Treating Maternal Depression in an Urban Community-Based Pediatric Asthma Clinic: Targeting Maternal Mood, Child Asthma Outcomes, and Health Disparities

在城市社区小儿哮喘诊所治疗孕产妇抑郁症：针对孕产妇情绪、儿童哮喘结果和健康差异

• 批准号: 10723233
• 负责人: Rachel H.F. Margolis
• 金额: $ 12.33万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-25 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10723233
• 关键词: Address; Affect; Antidepressive Agents; Appointment; Asthma; Awareness; Behavior Therapy; Behavioral; Black race; Caregivers; Caring; Child; Child Health; Childhood; Childhood Asthma; Chronic; Clinic; Clinical; Clinical Trials Design; Communities; Complex; Depression screen; Discipline of obstetrics; Disease Management; Disparity; Face; Family; Focus Groups; Frequencies; Goals; Guidelines; Health; Health Professional; Health Services; Improve Access; Intervention; Interview; Knowledge; Learning; Medical; Mental Depression; Mental Health; Mental Health Services; Mentors; Methods; Modeling; Moods; Morbidity - disease rate; Mothers; Outcome; Participant; Pediatrics; Physicians; Population; Pregnant Women; Primary Care; Process; Psychosocial Factor; Public Health; Published Comment; Randomized; Reporting; Research; Resources; Risk Factors; Scientist; Screening procedure; Symptoms; Training; Treatment Efficacy; United States National Institutes of Health; Urban Community; Woman; Work; access disparities; behavioral health; care coordination; community based treatment; depressive symptoms; effective therapy; efficacy testing; ethnic disparity; ethnic minority; experience; group intervention; health care model; health care service utilization; health care settings; health disparity; health equity; health equity promotion; health inequalities; implementation science; improved; informant; innovation; integrated care; interpersonal therapy; maternal depression; medication compliance; modifiable risk; multidisciplinary; outcome disparities; physical conditioning; pilot trial; poor health outcome; primary care provider; primary outcome; provider-level barriers; psychosocial; racial disparity; racial minority; routine screening; satisfaction; skills; social; socioeconomic disparity; standardize guidelines; standardized care; success; translational scientist; treatment as usual; uptake; urban setting

PROJECT SUMMARY/ABSTRACT: This proposal details a 5-year plan to provide Dr. Rachel Margolis with the knowledge and skills to become an independent clinical and translational researcher focused on promoting health equity by improving pediatric asthma outcomes. Research Plan: Striking socioeconomic and racial/ethnic disparities persist in pediatric asthma, particularly among under-resourced, Black children in urban settings. Evidence demonstrates that structural and psychosocial risk factors contribute to these disparities. Maternal depression is one prevalent and potentially modifiable risk factor. While there is evidence that treating maternal depression may improve child health outcomes, mothers from under-resourced communities face significant barriers to community-based treatment of depression. Integrated care (i.e., the delivery of mental health care within the context of other ongoing medical care in a physical health care setting) offers an exciting and under- explored option. It has been associated with reduced maternal depression and improved child health in pediatric primary care. However, the feasibility, acceptability, and efficacy of embedding maternal depression treatment into community-based pediatric asthma care needs to be demonstrated. Enhanced Brief Interpersonal Psychotherapy (IPT-B) is a promising depression treatment for under-resourced mothers that has proven efficacious among similar women in other settings, but it has not been studied within ongoing pediatric asthma care. To maximize the success of Enhanced IPT-B in an asthma clinic setting, it is necessary to identify and address potential mother and provider-level barriers to integrated depression care. Stakeholder engagement with mothers and asthma clinic staff can facilitate the process of understanding and mitigating these barriers. Thus, the overall goal of this proposal is to use stakeholder input to integrate and evaluate maternal depression treatment in a community-based asthma clinic providing care to predominately under-resourced, Black children with asthma. The Specific Aims are to: 1) Engage stakeholders in determining the most effective and acceptable model for integrating Enhanced IPT-B for mothers into community-based pediatric asthma care; 2) Determine the feasibility, acceptability, and preliminary efficacy of Enhanced IPT-B on decreasing maternal depressive symptoms in a specific community-based pediatric asthma clinic through a pilot RCT; and 3) Determine the preliminary efficacy of the intervention on improving child asthma care and health outcomes. Training Plan: Through didactic coursework and mentored research experiences with her multidisciplinary team of mentors/advisors, Dr. Margolis will develop advanced qualitative and mixed methods skills, learn clinical trial design with a focus on behavioral interventions for under-resourced and racial/ethnic minority families, and gain advanced implementation science skills. Dr. Margolis will emerge from her K01 training and research experience as an independent behavioral scientist committed to enhancing health equity.

项目摘要/摘要：该提案详细介绍了为Rachel Margolis博士提供的5年计划 成为一名专注于促进的独立临床和转化研究人员的知识和技能 通过改善小儿哮喘成果来改善健康公平。研究计划：惊人的社会经济和种族/种族 小儿哮喘的差异持续存在，尤其是在城市环境中资源不足的黑人儿童中。 证据表明，结构和社会心理风险因素导致了这些差异。母亲 抑郁症是一种普遍的危险因素。虽然有证据表明治疗产妇 抑郁症可能改善儿童健康状况，资源不足社区的母亲面临着重要的 基于社区的抑郁症治疗的障碍。综合护理（即，精神卫生保健的提供 在物理医疗保健环境中其他正在进行的医疗服务的背景下）提供了令人兴奋且不足的 探索的选项。它与孕产妇抑郁症减少和儿童健康的改善有关 初级保健。但是，嵌入母体抑郁症治疗的可行性，可接受性和功效 需要证明进入基于社区的小儿哮喘护理。增强的简短人际关系 心理治疗（IPT-B）是一种有前途的抑郁症治疗，用于资源不足的母亲 在其他环境中类似妇女的有效性，但尚未在正在进行的小儿哮喘中进行研究 关心。为了最大化在哮喘诊所环境中增强IPT-B的成功，有必要识别和 解决潜在的母亲和提供者级别的障碍，以解决综合抑郁症护理。利益相关者的参与 有了母亲和哮喘诊所的工作人员，可以促进理解和缓解这些障碍的过程。 因此，该提案的总体目标是使用利益相关者的意见来整合和评估产妇抑郁症 基于社区的哮喘诊所的治疗，为主要资源不足的黑人儿童提供护理 哮喘。具体目的是：1）让利益相关者确定最有效和可接受的 将增强的IPT-B整合到母亲中的模型中，以社区的儿科哮喘护理为基础； 2）确定 增强IPT-B的可行性，可接受性和初步功效在减少母体抑郁症方面 通过试点RCT，特定的基于社区的儿科哮喘诊所的症状； 3）确定 干预对改善儿童哮喘护理和健康成果的初步疗效。培训计划： 通过教学课程，并与她的多学科团队指导研究经验 导师/顾问，Margolis博士将发展高级定性和混合方法技能，学习临床试验 设计专注于资源不足和种族/族裔少数民族家庭的行为干预措施，并获得 高级实施科学技能。 Margolis博士将从她的K01培训和研究经验中脱颖而出 作为一名独立的行为科学家，致力于增强健康公平。