Depression Prevention in Pregnant AI Teens Using CBT

描述（由申请人提供）：该R34提案解决了美国最脆弱和服务不足的人群之一-怀孕的保留地美国印第安人（Al）青少年的需求。主要目的是确定由本地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期间的抑郁症状水平。青少年怀孕在保留地很常见，AI青少年报告了高水平的抑郁症状，并且由于许多心理社会和环境因素，他们患重度抑郁症（MDD）的风险很高。怀孕期间和产后抑郁症与母亲及其后代的功能严重受损有关。保留地缺乏心理健康服务，特别是对这一弱势群体，强调了需要低成本的早期干预，以减少抑郁症状。补助金的前三个月将被指定用于完成干预和评估电池，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。干预措施的初步有效性将使用2 （发言：和谐生活与教育支持比较）x5（评估期：干预前和干预后以及产后4周、12周和24周）设计。设盲的独立评价者（IE）将对结局进行评估。干预依从性和质量保证将通过结构化手册、由IE审查的录音会话和持续的每周监督进行评估。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有23年的历史。如果本研究的结果为阳性，则将在更大规模的研究（R 01）中评价干预措施。

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).