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

项目摘要 虽然21%的孕妇经历围产期情绪和焦虑症， 对低收入和少数民族妇女来说，这是沉重的负担。例如，非洲裔美国妇女有更高的风险 心理社会压力（例如，暴露于逆境，种族主义和创伤性生活事件）比白色 妇女此外，非洲裔美国妇女在孕产妇和新生儿不良反应的风险显着较高， 由心理困扰导致的事件，如早产（17%对10%）和低出生体重（13%） vs. 7%）。然而，非洲裔美国妇女是最不可能接受心理健康干预的群体 可以减少这些不同的结果。研究人员、临床医生、 而Patients正在努力通过开发、测试和实施一种新的模型来克服这些障碍： 提高声音，解决抑郁症，有毒的压力和群体产前护理公平（Elevate GC）。 Elevate GC基于小组产前护理，并在其中嵌入了一个创伤知情，循证医学 基于反压迫原则的行为健康干预。本提案的目标是 严格评估Elevate GC的有效性，并确定其可行性、可持续性和障碍 在现实世界的护理环境中实施Elevate GC。这些目标将通过开展一项 比较Elevate GC（n=563）与 个体产前护理（n=282）的孕妇在高风险的抑郁症。本试验将于 圣路易斯地区的八家不同的产前诊所，为早产率高的人群提供服务 （约16%对11%全国）。此外，这些网站服务的妇女中有80%有抑郁症史， 焦虑、创伤或其他心理健康诊断。在本试验中，目标1是确定 Elevate GC减少低收入人群的围产期抑郁症和不良妊娠结局， 主要是非洲裔美国女性。这一目标验证了一个假设，即与接受 个别照顾，那些在Elevate GC将有较低的围产期抑郁症（原发性）和早产的风险较低 新生儿和低出生体重儿（中学）。目标2是确定战略和背景实施 增强Elevate GC实施的因素。实用鲁棒实现和 可持续性模型将用于四个领域中的三个领域（干预设计、受援国、 实施和可持续性）。这个项目是 直接响应RFA-MH-20-400的呼吁，“测试实施战略的有效性， 可持续地提供循证心理健康治疗和服务，以改善心理健康 在美国资源不足的情况下，为服务不足的人口取得的成果”。

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".