IPT for major depression following perinatal loss

IPT 治疗围产期流产后重度抑郁症

基本信息

批准号：
10456800
负责人：
JENNIFER E JOHNSON
金额：
$ 65.9万
依托单位：
MICHIGAN STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-07 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10456800
关键词：
Address African American Aftercare Bereavement Birth Cessation of life Child Welfare Cities Clinical Clinical Treatment Cognitive Therapy Communities Competence Confidence Intervals Conflict (Psychology)Distress Equilibrium Event Family Fetal Death Fright Grief reaction Hospitalization Impairment Infant Intervention Location Major Depressive Disorder Manuals Mediating Mental Depression Mental disorders Michigan Minority Moods Mothers National Institute of Child Health and Human Development Outcome Parents Perinatal Personal Satisfaction Pilot Projects Population Post-Traumatic Stress Disorders Poverty Pregnancy Provider Public Health Randomized Randomized Controlled Trials Recovery Research Risk Role Sampling Schedule Sleep Social support Spontaneous abortion Structure Suicide attempt Symptoms Testing Time United States Woman Women&apos s Health Work coping depressive symptoms efficacy study efficacy testing evidence base experience follow-up improved improved outcome interpersonal therapy meetings neonatal death neonate peripartum depression pilot trial randomized trial satisfaction single episode major depressive disorder social communication social norm suicide rate treatment as usual uptake

项目摘要

The rates of major depressive disorder (MDD) among women who have recently experienced perinatal loss (including early and late fetal death and early neonatal death) are 3 times the rates of MDD among matched samples of community women. Mood difficulties can persist up to 4 years after the loss and can worsen with subsequent pregnancies. Suicide rates after perinatal loss are higher relative to mothers of living infants. PTSD is a common co-occurrence; PTSD rates after perinatal loss are 7 times that of mothers of living infants. Despite recognition that MDD following perinatal loss is an important public health concern, that it causes significant impairment, and that treatment as usual has been inadequate, the only treatment developed and tested for this population was part of a randomized trial conducted by our team in pilot work for this proposal. That study created the first manual for treating any psychiatric disorder after perinatal loss. The manual is structured, easy-to-follow, and uses interpersonal psychotherapy (IPT) principles to address the circumstances perinatal loss, such as resolving conflicts over how to respond to the loss, grieving and requesting support in the absence of social norms about how to do so, reviewing the loss event, and resolving questions of fault and role competence. It can be used by providers who do not know IPT. Our pilot trial randomized 50 women with MDD following perinatal loss to group IPT or to group Coping with Depression (CWD), an evidence-based cognitive behavioral treatment which did not focus on perinatal loss nor social support. IPT was feasible and acceptable, with significantly higher (p = .001) treatment satisfaction scores and PTSD recovery rates (among the 54% of the sample with PTSD; p = .009) in IPT than in CWD. Confidence intervals around between-groups effect sizes favored IPT for reductions in depressive symptoms during treatment as well as for improvement in mode-specific targets (social support, grief symptoms), over follow-up. Given these promising findings, the proposed R01 will conduct a fully-powered randomized efficacy study comparing IPT for MDD following perinatal loss to CWD in a sample of 274 women. The trial will be the first fully-powered randomized trial of treatment for any psychiatric disorder following perinatal loss. It addresses NICHD priority to improve the health of women before, during, and after pregnancy. Given that poverty increases risk of perinatal loss and that rates of perinatal loss for African- American women are double those for White women, the location of the trial in Flint and Detroit, Michigan (minority-majority cities with high rates of poverty) increases the significance of the trial. Outcomes will include time to recovery from MDD, depressive symptoms, PTSD symptoms, time to recovery from PTSD, social support, well-being, grief, and fear of subsequent pregnancies. Results have high potential for dissemination and uptake: we have received and fulfilled more than 160 requests for the free, unpublished IPT treatment manual. This study will provide an evidence base for treating a vulnerable and understudied population whose distress has historically been minimized, improving outcomes for these women and their families.

最近经历过围产期流产的女性患重度抑郁症 (MDD) 的比例（包括早期和晚期胎儿死亡以及早期新生儿死亡）是匹配人群中 MDD 发生率的 3 倍社区妇女样本。情绪困难可能会在失去亲友后持续长达 4 年，并且会因以下原因而恶化：随后的怀孕。与活婴母亲相比，围产期死亡后的自杀率更高。创伤后应激障碍是常见的共现现象；围产期死亡后的 PTSD 发生率是活婴母亲的 7 倍。尽管认识到围产期丢失后的 MDD 是一个重要的公共卫生问题，它会导致严重的损伤，并且照常治疗是不够的，为此开发和测试的唯一治疗方法人口是我们团队在该提案试点工作中进行的随机试验的一部分。该研究创建了第一本治疗围产期死亡后精神疾病的手册。该手册结构合理，易于理解，并使用人际心理治疗（IPT）原则来解决围产期损失的情况，例如解决在缺乏社交的情况下如何应对损失、悲伤和请求支持的冲突关于如何做到这一点、审查损失事件以及解决过失和角色能力问题的规范。它不了解 IPT 的提供商可以使用。我们的试点试验随机抽取了 50 名患有重度抑郁症的女性围产期失访组 IPT 或应对抑郁组 (CWD)，这是一种基于证据的认知行为治疗不关注围产期损失或社会支持。 IPT 是可行且可接受的，显着更高 (p = .001) 的治疗满意度评分和 PTSD 恢复率（54% 的患者中）患有创伤后应激障碍（PTSD）的样本； P = .009) 在 IPT 中比在 CWD 中。组间效应大小的置信区间赞成 IPT 减少治疗期间的抑郁症状以及改善特定模式目标（社会支持、悲伤症状），过度跟进。鉴于这些有希望的发现，拟议的 R01 将进行一项全功效随机疗效研究，比较 IPT 对围产期丧失 CWD 后的 MDD 的影响 274 名女性样本。该试验将是第一个针对任何精神科疾病的全功效随机治疗试验围产期丢失后的疾病。它解决了 NICHD 的优先事项，即在之前、期间、以及怀孕后。鉴于贫困增加了围产期损失的风险，并且非洲国家的围产期损失率美国女性是白人女性的两倍，审判地点在密歇根州弗林特和底特律（贫困率高的少数族裔占多数的城市）增加了试验的重要性。结果将包括从 MDD 中恢复的时间、抑郁症状、PTSD 症状、从 PTSD 中恢复的时间、社会支持、幸福感、悲伤以及对随后怀孕的恐惧。结果具有很高的传播和吸收潜力：我们已收到并满足了 160 多个免费、未出版的 IPT 治疗手册的请求。这研究将为治疗那些遭受痛苦的弱势群体和未被充分研究的群体提供证据基础历史上被最小化，改善了这些妇女及其家庭的成果。