CARE Intervention for Depressed Mothers & Their Infants

描述（由申请人提供）：产后抑郁症（PPD），一种常见的分娩并发症，危害母亲与婴儿互动的能力。在婴儿生命最初几个月的关键时期发病，威胁到母婴关系，对婴儿发育产生不利影响。尽管这个问题的临床意义，有限的信息存在与PPD相关的母婴关系障碍的治疗。这项随机临床试验的总体目标是通过促进抑郁母亲与婴儿之间的反应性互动来减轻PPD对婴儿发育的负面影响。具体的目的是测试的关系为重点的有效沟通和关系（关怀）干预的有效性，提高母婴关系的有效性，提高婴儿的清晰度的线索和响应父母，并减少父母的压力，治疗组在3个月，6个月和9个月后交付。这项拟议的研究建立在初步研究的基础上：（a）证明了筛查妇女产后抑郁症的可行性，（B）测试了护士提供的辅导干预的有效性，以促进抑郁的母亲和他们的婴儿之间的反应。在这项研究中，护理干预的目的是教抑郁的母亲认识和解释婴儿的参与和脱离线索，并指导母亲改变撤回和侵入性的母婴互动行为，特别是与PPD。护士将对大约1,500名产后妇女进行PPD筛查，随机将至少116名合格的参与者分配到治疗组或对照组，并通过诊断访谈确认抑郁状态。使用重复测量设计，将在产后6周以及产后3个月、6个月和9个月收集数据。 标准化的工具将评估抑郁症状和养育压力;盲编码的录像母婴互动将测量母婴关系的有效性和婴儿的行为反应。CARE干预将在产后6周和2、3、4、6个月的家访期间进行，通过教导母亲解释婴儿的行为线索并有效地做出反应。将使用R-ANOVA和R-MANOVA来检验研究假设并回答研究问题。结果预计将有助于知识的循证护理实践模式的治疗与PPD的母婴关系问题。

DESCRIPTION (provided by applicant): Postpartum depression, (PPD), a commonly experienced childbirth complication, jeopardizes mothers' ability to interact responsively with their infants. Onset during the critical period of the first months of infants' lives threatens the maternal-infant relationship and adversely affects infant development. Despite the clinical significance of the problem, limited information exists on the treatment of maternal-infant relational disturbances associated with PPD. The overall goal of this randomized clinical trial is to mitigate negative effects of PPD on infants' development by promoting responsive interaction between depressed mothers and their infants. The specific aim is to test the efficacy of the relationship-focused Communicating And Relating Effectively (CARE) intervention in increasing maternal-infant relational effectiveness, increasing infant clarity of cues and responsiveness to parent, and reducing parenting stress for the treatment group at 3-months, 6-months, and 9-months after delivery. This proposed study builds on preliminary studies that: (a) demonstrated the feasibility of screening women for postpartum depression, and (b) tested the efficacy of a coaching intervention delivered by nurses to promote responsiveness between depressed mothers and their infants. In this study, the CARE intervention is designed to teach depressed mothers to recognize and interpret Infants' engagement and disengagement cues, and to coach mothers to alter withdrawn and intrusive maternal-infant interactive behaviors that are associated specifically with PPD. Nurses will screen approximately 1,500 postpartum women for PPD, randomly assign a minimum of 116 eligible participants to either the treatment or control group, and confirm depression status with a diagnostic interview. Using a repeated measures design, data will be collected at 6-weeks, and 3, 6, and 9 months postpartum. Standardized instruments will evaluate depression symptoms and parenting stress; blind coding of videotaped maternal-infant interaction will measure maternal-infant relational effectiveness and infant behavioral responses. The CARE intervention will be conducted during home visits at 6-weeks, and 2, 3, 4, 6 months postpartum by teaching mothers to interpret their infants' behavioral cues and to respond effectively. R-ANOVA and R-MANOVA will be used to test the study hypotheses and to answer the research question. Outcomes are expected to contribute to knowledge of evidence-based nursing practice models for the treatment of maternal-infant relational problems associated with PPD.