Reducing Depressive Symptoms in Low-Income Mothers

描述(申请人提供)：抑郁症状在低收入母亲中更为普遍、严重和持久，这是由于复杂的生活问题、资源匮乏和社会支持不足造成的。除了限制母亲对婴儿/蹒跚学步的孩子的情感供应外，抑郁症状还会剥夺这些母亲用于上学和职业培训的精力，并减少她们对可供孩子使用的丰富计划的使用，从而阻碍她们摆脱贫困。这对最小的儿童--婴儿和蹒跚学步的儿童--尤其隐蔽，因为他们在发育方面最脆弱。采用两组重复测量的实验设计，这项研究将测试一项简短的(5个月)干预，使用一种改良的人际心理疗法，以帮助母亲在出现抑郁症状时有效地发挥作用，管理生活问题，利用社会支持，并抚养她们的婴儿或蹒跚学步的孩子。这项研究将在五个早期Head Start儿童充实项目中进行，其中四个在北卡罗来纳州，一个在纽约。来自这些项目的母亲如果有抑郁症状(流行病学研究中心抑郁量表(CES-D)得分16或以上)，并且有6周至30个月大的婴儿或蹒跚学步的孩子，并参加早期Head Start，将参与其中。226名母亲将被随机分为治疗组和常规护理/注意对照组，并将在四个收集点(基线、14周、22周和26周)上使用汉密尔顿抑郁症评级销售、结构化抑郁症临床访谈(SCID)、对录像的非结构化分析、家庭母婴/幼儿互动、日常压力源指数、社会支持和EHS服务的使用来衡量效果。将分析三个中介变量(自我效能、积极应对和寻求社会支持)和调节变量(母亲特征[年龄、教育、收入]、母亲健康和母亲负担[子女数量、儿童保健责任、交通便利、资源获取努力、工作压力和债务])对干预结果的影响。到目前为止，对高危母亲进行的受控干预措施很少。这项拟议的研究将通过在已经存在的早期儿童干预计划的基础上引入专门针对抑郁症状的干预来解决这一差距。通过帮助这些母亲更好地利用早期启动资源，可以保持干预的积极好处，从而为儿童和母亲带来持久的好处。

DESCRIPTION (provided by applicant): Depressive symptoms are more prevalent, severe and persistent in low-income mothers as a function of complex life problems, lean resources and poor social support. In addition to limiting the mother's emotional availability to her infant/toddler, depressive symptoms block these mothers' escape from poverty by robbing their energy for school and job training, and diminishing their use of available enrichment programs for their child. This is especially insidious for the very youngest children - infants and toddlers - because they are the most developmentally vulnerable. Using a 2-group, repeated measures experimental design, this study will test a brief (5 month) intervention using a modification of Interpersonal Psychotherapy to help mothers effectively function in the presence of depressive symptoms, manage life issues, use social support and parent their infant or toddler. The study will take place in five Early Head Start child enrichment programs, 4 in North Carolina and 1 in New York. Mothers from these programs who have depressive symptoms (score 16 or greater on the Center for Epidemiological Studies Depression Scale (CES-D) and who have infants or toddlers between 6 weeks and 30 months old who are enrolled in Early Head Start will participate. The 226 mothers will be randomized to treatment and usual care/attention control groups and the effects will be measured over four collection points (baseline, 14 weeks, 22 and 26 weeks) using the Hamilton Rating Sale for Depression, Structured Clinical Interview for Depression (SCID), analysis of videotaped unstructured, in-home mother-infant/toddler interactions, Everyday Stressors Index, social support and use of EHS services. Three mediators (self-efficacy, proactive coping and social support seeking) and moderators (maternal characteristics [age, education, income], maternal health and maternal burden [number of children, child healthcare responsibilities, access to transportation, resource acquisition effort, job strain and debt]) will be analyzed for effect on the intervention outcomes. Few controlled interventions with high-risk mothers such as these have been done to date. The proposed study will address this gap by bringing an intervention specifically for depressive symptoms alongside of an already-existing early child intervention program. By helping these mothers better utilize Early Head Start resources, the positive benefits of the intervention can be maintained and thus result in lasting benefit for the child as well as the mother.