mHealth Mindfulness Intervention for Pregnant Black and Latina Women at Risk of Postpartum Depression
针对有产后抑郁症风险的黑人和拉丁裔孕妇的移动健康正念干预
基本信息
- 批准号:10434908
- 负责人:
- 金额:$ 112.04万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2021
- 资助国家:美国
- 起止时间:2021-07-01 至 2024-06-30
- 项目状态:已结题
- 来源:
- 关键词:AddressAdherenceAdvisory CommitteesAffectAnxietyAttentionBlack PopulationsBlack raceCOVID-19 pandemicCOVID-19 pandemic effectsCaliforniaCause of DeathChildClinicControl GroupsCounselingDataDevicesDiagnosisDiscipline of obstetricsEconomic BurdenEffectivenessEffectiveness of InterventionsElectronic Health RecordEnrollmentEthnic OriginEvidence based interventionGoldHealthHealthcare SystemsHourInstructionIntegrated Delivery of Health CareInterventionLatinaLatina PopulationMediatingMental DepressionMental HealthMental Health ServicesMonitorMothersOutcomePatient Outcomes AssessmentsPatientsPersonal SatisfactionPersonsPilot ProjectsPopulationPopulation HeterogeneityPostpartum DepressionPostpartum PeriodPostpartum WomenPregnant WomenPreventionPreventive serviceProviderQuestionnairesRaceRandomizedReach Effectiveness Adoption Implementation and MaintenanceRecommendationRelapseResourcesRiskRoleServicesSleepSleep disturbancesStressSuicideSystemTimeVulnerable PopulationsWomanWomen&aposs Healthactive controlanxiety symptomsarmbaseblack womencare deliverycoronavirus diseasecostdepressive symptomsdigitaldigital interventiondosageeffective interventioneffective therapyeffectiveness evaluationeffectiveness implementation studyeffectiveness testingevidence baseexperiencehigh riskimplementation evaluationimplementation facilitatorsimplementation interventionimprovedmHealthmindfulnessmindfulness interventionpandemic diseaseperipartum depressionpost interventionpregnantpressurepreventprimary outcomeprogramspublic health relevanceracial and ethnic disparitiesreduce symptomsresponseroutine carescreening programsecondary outcomeskillsstress symptomsystem-level barrierstheoriestreatment arm
项目摘要
ABSTRACT
Postpartum depression (PPD) is a debilitating and costly condition affecting over 20% of postpartum women
and disproportionately impacts Blacks and Latinas. The COVID-19 pandemic is leading to a severe increase in
the rate of depression while the US is already struggling with deep-seated inequities in mental health care for
Black and Latina populations. The US Preventive Services Task Force recently recommended that women at
increased risk of PPD should be referred for counseling to reduce the risk of PPD. However, numerous patient-
level (e.g. lack of time or money) and system-level barriers (e.g. shortage of providers), now compounded with
the COVID-19 pandemic, pose challenges to the receipt of counseling, particularly among Black and Latina
populations that already experienced a lower rate of treatment initiation. There is an urgent need for evidence-
based accessible and scalable mental health care options for these high-risk and vulnerable women.
Mindfulness-Based Interventions (MBIs) are effective and theory-driven interventions for reducing depression
symptoms. However, standard MBIs require 30+ hours of in-person or online sessions for 8 weeks and are
often too intense for pregnant women with high depression symptom burden. Our pilot study of a self-paced,
small dosage (10-20 minutes/day for 6 weeks), mobile-based (mHealth) MBI for pregnant women with high
depression symptoms demonstrated promising feasibility and preliminary efficacy results in reducing
depression symptoms providing support for a fully-powered trial. We will conduct a hybrid effectiveness-
implementation study to test the effectiveness of the mHealth MBI to reduce postpartum depression symptoms
in Black and Latina pregnant women at increased risk of PPD, and examine barriers and facilitators of
implementation within a large healthcare system. The study will take place at Kaiser Permanente Northern
California (KPNC), an integrated health care delivery system with a diverse population and comprehensive
electronic health records. KPNC’s universal perinatal depression screening program will be leveraged to
efficiently identify eligible women. We will randomize 600 pregnant (300 Latina and 300 Black) women into the
intervention arm or time- and attention-matched control arm and ask them to practice mindfulness or another
program for 6 weeks, 10-20 minutes a day. We will partner with HeadspaceTM and tailor the digital platform to
deliver the mindfulness program and obtain adherence data. Patient-reported outcomes of depression (primary
outcome), anxiety, stress and sleep (secondary outcomes), and attention monitoring and acceptance (target
engagements) will be collected 3 times during the study (baseline, post intervention, and 4 weeks postpartum).
Implementation of the intervention will be evaluated using the RE-AIM framework (Reach, Effectiveness,
Adoption, Implementation and Maintenance). Further, using the results of this trial, we will determine optimal
dosage and tailor the digital intervention. Findings from the implementation evaluation will be highly applicable
to systems that are planning to incorporate self-paced mHealth mindfulness interventions.
摘要
产后抑郁症(PPD)是一种使人衰弱和昂贵的条件影响超过20%的产后妇女
对黑人和拉丁裔的影响也不成比例2019冠状病毒病大流行导致
抑郁症的发病率,而美国已经在精神卫生保健方面与根深蒂固的不平等作斗争,
黑人和拉丁裔。美国预防服务工作组最近建议,
PPD的风险增加应咨询,以减少PPD的风险。然而,许多患者-
在这方面,存在着两个层面的障碍(例如,缺乏时间或资金)和系统层面的障碍(例如,缺乏提供者),
COVID-19大流行对接受咨询提出了挑战,特别是在黑人和拉丁裔中
已经经历了较低的治疗开始率的人群。我们急需证据-
为这些高风险和弱势妇女提供可获得和可扩展的心理保健选择。
基于正念的干预(MBIs)是有效的和理论驱动的干预措施,以减少抑郁症
症状然而,标准的MBIs需要30多个小时的面对面或在线课程,为期8周,
对于抑郁症状负担高的孕妇来说往往过于强烈。我们的试点研究,
小剂量(10-20分钟/天,持续6周),基于移动(mHealth)的MBI,适用于孕妇,
抑郁症状表现出有希望的可行性和初步的疗效结果,减少
抑郁症状为全面试验提供支持。我们将进行混合式有效性-
实施研究,以测试mHealth MBI减少产后抑郁症状的有效性
在黑人和拉丁裔孕妇的PPD风险增加,并检查的障碍和促进因素,
在大型医疗保健系统中实施。该研究将在Kaiser Permanente北方进行
加州(KPNC),一个综合性的医疗保健提供系统,人口多样化,
电子健康记录。KPNC的普遍围产期抑郁症筛查计划将被利用,
有效识别合格女性。我们将600名孕妇(300名拉丁裔和300名黑人)随机分配至
干预臂或时间和注意力匹配控制臂,并要求他们练习正念或其他
6周,每天10-20分钟。我们将与HeadspaceTM合作,定制数字平台,
提供正念课程并获得依从性数据。患者报告的抑郁症结局(原发性
结果),焦虑,压力和睡眠(次要结果),以及注意力监测和接受(目标
在研究期间(基线、干预后和产后4周)将收集3次。
将使用RE-AIM框架(覆盖范围、有效性、
采用、实施和维护)。此外,使用本试验的结果,我们将确定最佳的
剂量和量身定制数字干预。执行情况评价的结果将具有高度适用性
到计划纳入自定进度的mHealth正念干预的系统。
项目成果
期刊论文数量(0)
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会议论文数量(0)
专利数量(0)
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Lyndsay Ammon Avalos其他文献
Lyndsay Ammon Avalos的其他文献
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{{ truncateString('Lyndsay Ammon Avalos', 18)}}的其他基金
Preconception and Prenatal Health Impacting Factors and Child Health
孕前和产前健康影响因素和儿童健康
- 批准号:
10746579 - 财政年份:2023
- 资助金额:
$ 112.04万 - 项目类别:
Long term adverse health outcomes for women and children following SARS-CoV-2 infection during pregnancy
怀孕期间感染 SARS-CoV-2 后妇女和儿童的长期不良健康后果
- 批准号:
10728195 - 财政年份:2023
- 资助金额:
$ 112.04万 - 项目类别:
mHealth Mindfulness Intervention for Pregnant Black and Latina Women at Risk of Postpartum Depression
针对有产后抑郁症风险的黑人和拉丁裔孕妇的移动健康正念干预
- 批准号:
10683084 - 财政年份:2021
- 资助金额:
$ 112.04万 - 项目类别:
mHealth Mindfulness Intervention for Pregnant Black and Latina Women at Risk of Postpartum Depression
针对有产后抑郁症风险的黑人和拉丁裔孕妇的移动健康正念干预
- 批准号:
10244836 - 财政年份:2021
- 资助金额:
$ 112.04万 - 项目类别:
Comparing the Effects of Prenatal Depression and its Treatment on Developmental Outcomes of the Offspring
比较产前抑郁症及其治疗对后代发育结果的影响
- 批准号:
10703372 - 财政年份:2020
- 资助金额:
$ 112.04万 - 项目类别:
Comparing the Effects of Prenatal Depression and its Treatment on Developmental Outcomes of the Offspring
比较产前抑郁症及其治疗对后代发育结果的影响
- 批准号:
10120323 - 财政年份:2020
- 资助金额:
$ 112.04万 - 项目类别:
Impact of in utero Marijuana Exposure on Neurodevelopment, Behavior and Mental Health: A Longitudinal Birth Cohort Study
子宫内大麻暴露对神经发育、行为和心理健康的影响:纵向出生队列研究
- 批准号:
10396071 - 财政年份:2020
- 资助金额:
$ 112.04万 - 项目类别:
Comparing the Effects of Prenatal Depression and its Treatment on Developmental Outcomes of the Offspring
比较产前抑郁症及其治疗对后代发育结果的影响
- 批准号:
10471288 - 财政年份:2020
- 资助金额:
$ 112.04万 - 项目类别:
Impact of in utero Marijuana Exposure on Neurodevelopment, Behavior and Mental Health: A Longitudinal Birth Cohort Study
子宫内大麻暴露对神经发育、行为和心理健康的影响:纵向出生队列研究
- 批准号:
10206084 - 财政年份:2020
- 资助金额:
$ 112.04万 - 项目类别:
Comparing the Effects of Prenatal Depression and its Treatment on Developmental Outcomes of the Offspring
比较产前抑郁症及其治疗对后代发育结果的影响
- 批准号:
10271274 - 财政年份:2020
- 资助金额:
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