Treatment Initiation for New Episodes of Depression in Pregnant Women

孕妇新发抑郁症的治疗启动

• 批准号: 10612412
• 负责人: Kristin Palmsten
• 金额: $ 60.85万
• 依托单位: HEALTHPARTNERS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-06 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10612412
• 关键词: Accounting; Acupuncture Therapy; Antidepressive Agents; Benefits and Risks; Birth; Blood flow; Breast Feeding; Cessation of life; Characteristics; Complementary and alternative medicine; Data; Decision Making; Depression screen; Dose; Emotional; Epidemiologic Methods; Goals; Guidelines; Immunosuppression; Infant; Internet; Intervention; Low Birth Weight Infant; Maternal Behavior; Mediator; Mental Depression; Mental Health; Observational Study; Outcome; Pattern; Perinatal; Persons; Pharmaceutical Preparations; Phototherapy; Population; Positioning Attribute; Postpartum Period; Predictive Factor; Pregnancy; Pregnancy Complications; Pregnant Women; Premature Birth; Problem behavior; Provider; Psychotherapy; Publishing; Randomized, Controlled Trials; Recurrence; Risk; Risk Factors; Self Care; Self-Injurious Behavior; Severities; Site; Small for Gestational Age Infant; Smoking; Support Groups; Surveys; Symptoms; Woman; Yoga; antenatal; antepartum depression; clinical decision-making; comorbidity; coping; demographics; depressive symptoms; electronic health data; ethnic diversity; experience; improved; infant outcome; instrument; maternal comorbidity; maternal depression; novel; offspring; peer support; perinatal outcomes; racial diversity; response; screening; substance use; treatment effect; treatment optimization

PROJECT SUMMARY Up to 12% of pregnant women have a new episode of depression, ie, an incident or recurrent depressive episode with symptom onset during pregnancy. Effects of untreated antenatal depression include unhealthy maternal behaviors (eg, diminished self-care, smoking, substance use, self-harm) and emotional and behavioral problems in offspring. Antenatal depression or elevated depression scores, identified by screening instruments, increase the risk of preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) birth, and are associated with breastfeeding discontinuation before 3 months postpartum. In-person psychotherapy and antidepressant medication improve depression symptoms in many with depression, yet <50% of pregnant women with new episodes of depression initiate these treatments. Although some barriers to initiating antidepressants and psychotherapy are known, other factors have not been well described, especially after accounting for depression severity. Furthermore, the impact of antidepressants and psychotherapy on perinatal outcomes, including PTB, LBW, SGA, and breastfeeding continuation among pregnant women with new episodes of depression after accounting for confounding by depression severity is unknown. Given the importance of factors influencing the decision to initiate antidepressant or psychotherapy treatment during pregnancy and the need for further evidence on the perinatal risks and benefits associated with antidepressant use and psychotherapy in pregnant women, the goal of this study is to identify predictors and perinatal effects of psychotherapy and antidepressant use for new episodes of depression during pregnancy while accounting for depression severity. We will conduct this study in a racially and ethnically diverse multi- site population using electronic health data, enriched with survey data from a subset of women. Among pregnant women with new episodes of depression, we will evaluate factors that influence the propensity to initiate psychotherapy or antidepressants; accounting for these is crucial when studying treatment effects. We will describe patterns of use of alternative depression management approaches (eg, Internet- based psychotherapy, peer support groups, and complementary and alternative medicine) and will evaluate whether initiation of psychotherapy or antidepressants is associated with these practices while accounting for depression severity. We will quantify the impact of psychotherapy and antidepressants (including dose, timing, and duration of use) on PTB, LBW, SGA, and breastfeeding continuation accounting for the propensity to initiate psychotherapy or antidepressants and depression severity. We are uniquely positioned to overcome limitations of confounding and small size in prior studies given our data on depression severity and maternal comorbidity for more than 8,000 pregnant women. Our study will be informative for understanding the mental health interventions utilized by pregnant women with depression and will inform decision making on optimal depression management during pregnancy.

项目概要 高达 12% 的孕妇有新的抑郁症发作，即突发或复发性抑郁症 怀孕期间出现症状的发作。未经治疗的产前抑郁症的影响包括不健康 母亲行为（例如，自我保健能力下降、吸烟、滥用药物、自残）以及情绪和 后代的行为问题。通过筛查发现的产前抑郁症或抑郁评分升高 器械，增加早产 (PTB)、低出生体重 (LBW) 和小于胎龄的风险 (SGA) 出生，并且与产后 3 个月前停止母乳喂养有关。面对面 心理治疗和抗抑郁药物可以改善许多抑郁症患者的抑郁症状，但 <50% 的新发抑郁症孕妇开始接受这些治疗。尽管存在一些障碍 开始抗抑郁药物和心理治疗是已知的，其他因素尚未得到很好的描述，特别是 在考虑了抑郁症的严重程度之后。此外，抗抑郁药和心理治疗对 围产期结局，包括患有以下疾病的孕妇的 PTB、LBW、SGA 和继续母乳喂养 考虑到抑郁症严重程度的混杂因素后，新的抑郁症发作尚不清楚。 鉴于影响开始抗抑郁药物或心理治疗决定的因素的重要性 怀孕期间需要进一步证据证明与妊娠相关的围产期风险和益处 孕妇抗抑郁药的使用和心理治疗，这项研究的目的是确定预测因素和 心理治疗和抗抑郁药物对妊娠期新发抑郁症的围产期影响 同时考虑抑郁症的严重程度。我们将在种族和民族多元化的多元群体中进行这项研究 使用电子健康数据进行现场人口调查，并补充了来自女性子集的调查数据。 在新发抑郁症的孕妇中，我们将评估影响抑郁症的因素 开始心理治疗或抗抑郁药物的倾向；在研究治疗时考虑这些因素至关重要 影响。我们将描述替代抑郁症管理方法的使用模式（例如，互联网- 基于心理治疗、同伴支持小组以及补充和替代医学）并将评估 开始心理治疗或抗抑郁药物是否与这些做法相关，同时考虑到 抑郁症的严重程度。我们将量化心理治疗和抗抑郁药物的影响（包括剂量、时间、 和使用持续时间）对 PTB、LBW、SGA 和母乳喂养持续性的影响 开始心理治疗或抗抑郁药物和抑郁的严重程度。 鉴于我们的研究，我们处于独特的地位，可以克服先前研究中混杂因素和小规模的限制 有关 8,000 多名孕妇的抑郁严重程度和孕产妇合并症的数据。我们的研究将是 为了解患有抑郁症的孕妇所采用的心理健康干预措施提供了信息 将为孕期最佳抑郁症管理决策提供信息。