Treatment of Depression in Mothers in Home Visitation

描述(由申请人提供)：有证据表明，多达13.5%的母亲在怀孕和产后经历过抑郁症。关于抑郁母亲的研究记录了抑郁对母亲的功能以及孩子的社会、情感和认知发展的破坏性影响。然而，大多数抑郁的母亲没有得到有效的治疗。特别是，表现出多种风险特征(单身、贫穷)的母亲在获得治疗方面面临着巨大的障碍。越来越多的高危母亲和幼儿参加早期预防性家访。这一群体特别容易患抑郁症，最近的研究结果表明，45%的家访母亲在服务的第一年经历了更严重的抑郁(Ammerman等人，2003年)。此外，在家访中，88%的抑郁症母亲尽管参与了家访，但没有得到治疗。我们建议开发和测试居家认知行为疗法(IH-CBT)，这是一种为家访中的抑郁母亲提供15个疗程的创新疗法。IH-CBT专门设计为与家访紧密结合，从而优化这两种干预措施的好处。我们将进行一项小规模的临床试验，以获得有效剂量，用于规划随后的更大规模的R01。具体来说，100名抑郁症母亲将被随机分配到IH-CBT或照常进行家访(HVAU)。抑郁、精神共病、适应功能、社会支持、创伤和儿童功能的测量将在治疗前、治疗后和3个月的随访中收集。假设IH-CBT在(1)减少抑郁症状，(2)从抑郁中恢复，(3)增加社会支持和社会网络方面优于HVAU。我们将进一步研究合并精神疾病的潜在缓和影响，以及抑郁与创伤和暴力之间的关系。我们认为，IH-CBT在有效治疗大量抑郁症母亲方面具有相当大的前景，否则她们得不到适当的心理健康服务。这项研究的结果将与公共卫生高度相关，因为IH-CBT(1)具有改善参与家访计划的母亲的抑郁症的潜力，(2)通过在家中提供治疗来克服获得治疗的重大障碍，(3)将被手册化，以便于在现场迅速采用和传播。

DESCRIPTION (provided by applicant): Evidence indicates that up to 13.5% of mothers experience depression during pregnancy and postpartum. Research on depressed mothers has documented the devastating impact of depression on maternal functioning and child social, emotional, and cognitive development. Yet, the majority of depressed mothers do not receive effective treatment. In particular, mothers exhibiting multiple risk characteristics (single, poor) face formidable barriers to obtaining treatment. There is a growing population of at-risk mothers and young children participating in early preventive home visitation. This group is especially vulnerable to depression, as evidenced by recent findings that 45% of mothers in home visitation experience elevated depression in the first year of services (Ammerman et al., 2003). Moreover, 88% of depressed mothers in home visitation did not receive treatment despite participation in home visitation. We propose to develop and test In-Home Cognitive Behavioral Therapy (IH-CBT), an innovative 15 session treatment for depressed mothers in home visitation. IH-CBT is specifically designed to be closely integrated with home visitation, thereby optimizing benefits for both interventions. We will conduct a small-scale clinical trial to obtain effect sizes for use in planning a subsequent larger scale R01. Specifically, 100 depressed mothers will be randomly assigned to IH-CBT or home visitation "as usual" (HVAU). Measures of depression, psychiatric comorbidity, adaptive functioning, social support, trauma, and child functioning will be collected at pre-treatment, post-treatment, and 3 month follow up. It is hypothesized that IH-CBT will be superior to HVAU in (1) reducing depressive symptoms, (2) recovery from depression, (3) and increasing social support and social network. We will further examine the potential moderating influences of comorbid psychiatric conditions, and the relationship between depression and trauma and violence. We believe that IH-CBT holds considerable promise for effectively treating a sizable population of depressed mothers who otherwise do not receive appropriate mental health services. Findings from this study will be highly relevant to public health because IH-CBT (1) has the potential to ameliorate depression in mothers participating in home visitation programs, (2) overcomes significant barriers to obtaining treatment by delivering therapy in the home, (3) will be manualized to facilitate rapid adoption by and dissemination in the field.