Efficacy of an integrated intervention to treat maternal depression and children’s behavior problems: A transactional perspective

综合干预治疗孕产妇抑郁症和儿童行为问题的功效：交易视角

• 批准号: 10456228
• 负责人: Linda Pfiffner
• 金额: $ 29.3万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456228
• 关键词: 4 year old; Address; Adult; Age; Behavioral; Child; Child Behavior; Child Development; Child Mental Health; Child Rearing; Child Welfare; Cognition; Cognitive Therapy; Collaborations; Conflict (Psychology); Data; Environment; Exposure to; Family; Goals; Home; Home visitation; Intervention; Link; Major Depressive Disorder; Mediating; Mental Depression; Mental Health; Modeling; Mothers; Nursery Schools; Outcome; Parents; Perinatal; Positive Reinforcements; Postpartum Period; Pregnancy; Problem behavior; Public Health; Randomized; Randomized Controlled Trials; Research; Risk; Symptoms; Testing; Thinking; Time; Toddler; Transact; Treatment Efficacy; Woman; aged; base; biobehavior; child depression; depressive behavior; depressive symptoms; disability; efficacy evaluation; experience; externalizing behavior; improved; maternal depression; maternal outcome; offspring; peer; perinatal period; post intervention; primary outcome; programs; prospective; recruit; response; stressor; therapy development; treatment program; treatment strategy

PROJECT SUMMARY/ABSTRACT At least 1 in every 10 children is exposed to maternal depression. Depression during adulthood is one of the leading causes of disability, and when it occurs among women with children, depression also carries a 3- to 6-fold increase in risk for offspring internalizing and externalizing behavior problems. Children's behavior problems, in turn, elevate risk for subsequent maternal depression. The intertwined, transactional relations between maternal depression and children's behavior problems call for integrated maternal-child mental health interventions. However, integrated programs are scarce; adult and child mental health treatment programs typically operate in narrow silos. For example, Attachment and Biobehavioral Catch-up (ABC) is an empirically-supported 10-session home-visiting parenting intervention that focuses on improving maternal sensitivity. ABC reduces children's behavior problems, but it does not treat maternal depression. Similarly, Mothers and Babies is an empirically- supported cognitive behavioral intervention for depression that focuses on improving mothers' negative thinking and behavioral activation. Mothers and Babies reduces perinatal maternal depression, but it does not treat children's behavior problems. Programs that address both maternal and child well-being are essential. The proposed project is a randomized controlled trial to evaluate the efficacy of an integrated intervention that dually treats maternal depressive symptoms and offspring behavior problems. Families (n = 240 mothers and their 2-to-4 year-old children) will be randomized to receive 10 sessions of ABC or 10 sessions of ABC+D in their home. ABC+D is an expanded version of ABC that additionally treats maternal depressive symptoms using Mothers and Babies adapted for mothers of toddlers. The specific aims of this proposed project are: Aim 1 – Evaluate the efficacy of ABC and ABC+D for reducing maternal depressive symptoms and child behavior problems. We will also determine the extent to which reductions in maternal depressive symptoms are a function of reductions in child behavior problems and vice versa, and Aim 2 – Test whether the effects of ABC+D on maternal depression and child behavior problems are mediated through decreases in maternal negative thinking, increases in maternal behavioral activation, and improved maternal sensitivity. Primary outcomes are maternal depressive symptoms and children's behavior problems. Our long-term goal is to contribute to precise interventions that are tailored to mental health problems at the level of the family. The proposed project has high public health significance for reducing the burden of maternal depression and children's behavior problems and for disrupting the transactional relations that perpetuate them over time.

项目概要/摘要 每 10 个儿童中至少有 1 个在成年期间患有母亲抑郁症。 是导致残疾的主要原因之一，当抑郁症发生在有孩子的妇女中时，抑郁症也会带来 3- 后代内化和外化行为问题的风险增加 6 倍。 反过来，问题又会增加产妇抑郁的风险。 母亲抑郁与儿童行为问题之间的关系呼吁母婴一体化心理健康 然而，成人和儿童心理健康治疗方案很少； 通常在狭窄的筒仓中操作。 例如，依恋和生物行为补习 (ABC) 是一个有经验支持的 10 节课程 家访育儿干预的重点是提高母亲的敏感性，从而降低儿童的敏感性。 行为问题，但它不能治疗产妇抑郁症。同样，《母亲与婴儿》是一种经验性的治疗。 支持抑郁症的认知行为干预，重点是改善母亲的消极情绪 母亲和婴儿的思维和行为激活可以减少围产期母亲的抑郁症，但并不能。 解决儿童行为问题的方案至关重要。 拟议的项目是一项随机对照试验，旨在评估综合治疗的有效性 双重治疗母亲抑郁症状和后代行为问题的干预措施（n =） 240 名母亲及其 2 至 4 岁的孩子将被随机分配接受 10 节 ABC 课程或 10 节 ABC+D 在家中进行的课程 ABC+D 是 ABC 的扩展版本，还可以治疗产妇。 《母亲和婴儿》的具体目的是针对幼儿母亲的抑郁症状。 拟议的项目是： 目标 1 – 评估 ABC 和 ABC+D 对于减少孕产妇抑郁的功效 我们还将确定孕产妇症状和儿童行为问题的减少程度。 抑郁症状是儿童行为问题减少的函数，反之亦然，目标 2 – 测试 ABC+D 对母亲抑郁和儿童行为问题的影响是否通过以下途径介导： 产妇消极思维减少，产妇行为激活增加，产妇改善 主要结果是母亲的抑郁症状和儿童的行为问题。 我们的长期目标是为针对心理健康问题的精准干预做出贡献 拟建项目对于减轻家庭负担具有较高的公共卫生意义。 母亲的抑郁症和儿童的行为问题以及破坏的交易关系 随着时间的推移使它们永久存在。