A Dyadic Approach to Perinatal Depression Treatment in Primary Care

项目摘要 10%到20%的妇女在围产期(怀孕到产后一年)有抑郁症， 特别是低收入种族/少数民族妇女，但许多人得不到适当的心理健康 治疗。父母教养自我效能感低和母婴互动受损是健康相关的原因 负担和消极的孕产妇和儿童结果。然而，这些育儿问题在当前并没有得到解决 以初级保健为基础的围产期抑郁症治疗。我们的团队已经开发，以用户为中心的设计 技巧，这是基于证据的促进首次关系(PFR)育儿干预的简短版本： PFR-B。我们现在建议测试一种全面的围产期抑郁症治疗方法--母婴和二元 护理(意识)-包括围产期协作护理的PFR-Brief，一种基于证据的干预措施 围产期抑郁症。Mind将响应初级保健环境中妇女的需求，在这些环境中， 未得到充分服务的妇女获得产前护理。通过关注产后恶化的重要调节因素 抑郁(父母教养自我效能感降低和母婴互动受损)，心智有潜力 以改善母亲的结果，并从长远来看，改善儿童的结果。我们项目的具体目标是：目标1至 在随机对照试验中比较Mind和通常的CC，以评估抑郁的结果。中国60名患有抑郁症的女性 怀孕将被随机分配到Mind或通常的CC。我们假设患者随机分成两组 在抑郁方面会有明显的改善(以爱丁堡产后评估 在产后3个月和6个月时)与通常的CC进行比较，并将患者随机 根据Sheehan残疾等级和Barkin指数的测量，To Mind的功能将显著改善 产妇功能与接受常规CC治疗的患者进行比较。目标2：探索两者之间的联系 父母教养自我效能感、二元互动和抑郁形成中介假设。我们假设 在随机选择的女性中，育儿自我效能感会更高，二元互动会得到改善 意念治疗后，将调解患者之间的抑郁结果的差异随机到 头脑和惯常的抄送。目标3：检验心智的相对利用率与通常的CC，进行心理测试的可行性 试验、评估负担和感知的治疗与患者需求的匹配。我们将使用混合方法 策略使用工作联盟清单和深入的患者访谈来比较Mind和通常的CC。 我们假设随机分组的患者将有更高的治疗利用率，通过 参加至少3次产前和产后CM会议。我们将探索研究问题：如何 随机入组患者的治疗经验是否与精神分裂症患者的治疗经验相比较？ 患者随机分为常规CC组？在这个项目结束时，我们的多学科和互补团队将 准备进行R01资助的更大规模的混合I型有效性-实施RCT，以研究 思想的有效性，并为实施做好准备。

Project Summary Ten to 20% of women have depression in the perinatal period (pregnancy through one year postpartum), especially low income racial /ethnic minority women, yet many do not receive appropriate mental health treatment. Low parenting self-efficacy and impaired mother - infant interactions contribute to health-related burden and negative maternal and child outcomes. Yet these parenting issues are not addressed in current primary care-based perinatal depression treatments. Our team has developed, with user centered design techniques, a brief version of the evidence based Promoting First Relationships (PFR) parenting intervention: PFR-B. We now propose to test a comprehensive perinatal depression treatment - Maternal Infant and Dyadic Care (MInD) - that includes PFR-Brief in perinatal collaborative care, an evidence based intervention for perinatal depression. MInD will be responsive to the needs of women in primary care settings where most underserved women obtain prenatal care. By focusing on important mediators of worsened postpartum depression (decreased parenting self-efficacy and impaired mother-infant interaction), MInD has the potential to improve maternal outcomes, and in the long run, child outcomes. Our project specific aims are: Aim 1 To compare MInD vs. usual CC in a RCT to assess depression outcomes. Sixty women with depression in pregnancy will be randomly assigned to MInD or usual CC. We hypothesize that patients randomized to MInD will experience significantly better improvement in depression (measured by the Edinburgh Postpartum Depression Scale) at 3 months and 6 months postpartum compared to usual CC and that patients randomized to MInD will have significantly better functioning as measured by Sheehan Disability Scale and Barkin Index of Maternal Functioning compared to patients receiving usual CC. Aim 2: To explore the association between parenting self-efficacy, dyadic interaction and depression to inform a mediational hypothesis. We hypothesize that parenting self-efficacy will be greater and dyadic interaction will be improved in women randomized to MInD post treatment and will mediate differences in depression outcomes between patients randomized to MInD and usual CC. Aim 3: To examine relative utilization of MInD vs usual CC, feasibility of conducting the trial, assessment burden and perceived match of treatment to patient need. We will use a mixed methods strategy using the Working Alliance Inventory and in-depth patient interviews to compare MInD and usual CC. We hypothesize that patients randomized to MInD will have higher utilization of treatment as measured by attendance at least 3 antenatal and 3 postpartum CM sessions. We will explore the research question: How do the treatment experiences of patients randomized to MInD compare with the treatment experiences of patients randomized to usual CC? At the end of this project our multidisciplinary and complementary team will be poised to conduct an R01 funded, larger Hybrid Type I effectiveness-implementation RCT to study the effectiveness of MInD and prepare for implementation.