INTERPERSONAL PSYCHOTHERAPY FOR POSTPARTUM DEPRESSION

这项拟议的研究将把接受治疗的产后抑郁母亲及其子女的样本和产后非抑郁母亲及其子女的样本的随访期延长约一年。这项研究的目的是：(1)确定成功接受治疗的女性在治疗结束后30个月内抑郁症的复发率，(2)评估成功接受治疗的女性抑郁复发的临床-社会模型，以及(3)比较三组女性(治疗结束时康复的女性，治疗结束时未恢复的女性，以及未经历产后抑郁的女性)在3岁时的儿童适应和母子互动。这项工作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a)妇女与其配偶、子女、家庭和朋友的关系的适应的影响，b)妇女对婴儿的反应，以及c)婴儿的情感表达和情绪调节(上文所述的目的2)。120名产后抑郁妇女的样本被随机分配到立即IPT或延迟IPT(等待名单对照)。治疗包括与私人治疗师进行12至16次治疗(超过12周)。在治疗前、治疗中和治疗后对女性进行了抑郁和社会适应方面的多项评估。在治疗试验之后，所有妇女目前被跟踪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。我们预计，接受人际心理治疗的女性将证明，与处于等待名单控制条件的女性相比，她们的抑郁水平明显较低，社会适应水平较高，并且对婴儿的反应更快。我们还预计，在18个月的随访期内，大约40%到50%的成功治疗的女性将经历抑郁的复发。我们预计，既往的抑郁症和其他精神障碍病史将与抑郁症复发的风险增加相关。这项正在进行的研究的最终目的是评估母亲在儿童生命的前三年的抑郁对他们3岁时适应能力的贡献。最后，我们预计，母亲在他们生命的前3年患有慢性抑郁的儿童在3岁时的适应能力会更差。

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.