Pevention of Depression among Mothers of Young Children with Developmental Delay

描述（由申请人提供）：作为一名护士，在我的职业生涯中，我看到了抑郁症对母亲和孩子的影响。患有抑郁症的母亲所生的孩子有很大的身体、认知和情感问题的风险。以社区为基础的针对弱势家庭的项目始终认为，母亲抑郁症是对母婴健康产生负面影响的一个因素。研究发现，这些女性患抑郁症的风险更高。因此，识别和治疗抑郁症母亲不仅是帮助受影响妇女的机会，也是改善其子女发展和行为结果的机会。拟议的k -申请旨在使候选人成为一名独立的研究人员，其工作重点是建立基于社区的预防性干预措施，以解决参加早期干预（El）的幼儿母亲的母亲抑郁症状。早期干预（El）是一个全国性的家庭项目，为大约280,000名三岁以下的高危儿童提供服务。我将利用这个奖项：1)在母亲情感障碍方面打下坚实的基础；2)加深对抑郁症预防和自我管理的问题解决方法的理解；3)在设计、调整和测试社区预防性心理健康干预措施方面发展专业知识。虽然存在针对抑郁症的有效预防性心理社会治疗方法，但在专门为患有发育和其他慢性疾病的婴儿和儿童的母亲开展的家庭方案竞赛中，没有一种方法得到实施和评估。计划进行三项研究，以适应和测试一种特殊的解决问题的干预措施，即解决问题治疗（PST），以防止其子女参加马萨诸塞州El计划的母亲抑郁症状的发作和复发。我将使用定性方法来探讨孕产妇和工作人员对解决El的孕产妇心理健康问题的看法。第二项研究将采用定性和定量方法，使PST适应El环境。最后一个项目将是一项准实验研究，其中6名接受过PST培训的El个案工作者将治疗24个家庭，以测试PST对母亲抑郁症状（该研究的主要结果）以及母亲的社会功能、养育压力和母婴互动质量的影响。该项目将用于定义设计后续项目所需的方法参数；适当动力的集群随机临床试验。我的目标是利用从这些研究中获得的信息来设计和寻求纵向集群随机对照试验的资金，以检验我的假设，即在El项目中整合基于证据的预防性心理健康干预可以减轻高危母亲的抑郁症状负担。

DESCRIPTION (provided by applicant): As a nurse, throughout my career, I have seen the effects of depression on both mothers and children. Children of depressed mothers are at risk for a vast range of poor physical, cognitive, and emotional problems. Community-based programs that target vulnerable families consistently identify maternal depression as a factor that negatively impacts maternal and child outcomes. These women have been found to be an increased risk for depression. Therefore, identifying and treating depressed mothers represents an opportunity not only to help the women affected, but also to improve developmental and behavioral outcomes for their children. The proposed K-application is designed to establish the candidate as an independent researcher whose work focuses on building community-based preventive interventions to address maternal depressive symptoms among mothers of young children who are enrolled in Early Intervention (El), a national home based program that serves approximately 280,000 at-risk children birth to three. I will use the award to 1) develop a strong foundation in maternal affective disorders; 2) enhance my understanding of problem solving approaches to depression prevention and self-management; and 3) develop expertise in the design, adaptation, and testing of community-based preventive mental health interventions. While effective preventative psychosocial treatments for depression exist, none have been delivered and evaluated in the contest of a home-based program specifically for mothers of infants and children with developmental and other chronic health conditions. Three studies are planned to adapt and test a specific problem solving intervention, Problem Solving Treatment (PST), to prevent the onset and reoccurrence of depressive symptoms among mothers whose children are enrolled in the Massachusetts El Program. I will use qualitative methods to explore both maternal and staff perceptions about addressing maternal mental health in El. The second study, using both qualitative and quantitative methods, will adapt PST to the El environment. The last project will be a quasi-experimental study, in which 6 El case workers, trained in PST, will treat 24 families, to test the effectiveness of PST to impact maternal depressive symptoms, the study's primary outcome, as well as maternal social function, parenting stress, and quality of maternal-child interactions. This project will be used to define the methodological parameters necessary to design a subsequent; appropriately powered cluster randomized clinical trial. My goal is use the information gained from these studies to design and seek funding for a longitudinal cluster RCT to test my hypothesis that integrating an evidenced-based preventive mental health intervention in El programs can decrease the burden of depressive symptoms among at-risk mothers.