Treatment of Depression in Mothers in Home Visitation

描述（由申请人提供）：有证据表明，高达13.5%的母亲在怀孕和产后经历过抑郁症。对抑郁母亲的研究记录了抑郁症对母亲功能和儿童社会、情感和认知发展的破坏性影响。然而，大多数患有抑郁症的母亲没有得到有效的治疗。特别是，表现出多重风险特征（单身、贫穷）的母亲在获得治疗方面面临巨大障碍。参与早期预防性家访的高危母亲和幼儿人数不断增加。这一群体尤其容易患抑郁症，最近的调查结果表明，接受家访的母亲中有45%在接受服务的第一年抑郁程度升高（Ammerman et al., 2003）。此外，88%接受家访的抑郁母亲尽管参加了家访，但没有得到治疗。我们建议开发和测试家庭认知行为疗法（IH-CBT），这是一种创新的家庭探视抑郁母亲的治疗方法。IH-CBT是专门为与家访紧密结合而设计的，从而优化了这两种干预措施的效益。我们将进行一项小规模临床试验，以获得效应量，用于计划随后的更大规模R01。具体来说，100名抑郁母亲将被随机分配到IH-CBT或家访“一如既往”（HVAU）。在治疗前、治疗后和3个月随访时收集抑郁、精神合并症、适应功能、社会支持、创伤和儿童功能的测量数据。假设IH-CBT在(1)减轻抑郁症状，(2)从抑郁中恢复，(3)增加社会支持和社会网络方面优于HVAU。我们将进一步研究共病精神状况的潜在调节作用，以及抑郁与创伤和暴力之间的关系。我们相信，IH-CBT在有效治疗大量得不到适当心理健康服务的抑郁母亲方面具有相当大的前景。这项研究的结果将与公共卫生高度相关，因为IH-CBT(1)有可能改善参加家访计划的母亲的抑郁症，(2)通过在家中提供治疗克服了获得治疗的重大障碍，(3)将被手工化，以促进该领域的快速采用和传播。

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.