Impact of treating perinatal depression on infant HPA axis function

治疗围产期抑郁症对婴儿HPA轴功能的影响

• 批准号: 10006021
• 负责人: Joanna Maselko
• 金额: $ 7.78万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10006021
• 关键词: Address; Adrenal Glands; Adrenal hormone preparation; Age-Months; Behavioral; Biological; Biological Markers; Brain; Child; Child Development; Child Health; Child Rearing; Chronic stress; Cognitive; Cognitive Therapy; Data; Data Set; Depressed mood; Development; Distress; Early Intervention; Enrollment; Environment; Evaluation; Exposure to; Future; Goals; Hair; Health; Home environment; Hormones; Hydrocortisone; Hypothalamic structure; Infant; Intervention; Intervention Trial; Interview; Knowledge; Life; Life Cycle Stages; Light; Link; Literature; Measurable; Measures; Mental Health; Mental disorders; Mission; Mothers; National Institute of Child Health and Human Development; Outcome; Output; Pakistan; Pituitary Gland; Postpartum Period; Pregnancy; Pregnant Women; Psyche structure; Public Health; Randomized; Research; Research Priority; Risk; Role; Sampling Studies; Shapes; Stress; Surveys; System; Thinking; Third Pregnancy Trimester; Variant; Woman; arm; base; caregiving; comparison group; control trial; dehydroepiandrosterone; design; health disparity; health of the mother; high risk population; hypothalamic-pituitary-adrenal axis; improved; indexing; insight; interest; intergenerational; maternal depression; maternal stress; novel; novel marker; offspring; peer; peripartum depression; prenatal; programs; public health priorities; randomized trial; recruit; response; sociodemographic factors; stem; transmission process; treatment arm

ABSTRACT Globally, about 20% of children are exposed to maternal depression in the first years of life, increasing risk for poor physical and developmental outcomes over the life course. Identifying interventions that can mitigate the negative consequences of maternal depression on children is key to reducing health disparities and is therefore a major public health priority. However, measurable impacts on child development may not emerge immediately after an intervention and so there is a great need to identify interim indicators of effect. Such indicators would provide early information about the intervention’s causal impact, as well as point to the biological mechanism through which these interventions shape future child development. The HPA axis is a robust marker of biological responses to stress, and there is growing evidence linking HPA axis biomarkers to both maternal depression and infant brain development. Using a cluster Randomized Control Trial in Pakistan, this study leverages novel hair-derived biomarker data (cortisol and DHEA), from 104 mother-infant dyads, to determine if treating maternal depression can alter infant HPA axis function, and to examine to what extent infant HPA axis function predicts future development outcomes. The trial’s intervention is a peer-delivered version of the Thinking Healthy Programme provided to women identified as depressed in their 3rd trimester. The study sample also includes a subset of women who were not depressed during pregnancy, as a low-risk comparison group. The mother-child dyads are being followed through 36 months post-partum, and the resulting dataset is rich with data related to mothers’ health, sociodemographic factors, parenting, and child development from 3 to 36 months post-partum. The randomized design allows us to assess the intervention’s causal effects on infant cortisol and DHEA. The main outcomes of interest are child cognitive and socioemotional development indicators at 36 months of age. The specific aims of this project are to (1) evaluate the impact of a perinatal depression intervention on infant cortisol in hair; (2) examine whether infant cortisol at 12 months predicts child development at 24 and 36 months; and (3) examine the impact of the intervention on DHEA levels in infants and the link between infant DHEA at 12 months and child developmental outcomes at 24 and 36 months. The results from this study will improve our understanding of the role of maternal mental health in child development as well as help identify important indicators to improve early intervention evaluation.

抽象的 在全球范围内，大约20％的儿童在生命的头几年暴露于孕产妇抑郁症，增加了风险 人生过程中的身体和发展成果差。确定可以减轻的干预措施 孕产妇抑郁对儿童的负面后果是降低健康差异的关键，因此是 一个主要的公共卫生优先事项。但是，对儿童成长的可衡量影响可能不会立即出现 干预后，因此非常需要确定临时效果指标。这样的指标会 提供有关干预因果影响的早期信息，并指向生物机制 这些干预措施塑造了未来的儿童发展。 HPA轴是生物学的强大标记 对压力的反应，越来越多的证据将HPA轴生物标志物与两个母体抑郁症联系起来 和婴儿脑发育。这项研究使用巴基斯坦的簇随机对照试验，利用新颖 从104个母亲二元组来确定是否治疗母体 抑郁会改变婴儿HPA轴功能，并检查婴儿HPA轴功能在多大程度上预测 未来的发展成果。试验的干预是健康思维的同行递送版本 提供给妇女在三个月中被确定为沮丧的妇女的计划。研究样本还包括 在怀孕期间不抑郁的女性的子集​​，作为低风险比较组。母子 在产后36个月之前，二元组一直遵循，并且由此产生的数据集富含与 母亲的健康，社会人口统计学因素，育儿和儿童发展后三个月至36个月。 随机设计使我们能够评估干预措施对婴儿皮质醇和DHEA的因果关系。 感兴趣的主要结果是儿童认知和社会情感发展指标在36个月大时。 该项目的具体目的是（1）评估围产期抑郁干预对 婴儿皮质醇的头发； （2）检查婴儿皮质醇在12个月时是否预测24岁的儿童发育 和36个月； （3）检查干预对婴儿和链接的DHEA水平的影响 在12个月时婴儿DHEA与24个月和36个月的儿童发育效果之间。结果 从这项研究中，我们将提高我们对孕产妇心理健康在儿童发展中的作用的理解 作为帮助确定重要指标以改善早期干预评估。