Depression Prevention in Pregnant AI Teens Using CBT

描述(由申请人提供)：这份R34提案解决了美国最脆弱和最缺乏服务的人群之一-怀孕的、基于保留地的美国印第安人(Al)青少年的需求。主要目的是确定由土著准专业人员提供的认知行为干预的可行性和初步有效性，以减少怀孕期间和产后抑郁症状的水平。青少年怀孕在保留地很常见，人工智能青少年报告抑郁症状水平很高，由于许多心理社会和环境因素，他们患上严重抑郁障碍(MDD)的风险很高。怀孕和产后抑郁与母亲和她的后代的功能严重受损有关。保留地缺乏心理健康服务，特别是针对这一弱势群体，这突出表明有必要采取低成本的早期干预措施，以减少抑郁症状。赠款的前三个月将被指定用于最终确定干预和评估单元，完成人工智能辅助专业人员的培训，并确保初步的可行性和可接受性。干预措施的初步效果将使用2 (干预：和谐生活与教育-支持比较)×5(评估期：干预前、干预后以及产后4、12和24周)设计。蒙面独立评估员(IE)将对结果进行评估。将通过结构化手册、IES审查的录音会议和持续的每周监督来评估干预遵守情况和质量保证。这项研究将由约翰·霍普金斯大学美国印第安人健康中心的员工进行，该中心在印第安人保留地工作已有23年的历史。如果本研究的结果是积极的，干预措施将在更大的研究中进行评估(R01)。

DESCRIPTION (provided by applicant): This R34 proposal addresses the needs of one of the most vulnerable and under- served populations in the United States - pregnant, reservation-based American Indian (Al) teens. The primary aim is to determine the feasibility and preliminary effectiveness of a cognitive behavioral intervention delivered by Native paraprofessionals to reduce levels of depressive symptoms during pregnancy and the postpartum period. Teen pregnancy is common on Reservations, and AI teens report high levels of depressive symptoms and are at a high risk for the development of major depressive disorder (MDD) due to numerous psychosocial and environmental factors. Depression during pregnancy and postpartum is associated with significant impairments in functioning for both the mother and her offspring. The lack of mental health services on Reservations, especially for this vulnerable population, underscores the need for a low-cost early intervention aimed at reducing depressive symptoms. The first three months of the grant will be designated to finalize the intervention and assessment battery, complete training of AI paraprofessionals, and ensure initial feasibility and acceptability. Preliminary effectiveness of the intervention will be assessed using a 2 (interventions: Living in Harmony versus an Education-Support comparison) x 5 (assessment periods: pre and post-intervention and 4, 12 and 24 weeks postpartum) design. Masked independent evaluators (IE) will conduct assessments of outcomes. Intervention adherence and quality assurance will be assessed via structured manuals, audio-taped sessions reviewed by IEs, and ongoing weekly supervision. The study will be conducted by employees of the Center for American Indian Health at Johns Hopkins University, which has a 23-year history working on Indian Reservations. If findings from the present study are positive, the intervention will be evaluated in a larger study (R01).