A peer-facilitated psychological group intervention for perinatal women living with HIV and depression in Tanzania-Healthy Options: A cluster-randomized controlled trial.
A peer-facilitated psychological group intervention for perinatal women living with HIV and depression in Tanzania-Healthy Options: A cluster-randomized controlled trial.
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DOI：
10.1371/journal.pmed.1004112
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发表时间：
2022-12
期刊：
影响因子：
15.8
通讯作者：
Larson, Elysia
中科院分区：
文献类型：
--
作者：
Kaaya, Sylvia;Siril, Hellen;Fawzi, Mary C. Smith;Aloyce, Zenaice;Araya, Ricardo;Kaale, Anna;Kasmani, Muhummed Nadeem;Komba, Amina;Minja, Anna;Mwimba, Angelina;Ngakongwa, Fileuka;Somba, Magreat;Sudfeld, Christopher R.;Larson, Elysia
与其他妇女相比，携带艾滋病毒的围产期妇女患抑郁症的风险更大；然而，向她们提供的专门心理健康服务有限。我们的目标是确定由训练有素的业馀人员提供的阶梯式护理干预是否可以改善产后妊娠黄体生成素患者的心理健康结果。Healthy Options是一项整群随机对照研究，在16家政府管理的产前护理诊所进行，为坦桑尼亚城市的孕妇提供艾滋病毒护理。招聘于2015年5月至2016年4月进行，最后一轮数据收集于2017年10月完成。参与者包括连续抽样的怀孕30周以下、感染艾滋病毒和抑郁症并前往研究诊所就诊的孕妇。对照地点接受了增强的抑郁症日常护理(EUDC)。干预地点接受EUDC和健康选项干预，包括产前小组会议的问题解决治疗(PST)加上认知行为治疗(CBT)的个人在产后6周表现出抑郁症状。我们使用患者健康问卷-9(PHQ-9)评估了与严重抑郁障碍(MDD)相似的抑郁症状，并在产后9个月和6周进行了局部验证。主要时点为产后9个月。我们使用意向治疗分析和完全病例方法检查了结果的差异，这意味着那些在相关时间点有数据的人被包括在分析中。我们使用了广义估计方程来考虑聚类。在使用PHQ-9进行筛查的818名妇女中，742名被确定为合格并被纳入(395名干预；347名对照)；649名妇女(87.5%)参与了第一次随访，641名妇女(86.4%)参加了第二次随访。在干预组中，大多数女性(270，74.6%)参加了5次或5次以上的PST治疗。参加健康方案的妇女在产后6周出现抑郁症状的可能性比参加健康方案的妇女低67%(RR0.33；95%CI：0.22，0.51；p值：<；0.001；对应绝对风险差异25.7%)。在产后9个月，选择健康方案的妇女出现抑郁症状的可能性比对照组妇女低26%(RR0.74；95%CI：0.42，1.3；p值：0.281；对应的绝对风险差异3.2%)。研究的局限性包括不使用诊断性访谈来衡量抑郁症，以及在随访期间不会使数据收集者对干预状态视而不见。健康选项干预没有显示产后9个月抑郁症状的减少，这是主要结果。在产后6周，抑郁症状显著减少，这是次要结果。分步护理干预可能与改善产后早期关键窗口的预后有关。临床试验注册号(不对新参与者开放)NCT02039973 Elysia Larson和他的同事报告了来自坦桑尼亚的一项整群随机试验的结果，该试验调查了同行促进的心理干预对患有艾滋病毒和抑郁症的围产期妇女的影响。妊娠期和产后期的抑郁症很常见，特别是在感染艾滋病毒的妇女中。在许多资源有限的地区，专门的精神卫生服务供应不足。需要有效的非专业卫生工作者促进的心理干预模式来填补护理缺口。在坦桑尼亚市区16家政府管理的卫生诊所进行了一项整群随机对照试验，以检查社区卫生工作者(CBHW)领导的团体干预对产后抑郁症状的影响。阶梯式护理干预包括在怀孕期间向所有登记的参与者提供问题解决治疗(PST)，以及向产后仍有抑郁症状的参与者提供认知行为治疗(CBT)。产后9个月，与强化对照组相比，干预组的抑郁症状没有明显减少。与对照组相比，干预组在产后6周出现抑郁症状的可能性降低了67%。这里测试的阶梯式护理模式在产后9个月时对减轻抑郁症状没有效果，但在产后6周时有效。需要探索产后的其他干预措施，从长远来看，显著减少携带艾滋病毒的孕妇的抑郁症状。
Perinatal women living with HIV (PWLH) have a greater risk of depression compared to other women; however, there are limited specialized mental health services available to them. We aimed to determine whether a stepped-care intervention facilitated by trained lay providers can improve mental health outcomes postpartum for PWLH. Healthy Options is a cluster-randomized controlled study conducted in 16 government-managed antenatal care clinics that provided HIV care for pregnant women in urban Tanzania. Recruitment occurred from May 2015 through April 2016, with the final round of data collection completed in October 2017. Participants included a consecutive sample of pregnant women under 30 weeks of gestation, living with HIV and depression, and attending the study clinics. Control sites received enhanced usual care for depression (EUDC). Intervention sites received EUDC plus the Healthy Options intervention, which includes prenatal group sessions of problem-solving therapy (PST) plus cognitive behavioral therapy (CBT) sessions for individuals showing depressive symptoms at 6 weeks postdelivery. We assessed depressive symptoms comparable to major depressive disorder (MDD) using the Patient Health Questionnaire-9 (PHQ-9) with a locally validated cutoff at 9 months and 6 weeks postpartum. The primary time point is 9 months postpartum. We examined differences in outcomes using an intent-to-treat analysis with a complete case approach, meaning those with data at the relevant time point were included in the analysis. We used generalized estimating equations accounting for clustering. Of 818 women screened using the PHQ-9, 742 were determined eligible and enrolled (395 intervention; 347 control); 649 women (87.5%) participated in the first follow-up and 641 women (86.4%) in the second. A majority (270, 74.6%) of women in the intervention arm attended 5 or more PST sessions. Women enrolled in Healthy Options demonstrated a 67% (RR 0.33; 95% CI: 0.22, 0.51; p-value: <0.001; corresponding to a 25.7% difference in absolute risk) lower likelihood of depressive symptoms than women in control clusters at 6 weeks postpartum. At 9 months postpartum, women enrolled in Healthy Options demonstrated a nonsignificant 26% (RR 0.74; 95% CI: 0.42, 1.3; p-value: 0.281; corresponding to a 3.2% difference in absolute risk) lower likelihood of depressive symptoms than women in control clusters. Study limitations include not using diagnostic interviews to measure depression and not blinding data collectors to intervention status during follow-up. The Healthy Options intervention did not demonstrate reduction in depressive symptoms at 9 months postpartum, the primary outcome. Significant reductions were seen in depression symptoms at 6 weeks postpartum, the secondary outcome. Stepped-care interventions may be relevant for improving outcomes in the critical early postpartum window. Clinical Trial registration number (closed to new participants) NCT02039973 Elysia Larson and colleagues report the results of a cluster-randomized trial from Tanzania which investigates the impact of a peer-facilitated psychological intervention for perinatal women living with HIV and depression. Depression during the pregnancy and postpartum periods is common, particularly among women living with HIV. In many resource-limited areas, availability of specialized mental health services is inadequate. Models of effective lay health worker-facilitated psychological interventions are needed to fill the care gap. A cluster-randomized controlled trial was conducted in 16 government-managed health clinics in urban Tanzania to examine the impact of a community-based health worker (CBHW)-led group intervention on symptoms of depression in the postpartum period. The stepped-care intervention included problem-solving therapy (PST) provided to all enrolled participants during pregnancy plus cognitive behavioral therapy (CBT) provided to participants who still showed symptoms of depression postpartum. At 9 months postpartum, the intervention group did not have a significant reduction in depressive symptoms compared to the enhanced control group. There was a 67% reduction in the likelihood of symptoms of depression at 6 weeks postpartum in the intervention group compared to the control group. The stepped-care model tested here was not effective in reducing symptoms of depression at 9 months postpartum, but was at 6 weeks postpartum. Additional interventions in the postpartum period need to be explored to significantly reduce symptoms of depression among pregnant women living with HIV in the longer term.
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DOI：
10.1097/00001648-199001000-00010
发表时间：
1990-01-01
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Rothman, K J
通讯作者：
Rothman, K J
影响因子：
3.7
作者：
Rotheram-Borus MJ;Richter LM;van Heerden A;van Rooyen H;Tomlinson M;Harwood JM;Comulada WS;Stein A
通讯作者：
Stein A
影响因子：
4.9
作者：
Corless, Inge B.;Wantland, Dean;Holzemer, William L.
通讯作者：
Holzemer, William L.
影响因子：
3.7
作者：
Rathod, Sujit D.;De Silva, Mary J.;Lund, Crick
通讯作者：
Lund, Crick
影响因子：
8.1
作者：
Fawzi, Mary C. Smith;Andrews, Kathryn G.;Fawzi, Wafaie W.
通讯作者：
Fawzi, Wafaie W.