Staying Well During Pregnancy and the Postpartum: A Pilot Randomized Trial of Mindfulness-Based Cognitive Therapy for the Prevention of Depressive Relapse/Recurrence
Staying Well During Pregnancy and the Postpartum: A Pilot Randomized Trial of Mindfulness-Based Cognitive Therapy for the Prevention of Depressive Relapse/Recurrence
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DOI：
10.1037/ccp0000068
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发表时间：
2016-02-01
影响因子：
5.9
通讯作者：
Beck, Arne
中科院分区：
文献类型：
--
作者：
Dimidjian, Sona;Goodman, Sherryl H.;Beck, Arne
目的：对于有抑郁症病史的孕妇及其医疗保健提供者来说，预防抑郁症的临床决策是复杂的。有抑郁症史的孕妇报告偏好非药物治疗，但几乎没有证据为基础的选择存在。基于正念的认知疗法在预防一般人群中的抑郁症复发/再发方面有强有力的证据，并且适用于围产期抑郁症（MBCT-PD）。通过一项初步随机临床试验，我们的目的是评估MBCT-PD相对于常规治疗（TAU）的治疗可接受性和疗效。方法：从2个地点的产科诊所招募有抑郁症病史的怀孕成年女性，并随机分配至MBCT-PD（N = 43）或TAU（N = 43）组。通过评估课程完成情况、家庭实践和满意度来衡量治疗的可接受性。临床结局是产后6个月内基于访谈的抑郁症复发/复发状态和自我报告的抑郁症状。结果如下：与预测一致，MBCT-PD的风险孕妇是可以接受的基础上完成的会议和在家里的实践任务，并与服务的满意度显着高于MBCT-PD比TAU。此外，与接受TAU的参与者相比，随机分配到MBCT-PD的高危女性报告了显着改善的抑郁结局，包括研究过程中抑郁复发/复发率显着降低和抑郁症状严重程度降低。结论：MBCT-PD对于有抑郁症病史的孕妇来说是一个可接受的和临床上有益的计划;在怀孕期间教授正念冥想和认知行为疗法的技能和实践可能有助于降低许多女性生活中重要转变期间抑郁症的风险。
Objective: Clinical decision-making regarding the prevention of depression is complex for pregnant women with histories of depression and their health care providers. Pregnant women with histories of depression report preference for nonpharmacological care, but few evidence-based options exist. Mindfulness-based cognitive therapy has strong evidence in the prevention of depressive relapse/recurrence among general populations and indications of promise as adapted for perinatal depression (MBCT-PD). With a pilot randomized clinical trial, our aim was to evaluate treatment acceptability and efficacy of MBCT-PD relative to treatment as usual (TAU). Method: Pregnant adult women with depression histories were recruited from obstetric clinics at 2 sites and randomized to MBCT-PD (N = 43) or TAU (N = 43). Treatment acceptability was measured by assessing completion of sessions, at-home practice, and satisfaction. Clinical outcomes were interview-based depression relapse/recurrence status and self-reported depressive symptoms through 6 months postpartum. Results: Consistent with predictions, MBCT-PD for at-risk pregnant women was acceptable based on rates of completion of sessions and at-home practice assignments, and satisfaction with services was significantly higher for MBCT-PD than TAU. Moreover, at-risk women randomly assigned to MBCT-PD reported significantly improved depressive outcomes compared with participants receiving TAU, including significantly lower rates of depressive relapse/recurrence and lower depressive symptom severity during the course of the study. Conclusions: MBCT-PD is an acceptable and clinically beneficial program for pregnant women with histories of depression; teaching the skills and practices of mindfulness meditation and cognitive-behavioral therapy during pregnancy may help to reduce the risk of depression during an important transition in many women's lives.