Video-Delivered Family Therapy for Perinatal Women With Depressive Symptoms and Family Conflict: Feasibility, Acceptability, Safety, and Tolerability Results From a Pilot Randomized Trial.
Video-Delivered Family Therapy for Perinatal Women With Depressive Symptoms and Family Conflict: Feasibility, Acceptability, Safety, and Tolerability Results From a Pilot Randomized Trial.
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DOI：
10.2196/51824
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发表时间：
2023-11-03
影响因子：
2.2
通讯作者：
Bruce, Martha L.
中科院分区：
文献类型：
--
作者：
Cluxton-Keller, Fallon;Hegel, Mark;Donnelly, Craig L.;Bruce, Martha L.
关键词：
尽管对患有抑郁症的孕妇和产后妇女有个人层面的治疗，但家庭冲突是导致围产期抑郁症状发展和严重程度的一个重要因素。然而，对于有中到重度抑郁症状和家庭冲突的围产期妇女的家庭治疗缺乏研究。此外，需要研究使用符合《健康保险携带和责任法案》的视频会议技术(VCT)提供的围产期抑郁症家庭疗法的可行性、可接受性、安全性和耐受性。本文描述了一种基于VCT的家庭治疗干预的可行性、可接受性、安全性和耐受性，该家庭治疗干预是针对具有中到重度抑郁症状和与家庭成员的中到高度冲突的围产期妇女的韧性增强技能训练(REST)。本文包括一项正在进行的随机试验的数据，该试验比较了实验性家庭治疗干预(REST)和标准护理(基于VCT的问题解决个人治疗)在治疗中到高度家庭冲突的围产期妇女中到重度抑郁症状方面的差异。这两种干预都是由大师级别的治疗师使用VCT进行的。共招募了83名围产期妇女及其成年家庭成员(N=166人)参与研究。可行性，定义为治疗师遵守≥80%的REST会议内容，由2名专家评分员在录音会议中进行评估。可接受性定义为≥80%的家庭完成休息，包括≥80%的家庭作业完成和家庭对休息满意的报告。通过回顾治疗师的会议记录来评估REST的完成情况，并通过参与者完成基于网络的问卷来评估满意度。Beck抑郁量表第二版由研究助理(对研究组分配是盲目的)对围产期妇女进行管理，以评估安全性，安全性被定义为在治疗阶段抑郁症状的减少。在治疗阶段，治疗师对参与者进行了家庭环境量表-家庭冲突子量表的测试，以评估耐受性，其定义是在治疗阶段减少家庭冲突。平均而言，治疗师对休息课程内容的忠诚度达到90%。在开始休息的家庭中，84%(32/38)的家庭完成了休息，平均完成了89%(8/9)的家庭作业。家庭报告说他们对休息感到满意。结果表明，对于有中度到重度抑郁症状的围产期妇女来说，休息是安全的，并且没有人因为抑郁症状恶化而停止休息。结果表明，家庭可以很好地容忍休息，没有家庭因持续的家庭冲突而停止休息。结果表明，家庭休息是可行的、可接受的、安全的、可容忍的。这些发现将指导我们在完成结果数据收集后对REST的初步有效性的解释。ClinicalTrials.gov NCT04741776；https://clinicaltrials.gov/ct2/show/NCT04741776
Although individual-level treatments exist for pregnant and postpartum women with depression, family conflict is a significant factor that can contribute to the development and severity of perinatal depressive symptoms. Yet, there is a lack of research on family therapy for perinatal women with moderate to severe depressive symptoms and family conflict. Further, research is needed on the feasibility, acceptability, safety, and tolerability of family therapies for perinatal depression that are delivered using Health Insurance Portability and Accountability Act–compliant videoconferencing technology (VCT). This paper describes the feasibility, acceptability, safety, and tolerability of a VCT-based family therapeutic intervention, Resilience Enhancement Skills Training (REST), for perinatal women with moderate to severe depressive symptoms and moderate to high conflict with their family members. This paper includes data from an ongoing randomized trial that compares an experimental family therapeutic intervention (REST) to standard of care (VCT-based problem-solving individual therapy) for the treatment of moderate to severe depressive symptoms in perinatal women with moderate to high family conflict. Both interventions were delivered by masters-level therapists using VCT. A total of 83 perinatal women and their adult family members (N=166 individuals) were recruited for participation in the study. Feasibility, defined as therapist adherence to ≥80% of REST session content, was assessed in audio-recorded sessions by 2 expert raters. Acceptability was defined as ≥80% of families completing REST, including completion of ≥80% homework assignments and family report of satisfaction with REST. Completion of REST was assessed by review of therapist session notes, and satisfaction was assessed by participant completion of a web-based questionnaire. The Beck Depression Inventory-Second Edition was administered to perinatal women by research assistants (blind to study group assignment) to assess safety, defined as a reduction in depressive symptoms during the treatment phase. The Family Environment Scale-Family Conflict subscale was administered by therapists to participants during the treatment phase to assess tolerability, defined as a reduction in family conflict during the treatment phase. On average, the therapists achieved 90% adherence to REST session content. Of the families who started REST, 84% (32/38) of them completed REST, and on average, they completed 89% (8/9) of the homework assignments. Families reported satisfaction with REST. The results showed that REST is safe for perinatal women with moderate to severe depressive symptoms, and none discontinued due to worsened depressive symptoms. The results showed that REST is well tolerated by families, and no families discontinued due to sustained family conflict. The results show that REST is feasible, acceptable, safe, and tolerable for families. These findings will guide our interpretation of REST’s preliminary effectiveness upon completion of outcome data collection. ClinicalTrials.gov NCT04741776; https://clinicaltrials.gov/ct2/show/NCT04741776
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