Treatment of Depression in Mothers in Home Visitation

家访中母亲抑郁症的治疗

• 批准号: 7426854
• 负责人: Robert Thompson Ammerman
• 金额: $ 19.66万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-06-01 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7426854
• 关键词: Adoption; Aftercare; Beck depression inventory; Characteristics; Child; Child Development; Clinical Trials; Cognitive; Cognitive Therapy; Communities; Comorbidity; Condition; Data; Databases; Depressed mood; Development; Diagnostic; Documentation; Dose; Emotional; Enrollment; Evaluation; Exhibits; Face; Home environment; Home visitation; House Call; Innovative Therapy; Intervention; Life; Link; Low income; Major Depressive Disorder; Manuals; Measures; Mental Depression; Mental Health; Mental Health Services; Modeling; Modification; Mothers; Outcome; Panic Disorder; Parenting behavior; Patient Self-Report; Personality Disorders; Population; Populations at Risk; Post-Traumatic Stress Disorders; Postpartum Period; Pregnancy; Preparation; Prevalence; Prevention; Prevention program; Preventive; Provider; Public Health; Randomized; Randomized Clinical Trials; Recording of previous events; Recovery; Relapse; Relative (related person); Reporting; Research; Research Personnel; Research Project Grants; Risk; Risk Factors; Sampling; Score; Services; Social support; Substance abuse problem; Techniques; Testing; Thinking; Time; Training; Trauma; Travel; Treatment Cost; Unmarried; Violence; Week; depressive symptoms; design; experience; follow-up; improved; maternal depression; prevent; programs; psychologic; response; size; social; therapy development; time interval; treatment effect; trial comparing

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.

描述（由申请人提供）：证据表明，高达13.5%的母亲在怀孕期间和产后经历抑郁症。对抑郁母亲的研究已经证明了抑郁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，大多数抑郁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。越来越多的高危母亲和幼儿参加了早期预防性家访。这一群体特别容易患抑郁症，最近的调查结果证明，45%的家访母亲在服务的第一年经历了抑郁症的加重（Ammerman等人，2003年）。此外，88%的抑郁症母亲在家访没有得到治疗，尽管参加家访。我们建议开发和测试在家里的认知行为疗法（IH-CBT），一个创新的15届治疗抑郁症的母亲在家访。IH-CBT是专门设计与家访紧密结合，从而优化两种干预措施的好处。我们将进行一项小规模临床试验，以获得用于计划后续更大规模R 01的效应量。具体来说，100名抑郁的母亲将被随机分配到IH-CBT或“照常”家访（HVAU）。将在治疗前、治疗后和3个月随访时收集抑郁、精神共病、适应功能、社会支持、创伤和儿童功能的指标。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上级HVAU。我们将进一步研究共病精神疾病的潜在调节作用，以及抑郁症与创伤和暴力之间的关系。我们认为，IH-CBT具有相当大的希望，可以有效地治疗相当大的抑郁症母亲群体，否则她们无法获得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）有可能改善参与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）将被手动化，以促进该领域的快速采用和传播。

项目成果

Depression improvement and parenting in low-income mothers in home visiting.

• DOI: 10.1007/s00737-014-0479-7
• 发表时间: 2015-06
• 期刊: ARCHIVES OF WOMENS MENTAL HEALTH
• 影响因子: 4.5
• 作者: Ammerman, Robert T.;Altaye, Mekibib;Putnam, Frank W.;Teeters, Angelique R.;Zou, Yuanshu;Van Ginkel, Judith B.
• 通讯作者: Van Ginkel, Judith B.