Mechanisms linking child health care use and maternal depression

儿童保健使用与孕产妇抑郁症之间的联系机制

• 批准号: 7570374
• 负责人: Margaret Langford Holland
• 金额: $ 3.4万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-30 至 2009-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7570374
• 关键词: Mechanisms; linking; child; health; care

DESCRIPTION (provided by applicant): Maternal depression is prevalent among low-income minority women and is associated with increased use of problem-oriented child health care services including sick-child visits, emergency department (ED) visits, and hospitalizations. A variety of mechanisms to explain these associations have been suggested, but few have been empirically tested. The overall goal of this research is to improve the understanding of how maternal depression impacts child health care use by examining potential mediating mechanisms. The investigation of the association between these mechanisms and child health care use will provide insights into strategies for developing more targeted interventions. The first specific aim is to determine if two mechanisms (self-efficacy and maternal-child interactions) are mediators between depressive symptoms and problem-oriented child health care use. Self-efficacy is the belief that one can be effective at a certain task. Mother-child interactions describe how well the mother and child communicate with each other through sending, receiving, and reacting to cues. The second specific aim is to explore how patterns of child health care use are impacted by maternal depression, focusing on three separate aspects: ambulatory care sensitive conditions (expected to increase with depressive symptoms), ED visits as a substitute for primary care, and well-child visits (expected to decrease with depressive symptoms). The existing evidence for ambulatory care sensitive conditions has not been replicated and the evidence for well-child visits is inconsistent. ED visits have not been tested as a substitute for primary care. The planned methods for testing the above relationships are linear and negative binomial regression, except for utilization of well-child visits which will use ordered logit regression. The relationships of depression and self-efficacy with health care use will be allowed to be non-linear, possibly quadratic. Model specification tests will confirm if the planned methods and functional forms are appropriate. ED visits and hospitalizations will be classified as ambulatory care sensitive or not using diagnoses in the medical records. All analyses will be risk adjusted for children's chronic conditions and birth weight. Common demographic variables will be used to control for other factors that may contribute to health care use. Data from the control subjects of the Nurse-Family Partnership trial in Memphis, TN will be used (n=460). Mothers were interviewed during pregnancy and at the child's ages of 36 weeks, 6 months, 12 months, and 24 months. Medical records for the children were obtained up to 24 months. If self-efficacy and/or mother-child interactions are found to be important contributors to child health care use, appropriate interventions will need to address these conditions in addition to depression to substantially impact utilization. Fortunately, interventions have been successful at improving both self-efficacy and mother-child interactions. A successful intervention would focus on decreasing the need for additional discretionary visits, without discouraging appropriate visits. Patterns uncovered by the second specific aim may inform policy decisions and future research hypotheses. Public Health Relevance: This study seeks to understand how maternal depression increases the number of sick-child visits, emergency department visits, and hospitalizations for children of depressed mothers. Understanding the specific mechanisms that explain these associations will allow for more successful interventions to be designed, resulting in more efficient use of health care resources as well as healthier families.

描述（由申请人提供）：孕产妇抑郁症在低收入少数民族妇女中普遍存在，并与增加使用以问题为导向的儿童保健服务有关，包括病童就诊、急诊科（艾德）就诊和住院治疗。已经提出了各种解释这些关联的机制，但很少有经验检验。本研究的总体目标是通过检查潜在的中介机制，提高对孕产妇抑郁症如何影响儿童卫生保健使用的理解。这些机制和儿童保健使用之间的关联的调查将提供深入了解的战略，制定更有针对性的干预措施。第一个具体目标是确定两种机制（自我效能和母子互动）是否是抑郁症状和以问题为导向的儿童医疗保健使用之间的中介。自我效能感是一种信念，认为一个人可以有效地完成某项任务。母子互动描述了母亲和孩子通过发送、接收和对暗示做出反应来相互沟通的程度。第二个具体目标是探讨母亲抑郁症如何影响儿童医疗保健的使用模式，重点关注三个独立的方面：门诊护理敏感的条件（预计会增加抑郁症状），艾德访问作为初级保健的替代品，以及良好的儿童访问（预计会减少抑郁症状）。门诊护理敏感性疾病的现有证据尚未得到复制，健康儿童就诊的证据也不一致。艾德就诊还没有被测试为初级保健的替代品。计划用于检验上述关系的方法是线性和负二项回归，但使用健康儿童访视除外，其将使用有序logit回归。抑郁症和自我效能与医疗保健使用的关系将被允许是非线性的，可能是二次的。模型规格测试将确认计划的方法和功能形式是否适当。艾德访视和住院将被分类为门诊护理敏感或不使用病历中的诊断。所有分析都将根据儿童的慢性病和出生体重进行风险调整。常见的人口统计学变量将用于控制可能影响医疗保健使用的其他因素。将使用来自孟菲斯，TN的护士-家庭伙伴关系试验的对照受试者的数据（n=460）。母亲在怀孕期间和孩子36周，6个月，12个月和24个月的年龄进行了采访。这些儿童的医疗记录长达24个月。如果自我效能和/或母子互动被发现是重要的贡献者，儿童卫生保健的使用，适当的干预措施，将需要解决这些条件，除了抑郁症，大大影响利用。幸运的是，干预措施在提高自我效能和母子互动方面取得了成功。成功的干预措施将侧重于减少额外酌情查访的需要，而不妨碍适当的查访。第二个具体目标所揭示的模式可能会为政策决定和未来的研究假设提供信息。 公共卫生相关性：本研究旨在了解母亲抑郁症如何增加患病儿童就诊，急诊室就诊和抑郁母亲子女住院的数量。了解解释这些关联的具体机制将允许设计更成功的干预措施，从而更有效地利用医疗保健资源以及更健康的家庭。