Improving Preschool Outcomes by Addressing Maternal Depression in Head Start

项目摘要 低收入家庭的孩子面临着无数的社会风险，这些风险会干扰他们的健康发展、行为和 学术成就这些孩子的母亲患抑郁症的几率很高，这本身就与 对儿童的持久影响。2009年，美国国家医学院发表了一份具有里程碑意义的报告， 抑郁症的父母，养育和儿童，其中呼吁以社区为基础的干预措施，以防止 父母抑郁症，并帮助抑郁的父母参与治疗。与本报告一致，我们的 一个研究小组进行了一系列由美国国立卫生研究院资助的研究，旨在减轻母亲的症状 在头开始抑郁症的风险-一个联邦资助的学前教育计划，提供服务约100万 美国低收入家庭。 在本项目中，我们的目标是通过部署一个阶梯式护理， 干预措施，其中为低水平抑郁症状的母亲提供基于以下内容的预防计划： 问题解决教育模式，并为症状更严重的母亲提供参与会议 将他们与正规的心理健康服务机构联系起来。模型的两个组成部分都有很强的随机试验 证据;但它们尚未在协调的干预措施中得到综合和测试，适用于 广泛的人口基础。利用马萨诸塞州的一个研究网络，我们建议 一项关于这种阶梯式护理模式的疗效试验（n=388）。 我们的主要目的是确定该模型在降低“先声夺人”母亲的比率方面的功效。 经历抑郁症状发作;母亲参与心理健康服务的可能性， 转介;父母的功能;和儿童缺勤从头部开始。我们的第二个目标是确定 行动机制，通过改善孕产妇福祉促进儿童的复原力。为此，我们将 评估母亲对压力、家庭冲突和母子互动模式的看法;我们将评估 儿童在情感、人际关系和认知领域的结果。最后，为以后的 我们将在另外20名母亲中进行一项单组试点研究， 将干预交付纳入常规Head Start工作流程的可行性。 我们的建议代表了NICHD的一个高度优先的研究领域，因为它涉及社会和 影响儿童适应行为和入学准备的环境因素。我们的学习计划 增强了先前研究的严谨性，因为它测试了全面抑郁症管理的有效性 模型，因为我们的设计使我们能够研究孕产妇和儿童的结果-以及机制， 把他们联系起来-在一个真正的社区样本中。我们的最终目标是减少心理健康 我们的目标是消除低收入母亲的不平等，并改善她们及其子女的成果。

PROJECT SUMMARY Children of low-income families face myriad social risks that interfere with healthy development, behavior, and academic achievement. Mothers of these children experience a high rate of depression, itself associated with lasting effects on children. In 2009, the National Academy of Medicine published a landmark report, Depression in Parents, Parenting, and Children, in which it called for community-based interventions to prevent parental depression and to help engage depressed parents in treatment. Consistent with this report, our research group has conducted a series of NIH-funded studies aimed at alleviating symptoms among mothers at risk for depression in Head Start – a federally funded preschool program that provides services for ~1 million low-income US families. In the present project, we aim to improve outcomes for Head Start children by deploying a stepped-care intervention, in which mothers with low level depressive symptoms are offered a prevention program based on the Problem Solving Education model, and mothers with greater symptoms are offered Engagement Sessions to link them with formal mental health services. Both components of the model have strong randomized trial evidence; but they have yet to be synthesized and tested within a coordinated intervention, applicable to a broad population base. Harnessing a research network of Head Start centers in Massachusetts, we propose an efficacy trial (n=388) of this stepped-care model. Our primary aim is to determine the model’s efficacy in decreasing the rate at which Head Start mothers experience depressive symptom episodes; mothers’ likelihood of engaging with mental health services when referred; parental functioning; and child absenteeism from Head Start. Our second aim is to determine mechanisms of action by which improved maternal wellbeing promotes child resiliency. To do this, we will assess mothers’ perceptions of stress, family conflict, and mother-child interaction patterns; and we will assess child outcomes in the affective, interpersonal and cognitive domains. Finally, to prepare for a subsequent effectiveness trial, we will conduct a single arm pilot study among 20 additional mothers to assess the feasibility of incorporating intervention delivery into usual Head Start workflow. Our proposal represents a high-priority research area for NICHD because it addresses social and environmental factors that impact children’s adaptive behaviors and school readiness. Our study plan enhances the rigor of prior research because it tests the efficacy of a comprehensive depression management model, and because our design allows us to study both maternal and child outcomes – and the mechanisms that link them – among a true community-based sample. Our ultimate goal is to reduce mental health disparities for low-income mothers and to improve outcomes for them and their children.