartum depression behavioral health intervention disparity reduction effectiveness evaluation effectiveness testing effectiveness-implementation RCT evidence base experience high risk implementation context implementation determinants implementation strategy improved improved outcome maternal risk novel outcome disparities parity peripartum depression pilot trial prenatal primary outcome programs psychological distress racism secondary outcome therapy design trial comparing women of color

项目摘要

Project Summary Although 21% of pregnant women experience perinatal mood and anxiety disorders, the burden is especially heavy for low-income and minority women. For example, African-American women have a higher risk of psychosocial stress (e.g., exposure to adversity, racism, and traumatic life events) throughout life than white women. Moreover, African-American women are at significantly higher risk for maternal and neonatal adverse events resulting from psychological distress, such as preterm birth (17% vs. 10%) and low birthweight (13% vs. 7%). However, African-American women are the least likely group to receive mental health interventions that could reduce these disparate outcomes. A cross-system collaboration between researchers, clinicians, and patients is working to overcome these barriers by developing, testing, and implementing a novel model: Elevating Voices, Addressing Depression, Toxic Stress and Equity in Group Prenatal Care (EleVATE GC). EleVATE GC is based on group prenatal care and has embedded within it a trauma-informed, evidence-based behavioral health intervention grounded in anti-oppressive principles. The objectives of this proposal are to rigorously assess the effectiveness of EleVATE GC and to determine the feasibility, sustainability, and barriers to implementing EleVATE GC in real-world care settings. These objectives will be achieved by conducting a pragmatic effectiveness-implementation randomized controlled trial comparing EleVATE GC (n=563) to individual prenatal care (n=282) for pregnant women at high risk for depression. This trial will be conducted at eight diverse prenatal clinics in the St. Louis region that serve a population with a high preterm birth rate (~16% vs. 11% nationally). Additionally, 80% of women served by these sites have a history of depression, anxiety, trauma, or another mental health diagnosis. Within this trial, Aim 1 is to determine the effectiveness of EleVATE GC to reduce perinatal depression and adverse pregnancy outcomes among low-income, predominantly African-American women. This aim tests the hypothesis that, compared to women receiving individual care, those in EleVATE GC will have lower perinatal depression (primary) and lower risk of preterm birth and low birthweight infants (secondary). Aim 2 is to identify strategies and contextual implementation factors to enhance implementation of EleVATE GC. An adaptation of the Practical Robust Implementation and Sustainability Model will be used across three of the four domains (intervention design, recipient, implementation and sustainability) at three levels (prenatal care clinic, clinician, and patient). This project is directly responsive to the call of RFA-MH-20-400 to "test the effectiveness of strategies for implementation and sustainable delivery of evidence-based mental health treatments and services to improve mental health outcomes for underserved populations in under-resourced settings in the United States".

项目摘要尽管有21％的孕妇经历了围产期情绪和焦虑症，但尤其是负担对于低收入和少数族裔妇女而言很重。例如，非裔美国妇女的风险更高整个生命中的社会心理压力（例如，暴露于逆境，种族主义和创伤性事件）比白人女性。此外，非裔美国妇女的孕产妇和新生儿不利的风险明显更高由心理困扰引起的事件，例如早产（17％vs. 10％）和低出生体重（13％） vs. 7％）。但是，非洲裔美国妇女是接受心理健康干预措施的最不可能的群体这可以减少这些不同的结果。研究人员，临床医生之间的跨系统合作，患者正在努力通过开发，测试和实施一种新型模型来克服这些障碍：提高声音，解决抑郁症，毒性应激和平等的产前护理（提升GC）。升高的GC基于组产前护理，并嵌入其中一种以创伤性的，基于证据的以反压迫原则为基础的行为健康干预措施。该提议的目标是严格评估提升GC的有效性并确定可行性，可持续性和障碍在实际护理设置中实施提升GC。这些目标将通过进行比较升高GC（n = 563）的务实有效性随机对照试验抑郁症高风险的孕妇个人产前护理（n = 282）。该试验将在圣路易斯地区八个不同的产前诊所，为人口的早产率很高（在全国范围内〜16％比11％）。此外，这些地点服务的妇女中有80％有抑郁史，焦虑，创伤或其他心理健康诊断。在此试验中，目标1是确定的有效性提升GC以减少低收入中的围产期抑郁和不良怀孕结果，主要是非裔美国妇女。这个目的检验了以下假设个人护理，升高GC的人的围产期抑郁症（主要）和早产风险较低出生和低出生体重婴儿（次要）。目标2是确定策略和上下文实施增强升高GC实施的因素。改编实用强大的实施和可持续性模型将在四个领域中的三个（干预设计，收件人，实施和可持续性）在三个级别（产前护理诊所，临床医生和患者）。这个项目是直接响应RFA-MH-20-400的呼吁，以“测试实施策略的有效性和可持续提供基于证据的心理健康治疗和服务以改善心理健康在美国资源不足的环境中服务不足的人口的结果”。