Preventing maternal mental health disorders in the context of poverty: pilot efficacy of a dyadic intervention.
Preventing maternal mental health disorders in the context of poverty: pilot efficacy of a dyadic intervention.
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DOI：
10.1016/j.ajogmf.2020.100230
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发表时间：
2020-11
影响因子：
6.3
通讯作者：
Werner E
中科院分区：
文献类型：
--
作者：
Scorza P;Monk C;Lee S;Feng T;Berry OO;Werner E
美国预防服务工作组建议临床医生为围产期抑郁症风险较高的孕妇和产后妇女提供或转介咨询干预措施。然而，这一预防目标需要有效的干预措施，以帮助处于抑郁症风险中（但在抑郁症发生之前）的女性。我们描述了一项预防常见孕产妇心理健康障碍 (MMHD) 的新型二元干预措施的试点功效试验，有效产后育儿实用资源 (PREPP)，在基于贫困状况的 MMHD 风险女性样本中进行。我们假设 PREPP 与常规强化治疗 (ETAU) 相比会减少出生后 MMHD 症状。从哥伦比亚大学医学中心产科诊所招募的 60 名孕妇被随机分配接受 PREPP (n=30) 或 ETAU (n=30) 干预。采用爱丁堡产后抑郁量表、汉密尔顿抑郁量表、汉密尔顿焦虑量表和患者健康问卷来比较产后6周、10周和16周时的产妇情绪。产后 6 周时，随机接受 PREPP 的女性平均爱丁堡产后抑郁评分较低 (p=.018)、平均汉密尔顿抑郁评分较低 (p<.001) 和平均汉密尔顿焦虑评分 (p=.041)，但不同治疗组的产后精神障碍发生率没有差异。 PREPP 是一种集成在产科护理中的干预措施，可在产后早期的关键时刻改善高危二人组的亚临床症状，但我们的研究并未发现产后精神障碍的发生率有所降低。一项简短的、以二元为重点的围产期心理治疗干预措施，有效产后育儿实用资源 (PREPP)，减少了低收入城市女性产后 6 周的亚临床抑郁和焦虑症状。
The US Preventive Services Task Force recommends that clinicians provide or refer pregnant and postpartum women who are at increased risk of perinatal depression to counseling interventions. However, this prevention goal requires effective interventions that reach women at risk for, but prior to, the development of a depressive disorder. We describe a pilot efficacy trial of a novel dyadic intervention to prevent common Maternal Mental Health Disorders (MMHDs), Practical Resources for Effective Postpartum Parenting (PREPP), in a sample of women at risk for MMHDs based on poverty status. We hypothesized that PREPP compared to enhanced treatment as usual (ETAU) would reduce MMHD symptoms after birth. Sixty pregnant women recruited from obstetric practices at Columbia University Medical Center were randomized to the PREPP (n=30) or ETAU (n=30) intervention. The Edinburgh Postnatal Depression Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Patient Health Questionnaire were used to compare maternal mood at 6 weeks, 10 weeks, and 16 weeks postpartum. At 6 weeks postpartum, women randomized to PREPP had lower mean Edinburgh Postnatal Depression scores (p=.018), lower mean Hamilton Depression scores (p<.001), and lower mean Hamilton Anxiety scores (p=.041), however incidence of postpartum mental disorders did not differ by treatment group. PREPP, an intervention integrated within obstetric care, improves sub-clinical symptomology for at-risk dyads at a crucial time in the early postpartum period, yet our study did not detect reductions in incidence of post-partum mental disorders. A brief, dyadic-focused, perinatal psychotherapy intervention, Practical Resources for Effective Postpartum Parenting (PREPP), reduced sub-clinical depression and anxiety symptoms at 6-weeks postpartum in low-income urban women.
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