INTERPERSONAL PSYCHOTHERAPY FOR POSTPARTUM DEPRESSION

拟议的研究将延长对产后抑郁症母亲和她们的孩子的随访时间，对产后非抑郁症母亲和她们的孩子的随访时间大约延长一年。本研究的目的是：(1)确定治疗成功的妇女在治疗结束后30个月内抑郁症复发率；(2)评估治疗成功的妇女抑郁症复发的临床-社会模型；(3)比较三组妇女（治疗结束时康复的妇女、治疗结束时未康复的妇女和未经历产后抑郁症的妇女）在3岁时的儿童适应和母子互动。本研究建立在正在进行的研究的基础上，其目的是：(1)评估人际心理治疗（IPT）作为产后抑郁症的治疗方法；(2)评估IPT对以下方面的影响：a)女性对配偶、子女、家庭和朋友关系的调整，b)女性对婴儿的反应，以及c)婴儿的情感表达和情绪调节（上述目的2）。120名产后抑郁症妇女的样本被随机分配到立即或延迟（等待名单控制）IPT。治疗包括与私人治疗师进行12至16次疗程（超过12周）。对妇女在治疗前、治疗期间和治疗后进行了评估，并采取了几种抑郁和社会适应措施。在治疗试验后，所有女性目前都被随访了18个月，每3个月进行一次抑郁和社会适应评估。对儿童的评估将在治疗前、治疗后以及大约2岁和3岁时进行。我们期望接受人际关系心理治疗的妇女比等候名单控制组的妇女表现出明显更低的抑郁水平，更高的社会适应水平，并且对婴儿的反应更积极。我们还预计，在18个月的随访期间，大约有40%到50%的成功治疗的女性会经历抑郁症复发。我们预计抑郁症和其他精神疾病的既往史将与抑郁症复发的风险增加有关。本研究的最终目的是评估母亲在儿童生命的前3年的抑郁对他们3岁时的适应的贡献。最后，我们预计母亲在3岁前患有慢性抑郁症的孩子在3岁时的适应能力会较差。

The proposed research will extend the period of follow-up of a sample of treated postpartum depressed mothers and their children and a sample of postpartum nondepressed mothers and their children by approximately one year. The purposes of this research are: (1) to determine the rate of recurrence of depression in successfully treated women over a 30 month period following the end of treatment, (2) to evaluate a clinical-social model of depression recurrence in successfully treated women, and (3) to compare child adjustment and mother-child interaction at age 3 among three groups of women (women recovered at the end of treatment, women not recovered at the end of treatment, and women who did not experience a postpartum depression). This work builds on the ongoing research whose purposes are: (1) to evaluate interpersonal psychotherapy (IPT) as a treatment for postpartum depression; (2) to evaluate the effect of IPT on a) women's adjustment in their relationships with their spouses, children, families, and friends, b) the women's responsiveness to their infants, and c) the infants' affective expression and emotional regulation (an purpose 2 stated above). A sample of 120 postpartum depressed women has been randomly assigned to immediate or delayed (a waiting list control) IPT. Treatment consisted of 12 to 16 sessions (over 12 weeks) with a private therapist. Assessments of women before, during, and after therapy with several measures of depression and social adjustment were undertaken. After the treatment trial, all women are currently followed for 18 months with assessments of depression and social adjustment occurring every 3 months. Assessments of children will take place at pre-therapy, post-therapy, and about 2 and 3 years of age. We expect that women receiving interpersonal psychotherapy will evidence significantly lower levels of depression, higher levels of social adjustment than women in the waiting list control condition, and be more responsive to their infants. We also expect that approximately 40 percent to 50 percent of successfully treated women will experience a recurrence of their depression during the 18 month follow-up period. We expect that previous history of depression and other psychiatric disorders will be associated with increased risk of depression recurrence. The final purpose of the ongoing research is to evaluate the contribution of maternal depression in the first three years of children's lives to their adjustment at age 3. Finally, we expect that children whose mothers were chronically depressed during their first 3 years of life will show poorer adjustment at 3 years of age.