Identification and Therapy of Postpartum Depression

产后抑郁症的识别和治疗

• 批准号: 7282396
• 负责人: KATHERINE L WISNER
• 金额: $ 62.25万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-01 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7282396
• 关键词: Activities of Daily Living; Address; Aftercare; Birth; Caring; Case Manager; Child; Chronic Disease; Classification; Clinical; Clinical Research; Clinical Trials; Community Health Planning; Cost Savings; Counseling; DSM-IV; Data; Data Collection; Depressed mood; Depression screen; Depressive disorder; Detection; Diagnosis; Diagnostic; Disease Management; Early treatment; Economics; Education; Evaluation; Failure; Family; Feeling; Grant; Gynecologist; Health Planning; Health Policy; Health Status; Healthy People 2010; Immunization; Infant; Intervention; Interview; Knowledge; Life; Maternal and Child Health; Measures; Medicaid; Medical; Mental Depression; Mental Health; Mental Health Services; Minority; Modeling; Mood Disorders; Mothers; Motivation; NIH Program Announcements; National Institute of Mental Health; Outcome; Participant; Patient Recruitments; Patients; Perinatal; Population; Population Heterogeneity; Positioning Attribute; Postpartum Depression; Postpartum Period; Postpartum Women; Pregnancy; Preventive Health Services; Primary Health Care; Problem Solving; Protocols documentation; Provider; Public Health; Randomized; Randomized Controlled Trials; Range; Rate; Recommendation; Research; Research Design; Research Personnel; Resources; Role; Safety; Sampling; Score; Screening procedure; Sensitivity and Specificity; Solutions; Symptoms; System; Telephone; Time; Treatment Protocols; Treatment outcome; United States Health Resources and Services Administration; Visit; Woman; Women' s Health Services; base; behavioral health; care systems; child bearing; clinically relevant; cost; depression education; depressive symptoms; experience; functional outcomes; functional status; health organization; improved; insight; instrument; intervention program; maternal depression; medical complication; member; payment; preference; programs; research study; response; success; tool

DESCRIPTION (provided by applicant): Depression during the perinatal period is a major public health concern. Postpartum depression (PPD) causes personal and family suffering at a time when adaptation to parenthood is critical. Successful interventions for treating depression in medical settings have been framed by a chronic disease management model. The key ingredient to success is a dedicated care manager who provides education and support to patients, actively coordinates care, and thereby improves treatment outcomes for patients. Compared to interventions in medical office settings, telephone care management positioned at the level of the health plan offers a systematic and efficient mechanism for ongoing treatment support of women with PPD, particularly in a geographically dispersed population. We propose to conduct a comprehensive project to improve treatment outcomes for depressed postpartum women through adaptation of the depression care management model used in primary care settings. The major components are: 1) depression screening in a population of postpartum women, 2) depression education for all who screen positive, 3) a diagnostic interview to evaluate for depressive disorders in women who score above and below a defined threshold on the screening instrument, 4) a randomized controlled trial of telephone-based care management intervention vs. usual care for depression, and, 5) longitudinal evaluation across the first year post-birth for depression and maternal and child public health outcomes. All women in this project will be eligible for mental health services through two health plans (Community Care Behavioral Health Organization and Highmark). Both serve Medicaid and commercial members. We plan to identify women with PPD (n=462) who agree to be randomly assigned to the depression care management intervention or a usual care group. They will be supported in making choices about depression treatment (after receiving education about options), encouraged to access their preferred treatment (through the direct discussion of barriers and solutions), counseled to comply with treatment recommendations, and assisted to problem-solve if failure to respond occurs. Both groups will have systematic evaluations at 3, 6, and 12 months post-birth. Outcomes include not only maternal depressive symptom levels but also functional and public health outcomes for mothers, families, and infants. We have developed a multi-disciplinary team with expertise in clinical research with depressed and minority women and health services to address these needs.

描述（由申请人提供）：围产期抑郁症是一个主要的公共卫生问题。在适应为人父母至关重要的时期，产后抑郁症 (PPD) 会给个人和家庭带来痛苦。在医疗环境中治疗抑郁症的成功干预措施是由慢性病管理模型构建的。成功的关键因素是一名专门的护理经理，他为患者提供教育和支持，积极协调护理，从而改善患者的治疗结果。 与医疗办公室环境中的干预措施相比，位于健康计划层面的电话护理管理为患有产后抑郁症的女性提供了系统且有效的持续治疗支持机制，特别是在地理分散的人群中。 我们建议开展一个综合项目，通过调整初级保健机构中使用的抑郁症护理管理模式来改善产后抑郁症妇女的治疗结果。主要组成部分是：1) 对产后妇女群体进行抑郁症筛查，2) 对所有筛查结果呈阳性的人进行抑郁症教育，3) 对筛查仪器得分高于或低于规定阈值的女性进行诊断性访谈，评估抑郁症情况，4) 基于电话的护理管理干预与抑郁症常规护理的随机对照试验，以及，5) 产后第一年抑郁症和母婴公共卫生的纵向评估 结果。该项目中的所有女性都将有资格通过两个健康计划（社区护理行为健康组织和 Highmark）获得心理健康服务。两者都为医疗补助和商业会员服务。我们计划确定同意随机分配到抑郁症护理管理干预组或常规护理组的产后抑郁症女性 (n=462)。我们将支持他们做出抑郁症治疗的选择（在接受有关选择的教育之后），鼓励他们获得他们喜欢的治疗（通过直接讨论障碍和解决方案），建议他们遵守治疗建议，并在无法做出反应的情况下协助解决问题。两组均将在出生后 3、6 和 12 个月进行系统评估。结果不仅包括产妇抑郁症状水平，还包括母亲、家庭和婴儿的功能和公共卫生结果。我们建立了一支多学科团队，拥有针对抑郁症和少数族裔妇女的临床研究和卫生服务方面的专业知识，以满足这些需求。