Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal: a cluster randomised trial in Pakistan.
Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal: a cluster randomised trial in Pakistan.
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DOI：
10.1016/s2215-0366(20)30258-3
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发表时间：
2020-09
期刊：
影响因子：
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通讯作者：
Rahman A
中科院分区：
文献类型：
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作者：
Maselko J;Sikander S;Turner EL;Bates LM;Ahmad I;Atif N;Baranov V;Bhalotra S;Bibi A;Bibi T;Bilal S;Biroli P;Chung E;Gallis JA;Hagaman A;Jamil A;LeMasters K;O'Donnell K;Scherer E;Sharif M;Waqas A;Zaidi A;Zulfiqar S;Rahman A
母亲抑郁症有一个反复出现的过程，可以影响后代的结果。关于如何使用任务转移，低强度可扩展的心理社会干预来治疗孕产妇抑郁症以改善长期孕产妇结局并减少精神病理学的代际传播的证据有限。我们试图填补这一空白，评估同龄人提供的心理社会抑郁症干预对母亲抑郁症和3岁儿童发育的影响。巴基斯坦的40个村庄被随机分配到治疗或加强常规护理（EUC）。将筛选为中度或重度抑郁症状阳性（患者健康问卷（PHQ-9）评分10+）的18岁或以上孕妇招募入试验（n=570），还招募了非抑郁队列（n=584）。主要结果是母亲抑郁症状和缓解（PHQ-9<10）和儿童社会情感技能（优势和困难问卷-总困难（SDQ-TD））。该试验在ClinicalTrials.gov注册，编号为NCT 02658994。在出生后36个月，完整的数据可从889母子二人组：206治疗（72.5%），216 EUC（75.3%），和467产前非抑郁症（80.0%）。我们没有观察到试验治疗组和EUC组之间的显著结局差异（PHQ-9总分：标准化Meand差异= −0.13，95%CI −0.33至0.07; PHQ-9缓解：RR= 1.08，95%CI 0.88至1.33; SDQ-TD治疗估计值：− 0.10; 95%CI − 1.39，1.19;）。大约40%的妇女没有完成治疗，同龄人的能力水平随着时间的推移而下降。两组均观察到症状严重程度降低和缓解率高，可能掩盖了任何治疗效果。多年的心理社会干预可以通过同伴转移任务，但随着时间的推移，忠诚度和剂量容易减少。早期干预工作可能需要依靠多种模式（如合作护理），更大的强度，并可能针对高风险的母亲，以减少精神病理学从母亲到儿童的代际传播。
Maternal depression has a recurring course that can influence offspring outcomes. There is limited evidence about how to treat maternal depression to improve longer term maternal outcomes and reduce intergenerational transmission of psychopathology using task-shifted, low-intensity scalable psychosocial interventions. We sought to fill this gap, evaluating the effects of a peer-delivered psychosocial depression intervention on maternal depression and child development at 3 years of age. Forty village clusters in Pakistan were randomly allocated to treatment or enhanced usual care (EUC). Pregnant women aged 18 years or over screening positive for moderate or severe depression symptoms (Patient Health Questionnaire (PHQ-9) score 10+) were recruited into the trial (n=570) and a non-depressed cohort was also enrolled (n=584). Primary outcomes were maternal depression symptoms and remission (PHQ-9<10) and child socioemotional skills (Strengths and Difficulties Questionnaire- Total Difficulties (SDQ-TD)/. Analyses were intention-to-treat. The trial was registered with ClinicalTrials.gov, number NCT02658994. At 36-months postnatal, complete data were available from 889 mother-child dyads: 206 treatment (72.5%), 216 EUC (75.3%), and 467 prenatally non-depressed (80.0%). We did not observe significant outcome differences between treatment and EUC arms of the trial (PHQ-9 total score: Standardized Meand Difference = −0.13, 95% CI −0.33 to 0.07; PHQ-9 remission: RR= 1.08, 95% CI 0.88 to 1.33; SDQ-TD treatment estimate: −0·10; 95%CI −1·39, 1·19;). Approximately 40% of women did not complete their treatment sessions, and competence levels of peers dropped over time. Reduced symptom severity and high remission rates were seen across both arms, possibly masking any treatment effects. A multi-year, psychosocial interventions can be task-shifted via peers but are susceptible to reductions in fidelity and dosage over time. Early intervention efforts might need to rely on multiple models (e.g. collaborative care), be of greater intensity, and potentially targeted toward higher risk mothers to reduce the intergenerational transmission of psychopathology from mothers to children.