The ROSE Scale-Up Study: Informing a decision about ROSE as universal postpartum depression prevention

ROSE 扩大研究：为有关 ROSE 作为通用产后抑郁症预防的决定提供信息

基本信息

批准号：
10523220
负责人：
JENNIFER E JOHNSON
金额：
$ 133.37万
依托单位：
MICHIGAN STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10523220
关键词：
Address Adult Advisory Committees Birth Caring Clinic Communities Counseling Data Decision Making Effectiveness Effectiveness of Interventions Electronic Health Record Enrollment Ensure Evidence based intervention Evidence based program Face Family General Population Health system Home visitation Incidence Individual Infant Intervention Intervention Trial Interview Judgment Low income Measures Medicaid Mental Health Minority Mothers Names Not Hispanic or Latino Outcome Perinatal Care Persons Postpartum Depression Pregnancy Pregnant Women Prenatal care Prevention Prevention approach Prevention trial Preventive service Process Provider Public Health Randomized Randomized Controlled Trials Recommendation Reporting Risk Risk Assessment Risk Factors Sampling Screening procedure Services Stigmatization Structure Testing Time Training Woman Work base community setting cost cost outcomes depression prevention depressive symptoms effectiveness evaluation effectiveness trial ethnic diversity ethnic minority evidence base flexibility healthcare community implementation barriers implementation facilitators implementation strategy implementation study implementation trial improved functioning indicated prevention intervention delivery intervention effect novel peripartum depression pregnant prenatal prevent preventive intervention programs racial and ethnic randomized trial relative effectiveness scale up screening selective prevention single episode major depressive disorder social stigma tool universal prevention

项目摘要

Project Summary/Abstract Postpartum depression (PPD) is a common and impactful public health problem, which can have severe and lasting consequences for the mother and infant, and sometimes the entire family. The Reach Out, Stand Strong, Essentials for New Mothers (ROSE) program is an evidence-based intervention that prevents half of cases of postpartum depression and was one of two interventions recommended by the US Preventive Services Task Force in 2019. All effectiveness trials of ROSE and of the other recommended PPD prevention intervention included only low-income women a single risk factor that doubles incidence of PPD. Thus, the existing evidence base for PPD prevention consists primarily of women at increased risk for PPD. Based on data from the PIs’ current implementation study of ROSE (R01 MH114883), many healthcare and community agencies in this implementation trial (78%) find it is more feasible for them to provide or offer ROSE to every woman as part of their standard work flow (i.e., provide it as universal prevention), than it is to create a screening and referral process for at risk women (i.e., an indicated or selective prevention approach). In addition to being more feasible for agencies, universal prevention may also be advantageous because the cost of a screening false negative (resulting in a preventable case of PPD; $32,000) far exceeds the cost of ROSE delivery ($50-$300/woman). Effectiveness of ROSE among low-income women at risk for PPD is known (ROSE prevents ~50% of PPD cases). To inform a recommendation about using ROSE as universal vs. selective or indicated prevention, we need to determine the effectiveness of ROSE among general populations of women, including women screening negative for PPD risk (defined in various ways). Thus, this project will assess ROSE effectiveness across PPD risk levels and across prevention approaches in a sample of 2,320 women from a large regional health system (based in Detroit, MI). Each proposed aim gathers a piece of information missing that is needed to guide decision-making about ROSE as universal prevention. We will assess ROSE as universal, selective, and indicated prevention in terms of: (1) ROSE effectiveness relative to a control for each prevention approach in preventing PPD and improving functioning; (2) cost- outcome, (3) equity, and (4) scalability of each prevention approach; and (5) mechanisms of ROSE effects across PPD risk levels. We will integrate results to advise about ROSE as universal prevention. This definitive PPD prevention trial will show how best to get an evidence-based program to those who need it in settings where they receive perinatal care by addressing a pragmatic and novel question (should ROSE be universal prevention?) and by examining equity and cost-outcome of universal vs. other prevention approaches.

项目概要/摘要产后抑郁症 (PPD) 是一种常见且影响深远的公共卫生问题，可能会造成严重的后果以及对母亲和婴儿，有时甚至是整个家庭的持久影响。新妈妈的强效必需品 (ROSE) 计划是一项基于证据的干预措施，可预防一半的产后抑郁症病例，是美国预防中心建议的两项干预措施之一 2019 年服务工作组。ROSE 和其他推荐的 PPD 预防的所有有效性试验干预措施仅包括低收入女性，这一因素使 PPD 的发病率翻倍。 PPD 的现有证据基础主要是预防 PPD 风险增加的女性。数据来自 PI 目前的 ROSE 实施研究 (R01 MH114883)、许多医疗保健和社区实施这项试验的机构 (78%) 发现向每个人提供或提供 ROSE 更为可行女性作为其标准工作流程的一部分（即，将其作为普遍预防），而不是创建一个针对高危女性的筛查和转诊流程（即指示性或选择性预防方法）。除了对各机构来说更可行之外，普遍预防也可能是有利的，因为成本筛查假阴性（导致可预防的 PPD 病例；32,000 美元）的费用远远超过 ROSE 的费用 ROSE 对有产后抑郁症风险的低收入妇女的有效性是已知的（$50-$300/女性）。（ROSE 可预防约 50% 的 PPD 病例）。选择性或指示性预防，我们需要确定 ROSE 在一般人群中的有效性女性，包括筛查 PPD 风险呈阴性的女性（以各种方式定义）。在 2,320 个样本中评估 ROSE 在 PPD 风险水平和预防方法中的有效性来自大型地区卫生系统（位于密歇根州底特律）的女性每项拟议目标都收集了一部分信息。缺少指导有关 ROSE 作为普遍预防的决策所需的信息。我们将从以下方面评估 ROSE 的普遍性、选择性和指示性预防： (1) ROSE 有效性相对于预防 PPD 和改善功能的每种预防方法的控制；结果、(3) 公平性、(4) 每种预防方法的可扩展性以及 (5) ROSE 效果的机制；我们将整合结果，就 ROSE 作为普遍预防措施提供建议。 PPD 预防试验将展示如何最好地为有需要的人提供基于证据的计划他们通过解决一个务实且新颖的问题来接受围产期护理（ROSE 应该普及吗？预防？）并检查通用预防方法与其他预防方法的公平性和成本结果。