Prevention of Perinatal Depression in Birthing People with a History of Adverse Childhood Experiences: A Type 2 Effectiveness Implementation Trial

预防有童年不良经历史的出生者的围产期抑郁症：2 类有效性实施试验

• 批准号: 10919910
• 负责人: Sheehan David Fisher
• 金额: $ 24万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10919910
• 关键词: Adult; Adverse effects; American; Attention; Belief; Birth; Caring; Case Manager; Childhood; Clinic; Clinical; Cluster randomized trial; Communication; Data; Depressive disorder; Diagnosis; Discipline; Discipline of obstetrics; Dissemination and Implementation; Divorce; Dose; Effectiveness; Eligibility Determination; Enrollment; Equity; Exclusion; Exposure to; Foundations; Generations; Goals; Health Services; Healthcare; Hybrids; Individual; Infrastructure; Infusion procedures; Intervention; Interview; Investigational Therapies; Justice; Life; Life Experience; Low Income Population; Low income; Major Depressive Disorder; Masks; Maternal and Child Health; Measures; Mediator; Medical; Medical Care Team; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Meta-Analysis; Methods; Modeling; Mothers; Outcome; Participant; Pathogenicity; Perinatal; Persons; Population; Postpartum Period; Poverty; Pregnancy; Prevention; Process; Provider; Public Health; Publishing; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recording of previous events; Reporting; Research; Research Personnel; Research Training; Risk; Self Efficacy; Services; Sexual abuse; Social support; Structural Racism; Structure; Symptoms; Third Pregnancy Trimester; Trauma; Treatment Protocols; United States; adverse childhood events; adverse outcome; anxiety symptoms; care systems; childhood adversity; collaborative care; cost; depression prevention; depressive symptoms; design; effectiveness evaluation; effectiveness trial; effectiveness/implementation design; effectiveness/implementation trial; emotional abuse; evidence base; experience; follow-up; implementation evaluation; implementation intervention; implementation outcomes; implementation strategy; improved; improved outcome; intergenerational; interpersonal therapy; meetings; multidisciplinary; neglect; obstetric care; offspring; patient registry; perinatal period; peripartum depression; physical abuse; pregnant; prevent; prevention service; preventive intervention; primary care setting; primary outcome; programs; public health insurance; randomized effectiveness trial; randomized trial; randomized, clinical trials; reproductive; response; screening; secondary outcome; service intervention; service programs; social adversity; socioeconomics; stress symptom; therapy design; traumatic event; treatment as usual

PROJECT SUMMARY Prevention of perinatal depression represents an opportunity to optimize maternal and child health outcomes. However, dissemination and implementation of evidence-based prevention interventions, such as Reach Out, Stand Strong, Essentials for New Mothers (ROSE), are challenged by the complexity of multidisciplinary engagement. The collaborative care model (CCM) is an evidence-based health services intervention designed to integrate mental health care into somatic healthcare contexts and bridge care across medical disciplines. Accordingly, the CCM represents an ideal and pragmatic infrastructure to support the delivery of ROSE within obstetric clinics. Adverse childhood experiences (ACEs) are physical, sexual, and emotional abuses incurred in childhood. A striking 16% of adults in the United States were exposed to at least 4 ACEs, and the burden of ACEs is disproportionately borne by historically and socioeconomically excluded populations. Exposure to ACEs is perniciously associated with somatic and mental health outcomes in adulthood, including perinatal depression. Perinatal depression, in turn, is associated with adverse outcomes in birthing people and their offspring. Mitigation of the intergenerational adverse effects of ACEs, via prevention of perinatal depression, is an essential component of a reproductive justice-focused public health strategy. Built on the foundations of interpersonal therapy (IPT), ROSE is a pertinent evidence-based approach for low- income birthing people with a history of ACEs. ROSE's emphasis on the enhancement of support structures may protect against the impact of ACEs on mental health via overcoming pathogenic beliefs that interfere with healthy interpersonal functioning. This mechanism is particularly salient during the transition to new parenthood as social support can decrease the risk of perinatal depression. The infusion of trauma-informed care into the ROSE intervention, including focused attention on obstetric triggers of trauma and communication of these risks across the multi-disciplinary health care team, alongside implementation of this intervention within the CCM defines Trauma-informed ROSE InterventiOn (TRIO). This project, “Prevention of Perinatal Depression in Birthing People with a History of Adverse Childhood Experiences: A Type 2 Effectiveness Implementation Trial”, aims, via a hybrid type 2 randomized trial, to evaluate TRIO, compared to enhanced treatment as usual. Aim 1 will evaluate wither TRIO improves perinatal depression (both symptom trajectories and dichotomized perinatal depression) among low-income pregnant people with a history of ACEs. Aim 2 will evaluate mechanisms by which TRIO may improve perinatal depression. Aim 3 will examine the acceptability, appropriateness, cost, feasibility, and fidelity of TRIO. This proposal will generate key data to inform the conduct of a full-scale cluster randomized trial of TRIO that will answer the key questions of how to effectively and equitably prevent perinatal depression.

项目摘要 预防围产期抑郁症代表了优化产妇和儿童健康结果的机会。 但是，传播和实施基于证据的预防干预措施，例如伸出 站稳脚跟，对新妈妈（玫瑰）的必需品，受到多学科的复杂性的挑战 订婚。协作护理模型（CCM）是设计基于证据的卫生服务干预 将心理保健纳入体卫生保健环境中，并跨越医学学科的护理。 彼此认为，CCM代表了一个理想的务实基础设施，以支持玫瑰在 产科诊所。 童年的不利经历是身体，性和情感虐待，童年时期引起的。一个 在美国，有16％的成年人暴露于至少4个ace，Aces的燃烧为 历史和社会经济排除的人群不成比例地承担。暴露于Aces是 与成年中的躯体和心理健康成果相关，包括围产期抑郁症。 反过来，围产期抑郁症与生日的人及其后代的不利结果有关。 通过预防围产期抑郁，缓解ACE的代际不良反应是必不可少的 重复以司法公共卫生战略的组成部分。 Rose建立在人际疗法（IPT）的基础上，是一种基于循证的低 - 收入分娩的人有王牌史。罗斯强调增强支持结构的可能性 通过克服干扰健康的致病信念来防止ACE对心理健康的影响 人际功能。在过渡到新生生的社会期间，这种机制尤其重要 支持可以降低围产期抑郁症的风险。输注创伤的护理中的玫瑰 干预措施，包括关注创伤的产科触发因素以及这些风险的交流 多学科卫生保健团队以及CCM内此干预的实施 创伤信息玫瑰干预（三重奏）。 这个项目，“预防有童年病史的分娩人的围产期抑郁症 经验：2型有效性实施试验”，旨在通过混合2型随机试验评估 三人，与往常一样增强的治疗。 AIM 1将通过三重奏进行评估可改善围产期抑郁症 （症状轨迹和二分化的围产期抑郁症）在低收入孕妇中 ac史的历史。 AIM 2将评估三重奏可以改善围产期抑郁症的机制。目标3意志 检查三重奏的可接受性，适当性，成本，可行性和保真度。该建议将生成密钥 数据以告知三重奏的全尺度集群随机试验的行为，该试验将回答 如何有效，同样防止围产期抑郁症。