Depression Prevention for Poor Pregnant Women

描述(由申请人提供)：产后抑郁症(PPD)是一个重大的公共卫生问题，发生在10%-16%的新近分娩的母亲中。美国每年约有400万名妇女分娩，与产后抑郁相关的发病率很高--每年至少有40万名产后妇女患有抑郁症。产后抑郁对妇女的伤害很大，这也波及到家庭；抑郁母亲的婴儿面临婴儿发育障碍和后来的儿童适应障碍的风险。此外，只有有限数量的研究测试了PPD治疗的有效性。显然，减少与产后抑郁相关的有害后果的干预措施非常重要，将特别引起卫生保健提供者和政策制定者的兴趣，特别是那些有可能加强社区护理的干预措施。到目前为止，很少有研究考察预防干预对高危妇女减少产后抑郁的效果，这一领域的研究受到方法学问题的限制。更被忽视的一个领域是对经济上处于不利地位的妇女进行这种干预的测试。降低贫困妇女的产后抑郁风险具有重要意义，因为贫困妇女是产后抑郁的高危人群，患有产后抑郁的贫困妇女的婴儿早期婴儿相互作用障碍的风险更高，贫困妇女比中产阶级妇女更不可能获得抑郁症治疗。我们建议对240名有PPD风险的公共援助孕妇进行随机试验。这项拟议项目的目的是比较主要基于人际治疗的干预措施(产后预防计划；PPP)和加强照常护理(ECU)情况的效果。PPP针对的是那些可能对产后抑郁的发展起重要作用的因素(即社会支持不足、角色转换和生活压力)，并在怀孕最后三个月和产后两周内实施。我们的主要假设是，在产后一年的过程中，PPP将明显比ECU条件更有效地降低PPD的风险。其他假设包括PPP将比ECU条件更有效地减少抑郁症状，利用精神卫生服务，以及提高母亲的敏感性和婴儿的依恋。

DESCRIPTION (provided by applicant): Postpartum depression (PPD) is a significant public health problem occurring in 10-16% of recently delivered mothers. With approximately 4,000,000 women giving birth annually in the United States, there is an enormous amount of morbidity associated with PPD - at least 400,000 postpartum women will be depressed each year. PPD exacts a substantial toll on women which extends to the family as well; infants of depressed mothers are at risk for disturbances in infant development and later child adjustment. Further, only a limited number of studies have tested the efficacy of treatments for PPD. Clearly, interventions that reduce the deleterious outcomes associated with PPD are of importance and will be of special interest to health care providers and policy makers, especially those interventions that have the potential to enhance community care. To date, there are few studies that have examined the effects of a preventive intervention to reduce PPD in high-risk women and research in this area has been limited by methodological problems. An area of even greater neglect is the testing of such an intervention for financially disadvantaged women. To reduce the risk of PPD in poor women is consequential as poor women represent a group of women at high-risk for PPD, the infants of poor women with PPD have an elevated risk for early infant interactional disturbances, and poor women are less likely to access treatment for depression than middle-class women. We propose to conduct a randomized trial in 240 pregnant women on public assistance at risk for PPD. The aim of this proposed project is to compare the efficacy of an intervention (the Postpartum Prevention Program; PPP) based primarily on interpersonal therapy to an enhanced care-as-usual control (ECU) condition. The PPP targets those factors that may play a significant role in the development of PPD (i.e., poor social support, role transitions, and life stressors) and is administered during the last trimester of pregnancy and within 2-weeks postpartum. Our main hypothesis is that the PPP will be significantly more efficacious than the ECU condition in reducing the risk of PPD over the course of one-year postpartum. Other hypotheses include that the PPP will be more efficacious than the ECU condition in reducing depressive symptoms, and utilization of mental health services as well as enhance maternal sensitivity and infant attachment.