Potential impact of trauma on the ability to prevent depression among low-income mothers.
Potential impact of trauma on the ability to prevent depression among low-income mothers.
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DOI：
10.1002/da.20817
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发表时间：
2011-06
影响因子：
7.4
通讯作者：
Beardslee, William
中科院分区：
文献类型：
--
作者：
Silverstein, Michael;Feinberg, Emily;Cabral, Howard;Linhart, Yaminette Diaz;Sandler, Jenna;Hegel, Mark;Appugliese, Danielle Pierce;Beardslee, William
暴力创伤在城市社区很常见。我们探讨了这一假设，即过去的创伤可以缓和旨在预防城市低收入母亲抑郁症的认知行为干预的效果。综合两项问题解决教育（PSE）的试点随机试验，在93名新生儿重症监护病房住院或参加社区早期干预计划的儿童母亲中进行。结果包括抑郁症状，感知压力，社会功能。结果根据基线抑郁症状进行调整，然后根据受试者的创伤史进行分层。在4个月的随访期间，44名PSE受试者中有15名（34%）经历了中度重度抑郁症状发作，而45名对照受试者中有21名（47%）经历了中度重度抑郁症状发作，调整后的比值比（aOR）为0.36（95%CI 0.13，1.02）。在没有创伤史的母亲中，PSE母亲（5/24; 21%）比对照组母亲（12/26; 46%）经历了中重度抑郁症状发作，显著aOR为0.15（95%CI 0.03，0.79）。相反，在有创伤史的母亲中，PSE母亲（19人中的10人; 53%）与对照母亲（19人中的9人; 47%）一样经历了中度重度抑郁症状。类似的趋势也适用于感知压力和社会功能。PSE可能更有效地预防没有创伤史的母亲的抑郁症。我们的研究结果是一致的抑郁症治疗文献，但新颖的，因为他们支持的原则，干预适度的风险预防-而不是治疗-范式。
Violent trauma is common in urban communities. We explored the hypothesis that past trauma could moderate the effect of a cognitive behavioral intervention designed to prevent depression among urban, low-income mothers. Synthesis of two pilot randomized trials of problem solving education (PSE), among 93 mothers of children hospitalized in the neonatal intensive care unit or enrolled in community-based Early Intervention programs. Outcomes included depressive symptoms, perceived stress, social functioning. Results were adjusted for baseline depressive symptoms, then stratified according to subjects’ trauma history. Fifteen of 44 PSE subjects (34%) experienced a moderately severe depressive symptom episode during the four-month follow-up period, as opposed to 21 of 45 control subjects (47%) – for a nearly significant adjusted odds ratio (aOR) of 0.36 (95% CI 0.13, 1.02). Among mothers without trauma histories, far fewer PSE mothers (5 of 24; 21%) experienced an episode of moderately severe depressive symptoms than control mothers (12 of 26; 46%), for a significant aOR of 0.15 (95% CI 0.03, 0.79). Conversely, among mothers with trauma histories, a similar proportion of PSE mothers (10 of 19; 53%) experienced an episode of moderately severe depressive symptoms as control mothers (9 of 19; 47%). Similar trends held for perceived stress and social functioning. PSE may be more effective at preventing depression among mothers without trauma histories. Our results are consistent with the depression treatment literature, but are novel because they support the principle of intervention moderation in a risk-prevention – as opposed to treatment – paradigm.
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影响因子：
5
作者：
COHEN, S;KAMARCK, T;MERMELSTEIN, R
通讯作者：
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