Elevating Voices, Addressing Depression, Toxic Stress and Equity in Group Prenatal Care (EleVATE GC)

项目摘要 尽管21%的孕妇经历过围产期情绪和焦虑症，但这种负担尤其 对于低收入和少数族裔女性来说，这一比例很高。例如，非裔美国女性患癌症的风险更高。 心理社会压力(例如，暴露在逆境、种族主义和创伤性生活事件中)贯穿一生，而不是白人 女人。此外，非裔美国妇女患母亲和新生儿不良反应的风险要高得多。 由心理困扰引起的事件，如早产(17%对10%)和低出生体重(13% 与7%相比)。然而，非裔美国女性是最不可能接受心理健康干预的群体 这可能会减少这些截然不同的结果。研究人员、临床医生、 Patients正在努力通过开发、测试和实施一种新的模式来克服这些障碍： 提升声音，解决抑郁、有毒压力和集体产前护理中的平等(提升GC)。 Elevate GC以集体产前护理为基础，并嵌入了创伤信息、基于证据的 基于反压迫原则的行为健康干预。这项建议的目标是 严格评估提升GC的有效性，并确定其可行性、可持续性和障碍 在实际护理环境中实施Elevate GC。这些目标将通过开展一项 实用有效性-实施随机对照试验比较Elevate GC(n=563)与 为抑郁高危孕妇提供个人产前护理(n=282)。这场审判将在 圣路易斯地区八家不同的产前诊所，为早产率较高的人群提供服务 (约16%，而全国为11%)。此外，这些网站服务的女性中有80%有抑郁症病史， 焦虑、创伤或其他精神健康诊断。在这项试验中，目标1是确定 在低收入人群中提高GC以减少围产期抑郁和不良妊娠结局， 主要是非洲裔美国女性。这一目的验证了这样的假设，与女性接受 个体护理，GC升高的人围产期抑郁(原发)较低，早产风险较低 出生和低出生体重儿(次要)。目标2是确定战略和背景实施 促进实施提升GC的因素。适应实际的稳健执行和 可持续性模型将用于四个领域中的三个领域(干预设计、接受者、 实施和可持续性)在三个层面(产前保健诊所、临床医生和患者)。这个项目是 直接响应RFA-MH-20-400的号召，“测试执行和 可持续地提供循证心理健康治疗和服务，以改善心理健康 在美国，在资源匮乏的情况下，服务不足人口的结果“。

Project Summary Although 21% of pregnant women experience perinatal mood and anxiety disorders, the burden is especially heavy for low-income and minority women. For example, African-American women have a higher risk of psychosocial stress (e.g., exposure to adversity, racism, and traumatic life events) throughout life than white women. Moreover, African-American women are at significantly higher risk for maternal and neonatal adverse events resulting from psychological distress, such as preterm birth (17% vs. 10%) and low birthweight (13% vs. 7%). However, African-American women are the least likely group to receive mental health interventions that could reduce these disparate outcomes. A cross-system collaboration between researchers, clinicians, and patients is working to overcome these barriers by developing, testing, and implementing a novel model: Elevating Voices, Addressing Depression, Toxic Stress and Equity in Group Prenatal Care (EleVATE GC). EleVATE GC is based on group prenatal care and has embedded within it a trauma-informed, evidence-based behavioral health intervention grounded in anti-oppressive principles. The objectives of this proposal are to rigorously assess the effectiveness of EleVATE GC and to determine the feasibility, sustainability, and barriers to implementing EleVATE GC in real-world care settings. These objectives will be achieved by conducting a pragmatic effectiveness-implementation randomized controlled trial comparing EleVATE GC (n=563) to individual prenatal care (n=282) for pregnant women at high risk for depression. This trial will be conducted at eight diverse prenatal clinics in the St. Louis region that serve a population with a high preterm birth rate (~16% vs. 11% nationally). Additionally, 80% of women served by these sites have a history of depression, anxiety, trauma, or another mental health diagnosis. Within this trial, Aim 1 is to determine the effectiveness of EleVATE GC to reduce perinatal depression and adverse pregnancy outcomes among low-income, predominantly African-American women. This aim tests the hypothesis that, compared to women receiving individual care, those in EleVATE GC will have lower perinatal depression (primary) and lower risk of preterm birth and low birthweight infants (secondary). Aim 2 is to identify strategies and contextual implementation factors to enhance implementation of EleVATE GC. An adaptation of the Practical Robust Implementation and Sustainability Model will be used across three of the four domains (intervention design, recipient, implementation and sustainability) at three levels (prenatal care clinic, clinician, and patient). This project is directly responsive to the call of RFA-MH-20-400 to "test the effectiveness of strategies for implementation and sustainable delivery of evidence-based mental health treatments and services to improve mental health outcomes for underserved populations in under-resourced settings in the United States".