Detection and Care for Depression in the Peripartum

围产期抑郁症的检测和护理

• 批准号: 7848977
• 负责人: JAMES C COYNE
• 金额: $ 54.14万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-19 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7848977
• 关键词: Accounting; Adherence; Affect; African American; Antidepressive Agents; Attention; Attitude; Belief; Caring; Characteristics; Child Development; Clinical; Data; Decision Making; Depressed mood; Detection; Disadvantaged; Discipline of obstetrics; Disease remission; Documentation; Effectiveness; Enabling Factors; Epidemiology; Family; Goals; Health Personnel; Health Services; Health Services Research; Health system; High Risk Woman; Insurance; Insurance Coverage; Interview; Investigation; Learning; Level of Evidence; Low income; Major Depressive Disorder; Measures; Medicaid; Medical; Mental Depression; Mental Health; Mental Health Services; Methods; Modeling; Monitor; Observational Study; Outcome; Participant; Patients; Perinatal; Population; Postpartum Period; Predisposing Factor; Pregnancy; Prenatal care; Process; Protocols documentation; Provider; Qualitative Research; Recommendation; Recording of previous events; Recruitment Activity; Relapse; Research; Research Methodology; Research Personnel; Risk; Sampling; Services; Site; Social Network; Social support; Symptoms; System; Time; Treatment outcome; United States; United States National Center for Health Statistics; Unmarried; Visit; Woman; Work; abstracting; base; clinical research site; depressive symptoms; design; experience; fetal; follow up assessment; follow-up; health care service utilization; help-seeking behavior; high risk; informant; maternal depression; meetings; motherhood; pregnant; prenatal; psychologic; response; social; uptake

DESCRIPTION (provided by applicant): Detection and Care for Depression in the Perinatal Period Major depressive disorder (MDD) among women in pregnancy and the postpartum can have profoundly negative implications for women; fetal, infant, and child development; and the larger family. This mixed method study examines the detection and treatment of depression in a sample of high-risk women recruited during their first prenatal visit at one of two prenatal care sites chosen for diversity. One site serves a predominately white, married, insured population and the other a predominately African-American, unmarried, Medicaid population. The overarching goal is to identify influences on access and barriers to care for MDD in pregnancy and postpartum. Such influences include not only institutional, financial, provider, and practical issues, but often overlooked factors such as personal and cultural attitudes about depression, engagement with the medical system, competing priorities, and difficulties maintaining a focus on personal mental health during pregnancy and early motherhood, particularly for disadvantaged women. The research involves identifying a group of approximately 1600 women at high risk for MDD based on history of MDD, treatment for MDD, or current depressive symptomatology. These women will be assessed twice in pregnancy and twice postpartum for emergence of MDD. When these women meet criteria for MDD, they will be entered into a treatment monitoring protocol. This protocol involves systematically assessing symptom level, evidence of help-seeking, the detection of depression and offering of treatment by health providers, interactions with the health system, and the initiation of treatment and follow up care for depression. A targeted and purposively selected subsample of these women will also receive qualitative interviews to provide a more nuanced, comprehensive understanding of their responses to the quantitative assessments. Finally, a sample of maternal care providers will be interviewed to understand the provider's perspective on the process of identifying and obtaining treatment of depression. Results will show how design, implementation, and uptake and effective use of enhancements of care for depression in the perinatal period must be based on a realistic understanding of the full range of factors affecting the accessibility and acceptability of care and how these factors vary with the circumstances of women. This project examines the rates of detection of depression, quality of treatment received and outcomes achieved, and moderating factors of these in more than 1600 high-risk women recruited during their first prenatal visit. Results will show how design, implementation, and, importantly, uptake and effective use of enhancements of care for depression in the peripartum must be based on a more realistic understanding of the full range of factors affecting the accessibility and acceptability of care and how these factors vary with the circumstances of women.

描述（由申请人提供）：围产期抑郁症的抑郁症的检测和护理主要抑郁症（MDD）在怀孕和产后的妇女中对妇女产生深远的负面影响；胎儿，婴儿和儿童发育；还有更大的家庭。这项混合方法研究研究了在首次访问产前访问期间，在两个用于多样性的产前护理场所之一中招募的高危妇女样本中对抑郁症的检测和治疗。一个地点为白人，已婚，被保险人口提供服务，另一个地点为非裔美国人，未婚，医疗补助人口。总体目标是确定对妊娠和产后MDD的访问和护理障碍的影响。这种影响不仅包括机构，财务，提供者和实际问题，而且通常被忽视的因素，例如对抑郁症，与医疗体系的互动，竞争优先级的个人和文化态度，以及在怀孕期间和早期母性期间关注个人心理健康的困难，尤其是对弱势妇女。该研究涉及根据MDD的史，MDD治疗或当前的抑郁症状，确定大约1600名MDD高风险的女性。这些妇女将在怀孕期间两次评估，并在产后两次出现MDD。当这些妇女符合MDD的标准时，她们将进入治疗监测方案。该协议涉及系统地评估症状水平，寻求帮助的证据，抑郁症的检测和卫生提供者提供治疗，与卫生系统的互动以及治疗的启动以及抑郁症的后续护理。这些妇女的有针对性且目的选择的子样本还将接受定性访谈，以提供对她们对定量评估的反应的更细微，更全面的理解。最后，将采访孕产妇护理提供者的样本，以了解提供者在识别和获得抑郁症治疗过程中的观点。结果将表明，在围产期期间，设计，实施，采用和有效利用增强抑郁症的护理能力必须基于对影响护理的可及性和可接受性的全部因素的现实理解，以及这些因素如何随妇女的情况而变化。该项目研究了在第一次产前访问期间招募的1600多名高风险妇女的抑郁症，接受的治疗质量和获得的治疗质量的检测率，并调查了这些因素。结果将表明，设计，实施，重要的是，围绕围绕抑郁症的护理的吸收和有效利用必须基于对影响护理的可及性和可接受性的全部因素以及这些因素如何随妇女的情况而变化的全部因素。