A novel app-based cognitive behavioral therapy intervention for preventing postpartum depression

一种基于应用程序的新型认知行为治疗干预措施，用于预防产后抑郁症

• 批准号: 10300700
• 负责人: Adam Korrick Lewkowitz
• 金额: $ 17.96万
• 依托单位: WOMEN AND INFANTS HOSPITAL-RHODE ISLAND
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10300700
• 关键词: Affect; American College of Obstetricians and Gynecologists; Area; Behavior; Biometry; Birth; Breast Feeding; Breastfed infant; COVID-19; Cellular Phone; Child; Childbirth; Childhood; Client satisfaction; Cognitive; Cognitive Therapy; Color; Consent; Control Groups; Coping Skills; Data; Depression screen; Development; Diagnosis; Education; Educational Curriculum; Evaluation; Feedback; Focus Groups; Funding; Goals; Group Interviews; Health Insurance; Healthcare; High Risk Woman; Impairment; Individual; Infant Care; Internet; Intervention; Intervention Studies; Interview; K-Series Research Career Programs; Low income; Measures; Medical; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentors; Mentorship; Mothers; Outcome Study; Parenting Education; Perinatal; Perinatal Care; Persons; Phase; Physiological; Postpartum Depression; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Prevalence; Prevention; Preventive; Protocols documentation; Psychology; Questionnaires; Randomized; Randomized Controlled Trials; Recommendation; Recording of previous events; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Risk; Risk Factors; Services; Social support; Structure; Symptoms; System; Technology; Testing; Text Messaging; Therapeutic Intervention; Time; Training; Transportation; United States; United States National Institutes of Health; Unmarried; Visit; Woman; acceptability and feasibility; adaptive intervention; aged; antenatal; barrier to care; base; cognitive development; depressive symptoms; design; digital health; efficacy testing; ethnic diversity; experience; falls; feasibility trial; food insecurity; group intervention; health equity; high risk; improved; improved outcome; innovation; innovative technologies; insight; multidisciplinary; novel; obstetric outcomes; patient oriented; patient oriented research; perinatal mental health; pilot trial; postpartum health; prevent; primary outcome; programs; prototype; racial diversity; randomized trial; recruit; screening; screening guidelines; secondary outcome; smartphone Application; telehealth; tool; trial design; usability

The prevalence of depression is high after childbirth: rates of postpartum depression (PPD) are as high as 25% among women without prior PPD or depression but with personal or structural risk factors such as being low- income or a women of color, among others. As such, the American College of Obstetricians and Gynecologists recommends screening women for PPD. However, disparities in postpartum mental health care exist: <60% of women attend post-partum visits where PPD screening occurs, and barriers such as lack of transportation or childcare have been shown to not only reduce rates of postpartum visit attendance but to disproportionately affect low-income women or women of color. In addition, the risk of PPD extends beyond 60 days post-partum, when pregnancy-related federal health insurance often expires. Smartphone applications (apps) may increase equity in postpartum mental health by providing long-term access to mental health treatment to most women. Indeed, in the United States, 96% of those aged 18-29 own a smartphone, and medical apps have been shown to improve obstetric outcomes and increase access to mental health services. Though in-person, cognitive behavioral therapy given through the Mothers and Babies Program (MB) has been shown to reduce PPD by 53% among low-income women of color, the effect of app-provided group MB is unclear. The purpose of this Mentored Patient-Oriented Career Development Award (K23) is to enable the candidate to develop a funded research program to optimize postpartum mental health care for low-income women of color via an innovative technology-based intervention that may decrease their rates of PPD. To achieve this goal, training and mentor- ship are proposed in three key areas: 1) Advanced training in mixed methods research, perinatal psychology, digital health, and biostatistics; 2) Mentorship from a multi-disciplinary team of established researchers; and 3) Protected time to perform patient-oriented research on the feasibility of utilizing app-provided MB as a study intervention for low-income women of color with risk factors for PPD. Two study phases are required. First, focus groups and interviews will optimize the study intervention, which contains MB and parenting education (PE). Those in the intervention group will access MB+PE while those in the control group will access PE to encourage app engagement with both study groups. This is because women in both groups will receive bimonthly Edinburgh Postnatal Depression Scales (EPDS) scores from birth to six months postpartum. The primary outcome of the proposed randomized trial is demonstrated feasibility and acceptability of app-based MB, defined via recruitment and app usage (feasibility), and scores on the System Usability Scale and Client Satisfaction Questionnaire (acceptability). Secondary outcomes include EDPS scores. The proposed trial will provide critical insight into a subsequent R01-supported randomized trial designed to examine the effect of app-based MB on PPD among low-income, racially and ethnically diverse women. If effective, app-based MB has great potential for scalability and could increase postpartum mental health equity for most women.

分娩后抑郁症的患病率很高：产后抑郁症（PPD）高达25％ 在没有事先PPD或抑郁症的女性中，但具有个人或结构性风险因素，例如低 - 收入或有色女性等。因此，美国妇产科医生学院 建议对女性进行PPD筛查。但是，产后精神卫生保健存在差异：<60％ 妇女参加PPD筛查发生的产后访问，以及缺乏交通或 育儿不仅可以降低产后访问率，而且会降低 影响低收入妇女或有色妇女。此外，PPD的风险延长了下方60天以上， 与怀孕有关的联邦健康保险经常到期。智能手机应用程序（应用程序）可能会增加 产后心理健康的公平性通过为大多数女性提供长期获得心理健康治疗的机会。 确实，在美国，18-29岁的人中有96％拥有智能手机，并且已经显示了医疗应用程序 改善产科结果并增加获得心理健康服务的机会。虽然面对面，但认知 通过母亲和婴儿计划（MB）给予的行为疗法已被证明可以减少PPD 在低收入有色妇女中，有53％的人尚不清楚APP提供的MB组的作用。这个目的 受到指导的以患者为导向的职业发展奖（K23）是为了使候选人能够开发一个资助的 研究计划，通过创新来优化低收入有色妇女的产后心理保健 基于技术的干预措施可能会降低其PPD的速度。为了实现这一目标，培训和指导 - 在三个关键领域提出了船：1）混合方法研究中的高级培训，围产期心理学， 数字健康和生物统计学； 2）由成熟研究人员组成的多学科团队的指导； 3） 受保护的时间进行以患者为导向的研究，以利用应用程序提供的MB作为研究的可行性 对有色妇女的干预，PPD的危险因素。需要两个研究阶段。第一的， 焦点小组和访谈将优化研究干预措施，其中包含MB和育儿教育 （PE）。干预组中的人员将访问MB+PE，而对照组中的人员将访问PE 鼓励与两个学习组的应用程序参与。这是因为两组的女性都会收到 两次爱丁堡产后抑郁量表（EPDS）从出生到产后六个月的得分。这 拟议的随机试验的主要结果证明了基于应用程序的可行性和可接受性 MB，通过招聘和应用程序使用（可行性）定义，并在系统可用性量表和客户 满意度问卷（可接受性）。次要结果包括EDPS分数。拟议的审判将 对随后的R01支持的随机试验提供批判性洞察力，旨在检查 在低收入，种族和种族多样的女性中，基于应用程序的MB。如果有效，基于应用程序的MB 具有巨大的可伸缩性潜力，可以增加大多数女性产后心理健康公平。