Literacy and Utilization of Maternal Depression Care

描述（由申请人提供）：10- 20%的妇女在分娩后6个月内发生非精神病性重度抑郁症（MOD），早产后发生率更高。减少参与MOD护理的患者因素是提供有效抑郁症治疗的主要障碍。识字率低的成年人患抑郁症的风险更高，对各种保健服务的利用率更低，在孕产妇健康差距风险最高的人群中，20- 37%的妇女识字率低（<6年级）。健康素养结构，获得健康决策所需信息的能力，已被提议作为低识字率和低卫生保健服务使用之间的关联的调解人。评估识字率低的作用，在利用保健的MOD确定产后可能会允许干预措施，将减少障碍，为这一弱势群体的治疗。本申请概述了一项混合方法研究（R 03），其中定性方法将添加到正在进行的随机对照试验中，以治疗重复早产的风险因素（n=1420）。在早期早产（<34周EGA）后被诊断为DSM-IV MOD的参与者将被提供免费治疗（心理治疗，抗抑郁药物或两者的组合）。这项调查的主要目的是对患有抑郁症和识字率低的妇女进行调查，（<6年级，n=117）是为了：1）确定与接受和拒绝抑郁症护理的高抑郁症患者的妇女转诊的相关因素（CES-D 22）2）确定与接受或拒绝DSM-IV MOD女性中提供的任何抑郁症积极治疗相关的因素;本研究将利用母研究中收集的大量定量数据，结合半结构化访谈（n=60）和临床访谈（n=40）的定性分析，确定DSM-IV MOD妇女中抑郁症治疗持续与中断的相关因素。定性方法将大大提高定量评估，提供了一个机会，以澄清结果的不一致性，并有机会发现新的因素联系健康素养和抑郁症治疗的利用。这项研究代表了一个独特的和具有成本效益的机会，研究患者因素，这是低识字率妇女抑郁症治疗的障碍，并为未来的干预措施提供信息。

DESCRIPTION (provided by applicant): Nonpsychotic major depression (MOD) occurs in 10-20 percent of women within 6 months of delivery with higher rates seen following preterm birth. Patient factors which reduce participation in care for MOD are major barriers to the delivery of effective depression treatments. Adults with low literacy have higher risk of depressive symptomatology and less utilization of a variety of health care services 20-37 percent of women in populations most at risk for maternal health disparities have low literacy (< 6th grade). The health literacy construct, the capacity to access information needed for health decisions, has been proposed as a mediator of the association between low literacy and low health care service use. Assessing the role of low literacy in the utilization of care for MOD identified postpartum may allow interventions that would reduce barriers to treatment for this vulnerable population. This application outlines a mixed methods study (R03) in which qualitative methods will be added to an ongoing randomized controlled trial to treat risk factors for repeat preterm birth (n=1420). Participants who are diagnosed with DSM-IV MOD following an early preterm birth (<34 weeks EGA) will be offered a choice of free treatments (psychotherapy, antidepressant medication, or a combination of the two). The primary aims of this investigation of women with depression and low literacy (< 6th grade, n=117) are to: 1) Identify factors associated with accepting versus declining referral for depression care among women with high depressive symptomatology (CES-D 22); 2) Identify factors associated with accepting versus declining any of the active treatments for depression offered among women with DSM-IV MOD; and 3) ldentify factors associated with depression treatment continuation versus discontinuation among women with DSM-IV MOD. The proposed study will take advantage of extensive quantitative data collected in the parent study which will be linked to qualitative analyses of transcripts from semi-structured interviews (n=60) and clinical interviews (n=40) The qualitative methods will greatly enhance the quantitative assessments, provide an opportunity to clarify inconsistencies in results, and an opportunity to uncover novel factors linking health literacy and depression treatment utilization. This study represents a unique and cost effective opportunity to study patient factors which are obstacles to depression treatment in women with low literacy and inform future interventions.