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: 10478190
• 负责人: Adam Korrick Lewkowitz
• 金额: $ 18万
• 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/10478190
• 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; Consent; Control Groups; Coping Skills; Data; Depression screen; Development; Diagnosis; Education; Educational Curriculum; Evaluation; Feedback; Focus Groups; Funding; Goals; Group Interviews; Health Insurance; 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; 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; implementation barriers; 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; women of color

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.

产后抑郁的发生率很高：产后抑郁症(PPD)的比率高达25% 在没有产后抑郁或抑郁病史，但有个人或结构性风险因素的女性中， 收入或有色人种女性等等。因此，美国妇产科医生学会 建议对女性进行产后抑郁筛查。然而，产后精神卫生保健方面存在差异：60% 妇女参加产后探视，在那里进行PPD筛查，以及缺乏交通工具或 儿童保育被证明不仅降低了产后就诊率，而且不成比例地减少了 影响低收入妇女或有色人种妇女。此外，产后抑郁的风险超过产后60天， 当与怀孕相关的联邦医疗保险经常到期时。智能手机应用程序(App)可能会增加 通过向大多数妇女提供长期的心理健康治疗，实现产后心理健康的公平。 事实上，在美国，96%的18-29岁的人拥有智能手机，而且已经显示了医疗应用程序 改善产科结局，增加获得精神卫生服务的机会。虽然是面对面的，认知的 通过母婴计划(MB)提供的行为疗法已被证明通过以下方式减少产后抑郁 53%的低收入有色人种女性中，APP提供的MB组的效果尚不清楚。这样做的目的是 以病人为导向的导师职业发展奖(K23)是为了使应聘者能够发展出一个有资金的 通过一项创新的研究计划，优化低收入有色人种妇女的产后心理健康护理 以技术为基础的干预可能会降低他们的产后抑郁发生率。为了实现这一目标，培训和指导- 建议在三个关键领域进行培训：1)混合方法研究、围产期心理学、 数字健康、生物统计学；2)由知名研究人员组成的多学科团队的指导；3) 保护时间，以患者为中心，研究利用APP提供的MB作为研究的可行性 对有产后抑郁危险因素的低收入有色人种妇女进行干预。需要两个研究阶段。第一, 焦点小组和访谈将优化研究干预，其中包括MB和育儿教育 (PE)。干预组访问MB+PE，而对照组访问PE 鼓励应用程序与两个学习小组接触。这是因为两组中的女性都将获得 两个月一次的爱丁堡产后抑郁量表(EPDS)从出生到产后6个月进行评分。这个 建议的随机试验的初步结果证明了基于APP的治疗方案的可行性和可接受性 MB，通过招聘和应用程序使用定义(可行性)，以及系统可用性量表和客户端的得分 满意度问卷(可接受性)。次要结果包括EDPS评分。拟议的审判将 为随后的R01支持的随机试验提供关键洞察力，旨在检查 在低收入、种族和族裔多样化的妇女中，基于应用程序的甲基溴对PPD的影响。如果有效，基于应用程序的MB 具有很大的可伸缩性潜力，可以增加大多数妇女产后心理健康的公平性。