COLLABORATIVE CARE FOR PERINATAL DEPRESSION IN SOCIOECONOMICALLY DISADVANTAGED WOMEN: A RANDOMIZED TRIAL
COLLABORATIVE CARE FOR PERINATAL DEPRESSION IN SOCIOECONOMICALLY DISADVANTAGED WOMEN: A RANDOMIZED TRIAL
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DOI：
10.1002/da.22405
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发表时间：
2015-11-01
影响因子：
7.4
通讯作者：
Carson, Kathy
中科院分区：
文献类型：
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作者：
Grote, Nancy K.;Katon, Wayne J.;Carson, Kathy
研究背景产前和产后抑郁症对母婴健康都有不良的、持久的影响。处于社会经济不利地位的妇女患围产期抑郁症的风险增加，并且难以获得循证抑郁症护理。作者评估是否MOMCare，一种文化相关的，合作的护理干预，提供一个简单的人际心理治疗和/或抗抑郁药的选择，与改善护理质量和抑郁的结果相比，密集的公共卫生产妇支持服务（MSS-Plus）。MethodsA随机多地点对照试验，盲法结果评估进行了西雅图国王县公共卫生系统。从2010年1月至2012年7月，招募了符合可能的重度抑郁症和/或心境恶劣标准、讲英语、能打电话且18岁的孕妇。主要结果是抑郁症的严重程度在3-，6-，12-，18个月的基线后评估;次要结果包括功能改善，创伤后应激障碍的严重程度，抑郁症的反应和缓解，和抑郁症的质量care.ResultsAll参与者的医疗补助和27岁的平均水平; 58%是非白人; 71%未婚;和65%可能有创伤后应激障碍。从出生前到基线后18个月，MOMCare（n = 83）与MSS+参与者（n = 85）相比，抑郁严重程度显著降低（Wald（2）= 6.09，df = 1，P = .01）和PTSD严重程度（Wald（2）= 4.61，df = 1，P = .04），抑郁缓解率较高（Wald’s（2）= 3.67，df = 1，P = .05），并且接受4次心理健康访问的可能性更大（Wald’s（2）= 58.23，df = 1，P < .0001）和前一个月坚持服用抗抑郁药（Wald’s（2）= 10.00，df = 1，P <0.01）.结论与MSS-Plus相比，MOMCare在护理质量、抑郁严重程度以及社会经济弱势妇女从出生前到基线后18个月的缓解率。研究结果表明，循证围产期抑郁症护理可以整合到一个县的公共卫生系统在美国的服务。临床试验注册：ClinicalTrials.govNCT01045655。(C)2015 Wiley Periodicals，Inc.
BackgroundBoth antenatal and postpartum depression have adverse, lasting effects on maternal and child well-being. Socioeconomically disadvantaged women are at increased risk for perinatal depression and have experienced difficulty accessing evidence-based depression care. The authors evaluated whether MOMCare,a culturally relevant, collaborative care intervention, providing a choice of brief interpersonal psychotherapy and/or antidepressants, is associated with improved quality of care and depressive outcomes compared to intensive public health Maternity Support Services (MSS-Plus).MethodsA randomized multisite controlled trial with blinded outcome assessment was conducted in the Seattle-King County Public Health System. From January 2010 to July 2012, pregnant women were recruited who met criteria for probable major depression and/or dysthymia, English-speaking, had telephone access, and 18 years old. The primary outcome was depression severity at 3-, 6-, 12-, 18-month postbaseline assessments; secondary outcomes included functional improvement, PTSD severity, depression response and remission, and quality of depression care.ResultsAll participants were on Medicaid and 27 years old on average; 58% were non-White; 71% were unmarried; and 65% had probable PTSD. From before birth to 18 months postbaseline, MOMCare (n = 83) compared to MSS-Plus participants (n = 85) attained significantly lower levels of depression severity (Wald's (2) = 6.09, df = 1, P = .01) and PTSD severity (Wald's (2) = 4.61, df = 1, P = .04), higher rates of depression remission (Wald's (2) = 3.67, df = 1, P = .05), and had a greater likelihood of receiving 4 mental health visits (Wald's (2) = 58.23, df = 1, P < .0001) and of adhering to antidepressants in the prior month (Wald's (2) = 10.00, df = 1, P < .01).ConclusionCompared to MSS-Plus, MOMCare showed significant improvement in quality of care, depression severity, and remission rates from before birth to 18 months postbaseline for socioeconomically disadvantaged women. Findings suggest that evidence-based perinatal depression care can be integrated into the services of a county public health system in the United States.Clinical Trial Registration: ClinicalTrials.govNCT01045655. (C) 2015 Wiley Periodicals, Inc.