Preventing Postpartum Depression in Adolescent Mothers

说明(申请人提供)：青少年生育的后果包括对养育青少年及其子女的重大社会和健康影响。在美国，每年有超过40万名不到20岁的母亲出生。怀孕的青少年面临着更高的不良生育结局和育儿困难的风险。产后抑郁症将一个本已具有挑战性的过程转变为一个潜在的压倒性过程。这种困难可能是这些年轻母亲及其子女结局不佳的一个主要决定因素。显然，预防这一弱势群体的产后抑郁症应该是产前护理的一个组成部分，也是卫生保健提供者和政策制定者特别关心的问题。不幸的是，几乎没有研究检验预防性干预对减少怀孕青少年产后抑郁的效果。这一治疗发展赠款的目的是为经济困难的怀孕青少年制定一种心理社会干预措施，并收集关于这一干预措施在降低产后抑郁程度方面的效果的初步数据。这项干预主要是针对那些可能在青春期母亲产后抑郁的发展中起重要作用的因素(即，社会支持不足、角色转换和生活压力)，以个人间为导向的干预。该项目的具体目标是：(SA1)制定干预计划，包括完善干预手册以反映我们目标人群的需求，并制定依从性和能力量表、治疗师培训程序以及招募和保留受试者的研究程序；(SA2)在100名怀孕青少年样本中进行随机对照初步研究，以评估拟议干预与教学控制条件相比的初步效果，并提供与对照条件比较的效果大小的估计；以及，(SA3)评估先导研究的结果和程序，以便为改进干预措施和程序提供信息，为评估这种干预措施的有效性的更大规模的临床试验做准备。这项研究的结果将对预防青春期母亲及其子女的严重发病率具有重要意义。

DESCRIPTION (provided by applicant): The consequences of adolescent childbearing include significant social and health impacts on the parenting teens and their children. Each year, more than 400,000 births in the United States are to mothers less than 20 years old. Pregnant teenagers are at increased risk for adverse birth outcomes and parenting difficulties. Depression during the postpartum period transforms an already challenging process into a potentially overwhelming one. This hardship may be a major determinant of poor outcomes for these young mothers and their children. Clearly, the prevention of postpartum depression with this vulnerable population should be an integral part of prenatal care and of special interest to health care providers and policy makers. Unfortunately, virtually no research has examined the effects of a preventive intervention to reduce postpartum depression in pregnant teenagers. The objective of this treatment development grant is to develop a psychosocial intervention for financially disadvantaged, pregnant adolescents and to collect preliminary data on the efficacy of this intervention in reducing the degree of postpartum depression. The intervention is primarily an interpersonally-oriented intervention that targets those factors that may play a significant role in the development of postpartum depression in adolescent mothers (i.e., poor social support, role transitions, and life stressors). The specific aims of this project are to: (SA1) Develop the intervention program, including refining the intervention manual to reflect the needs of our target population, and developing adherence and competence scales, therapist training procedures, and research procedures for recruitment and retention of subjects; (SA2) Conduct a randomized controlled pilot study to evaluate the initial efficacy of the proposed intervention compared to a didactic control condition in a sample of 100 pregnant adolescents and to provide an estimate of effect size in comparison to the control condition; and, (SA3) Evaluate the pilot study results and procedures to inform the refinement of the intervention and procedures to prepare for a larger clinical trial evaluating the efficacy of this intervention. Findings from this study will have important implications for preventing significant morbidity in adolescent mothers and their children.