Prevention for Infants of Low-Income Depressed Mothers

描述(由申请人提供)：这项纵向调查将评估两种理论上知情的预防适应不良的方法的相对有效性，这两种方法是抑郁类型的发育组织，以及低收入抑郁母亲的年轻后代的紧急精神病理学。研究参与者将包括260名母亲和她们的婴儿；195名母亲目前患有严重抑郁症，65名在人口统计学上相似的母亲将没有终生精神障碍史。所有家庭都将达到或低于联邦贫困水平。抑郁症母亲及其婴儿将被随机分配到3种治疗条件中的一种：1)人际心理治疗(IPT)4个月，然后进行8个月的注意力控制；2)IPT 4个月，然后是婴儿-父母心理治疗(IPP)8个月；以及3)增强型社区标准(ECS)治疗抑郁症，包括便于转介到社区进行标准干预。 基线评估将在婴儿12个月大时进行，随后在婴儿14、16、24、36和48个月大时进行重新评估。评估将衡量三个主要领域：1)母亲抑郁症状和严重抑郁障碍(MDD)的诊断、社会角色功能、支持和家庭背景特征；2)母子关系的质量和父母养育的情感特征；3)儿童功能、阶段突出问题和压力反应。通过对两个积极预防干预组(IPT和IPT/IPP)与ECS和非障碍组的纵向比较，确定：1)IPT和IPT/IPP在减少母亲抑郁症状和儿童4岁期间MDD复发方面是否有效；2)针对母亲抑郁的治疗是否足以改变子女的发育进程；以及3)对于母亲抑郁的年轻子女，是否有必要进行直接以母子关系为重点的干预措施，以促进积极结果，降低适应不良和精神病理的风险。

DESCRIPTION (provided by applicant): This longitudinal investigation will evaluate the relative efficacy of two theoretically-informed approaches to preventing maladaptation, a depressotypic developmental organization, and emergent psychopathology in young offspring of low-income depressed mothers. Research participants will include 260 mothers and their infants; 195 mothers will have a current major depressive disorder and 65 demographically comparable mothers will have no lifetime history of mental disorder. All families will be at or below the federal poverty level. Depressed mothers and their infants will be randomly assigned to 1 of 3 treatment conditions: 1) Interpersonal Psychotherapy (IPT) for 4 months followed by an attention control for 8 months; 2)IPT for 4 months followed by Infant-Parent Psychotherapy (IPP) for 8 months; and 3) Enhanced Community Standard (ECS) treatment for depression, involving facilitated referrals for standard interventions in the community. Baseline assessments will be conducted when infants are 12 months old, with subsequent re-assessments when infants are 14, 16, 24, 36, and 48 months of age. Assessments will measure three major areas: 1) Maternal depressive symptomatology and Major Depressive Disorder (MDD) diagnosis, social role functioning, support, and home contextual features; 2) the quality of the mother-child relationship and affective features of parenting; and 3) child functioning, stage-salient issues, and stress-reactivity. Longitudinal comparisons of the two active preventive intervention groups (IPT and IPT/IPP) with the ECS and nondisordered groups will be used to determine: 1) whether IPT and IPT/IPP are efficacious in reducing maternal depressive symptomatology and MDD relapse through the child's age of four; 2) whether treatment targeted on maternal depression is sufficient to alter the developmental course in offspring; and 3) whether intervention directly focused on the mother-child relationship also is necessary to promote positive outcomes and reduce risk for maladaptation and psychopathology in young offspring of depressed mothers.