Collaborative Perinatal Mental Health and Parenting Support in Primary Care

初级保健中的协作围产期心理健康和育儿支持

基本信息

批准号：
9460917
负责人：
Susan Joan Spieker
金额：
$ 64.92万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-04-01 至 2020-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9460917
关键词：
Adverse effects Affect Affective Affordable Care Act Age Behavioral Birth Caregivers Child Child Behavior Child Development Child Rearing Child Welfare Childhood Clinic Communities Community Health Centers Competence Consultations County Cues Depressed mood Education Educational Curriculum Educational process of instructing Effectiveness Exposure to Family Federal Government Feedback Feeling Funding Goals Home environment Home visitation Impairment Infant Infant Development Intervention Lifting Low income Major Depressive Disorder Maternal Age Measures Mental Depression Mental Health Mental disorders Mothers Newborn Infant Outcome Parents Participant Patient Self-Report Perinatal Physiological Play Population Postpartum Period Poverty Pregnancy Primary Health Care Problem behavior Provider Public Health Randomized Controlled Trials Regulation Reporting Research Risk Risk Factors Sampling Services Social Interaction Social support Standardization Subgroup Symptoms System Techniques Testing Toddler Training Universities Vulnerable Populations Washington Withdrawal Woman antepartum depression base bilingualism depressive symptoms early childhood evidence base experience federal poverty level high risk improved improved outcome infancy infant outcome intervention program maternal depression offspring perinatal mental health perinatal period peripartum depression pregnant prenatal programs public health relevance safety net single episode major depressive disorder social toliprolol treatment program

项目摘要

DESCRIPTION (provided by applicant): Infants exposed to impaired parenting as a result of their mothers' major depression in the perinatal period are at risk for compromised social interaction and affective and behavioral regulation. About 9% of infants less than one year have mothers who experience a major depressive episode. That rate nearly triples to 25% for infants of mothers below 200% of the federal poverty level. In addition to poverty, young maternal age, lack of social support, low education, and adverse childhood experiences are all risk factors for depression. Two strands of research point to the need for effective parenting support for mothers following treatment for their depression in pregnancy. First, depressed mothers frequently fail to accurately notice, interpret, or respond sensitively to infant cues. Alarmingly, mothers' impaired parenting of their infants continues even after their depression has been successfully treated. Second, newborns of prenatally depressed women are physiologically dysregulated and hence more challenging to nurture. With the passage of the Affordable Care Act and Maternal, Infant, and Early Childhood Home Visiting, the federal government is supporting states to implement high-quality home visiting programs as part of a comprehensive early childhood system for vulnerable families experiencing the risk factors associated with maternal depression. But two important limitations of home visiting have been identified: child development home visitors are not trained to deal meaningfully with maternal depression, and they are often not sufficiently trained to support infant-mother relationships. Our application has the potential to inform intervention programs nationwide by testing the effectiveness of adding a short, attachment-based, home-visiting parenting program to an existing, evidence-based depression treatment program delivered via community primary care clinics serving pregnant and parenting women from vulnerable populations. The goal of this research is to conduct a randomized controlled trial to evaluate the effectiveness of Promoting First Relationships(r) for English and Spanish-speaking low-income mothers who were treated for depression beginning in pregnancy and as needed in the perinatal year. Depression treatment will be coordinated through the publicly funded, evidenced-based Mental Health Integration Program for High-Risk Pregnant and Parenting Women (MHIP Moms) in primary care community health centers that target safety-net populations in King County, Washington. Promoting First Relationships(r) is a research-based, 10-week home visiting program that uses video feedback and strengths-based consultation strategies to increase mothers' parenting competence and confidence. Bilingual community providers will deliver Promoting First Relationships(r) after a baseline assessment and random assignment at infant age three months. Post tests will occur at infant age six and twelve months. The primary specific aims are to test the effectiveness of PFR to improve parenting quality for low income, English and Spanish speaking mothers who began treatment for depression during pregnancy, and to improve social and regulatory outcomes for their infants.

描述（由申请人提供）：由于母亲在围产期患有严重抑郁症而导致的婴儿面临着社交互动以及情感和行为调节受损的风险，大约 9% 的一岁以下婴儿的母亲患有此类疾病。低于联邦贫困线 200% 的母亲所生的婴儿患重度抑郁症的比例几乎增加了三倍，此外还有贫困、低龄产妇、缺乏社会支持、教育程度低和不良的童年经历。两项研究表明，在怀孕期间接受抑郁症治疗后，母亲需要获得有效的养育支持。其次，即使抑郁症得到成功治疗，母亲对婴儿的养育方式也会受到影响。其次，随着《平价医疗法案》和《孕产妇、婴儿和幼儿阶段》的通过，产前抑郁症妇女的新生儿在生理上会出现失调，因此养育更具挑战性。家访方面，联邦政府正在支持各州实施高质量的家访计划，作为针对患有母亲抑郁症风险因素的弱势家庭的综合幼儿系统的一部分，但家访的两个重要限制已被确定：儿童发展。家庭访客没有接受过培训有意义地处理母亲抑郁症，但他们往往没有受到足够的培训来支持婴儿与母亲的关系。通过测试在现有的基于证据的抑郁症治疗方案中添加一个简短的、基于依恋的、家访的育儿方案的有效性，为全国范围内的干预方案提供信息的潜力，该方案是通过社区初级保健诊所为弱势群体的孕妇和育儿妇女提供服务的。本研究的目的是进行一项随机对照试验，以评估促进第一关系（r）对于在怀孕期间开始接受抑郁症治疗并在围产期抑郁症需要时接受治疗的英语和西班牙语低收入母亲的有效性。治疗将通过公共资助的、初级保健社区卫生中心针对高危孕妇和育儿妇女 (MHIP Moms) 的循证心理健康整合计划以华盛顿州金县的安全网人群为目标，促进第一关系 (r) 是一项基于研究的 10。为期一周的家访计划，使用视频反馈和基于优势的咨询策略来提高母亲的育儿能力和信心，双语社区提供者将在婴儿三个月后进行基线评估和随机分配后提供“促进第一关系”(r)。主要具体目标是测试 PFR 的有效性，以提高在怀孕期间开始治疗抑郁症的低收入、讲英语和西班牙语的母亲的养育质量，并改善社会和监管结果。他们的婴儿。