Treatment of Maternal Depression in Home Visitation: Mother and Child Impacts

描述（由申请人提供）：家访是一项针对社会人口高风险、首次生育的母亲及其子女的预防计划，旨在优化母亲的生命历程和儿童轨迹。研究表明，母亲抑郁(1)是家访的一个重要问题，高达45%的母亲出现临床症状升高，而只有14%的母亲得到治疗，(2)会显著干扰家访的效果。此外，母亲抑郁会对母子互动和儿童功能产生负面影响，从而潜在地阻止二人组从家访中充分受益。为了解决现有家访项目中母亲抑郁的高发率，通过R34拨款开发了家庭认知行为疗法（IH-CBT），用于治疗家访中经历产后抑郁的母亲。IH-CBT由CBT的核心特征组成，这些特征已被调整以解决接受家访的母亲的独特需求和挑战。R34的研究结果表明，IH-CBT在减少抑郁症方面非常有效，66.7%的抑郁母亲在治疗结束时不再被诊断为重度抑郁症，而单独接受家访的母亲这一比例为24.3%。此外，接受IH-CBT的母亲报告社会支持增加，其他精神症状减少，其中大部分在3个月的随访中保持不变。本研究试图在更大的样本中复制IH-CBT，将治疗与更严格的对照条件（以现在为中心的治疗- pct）进行比较，并将随访时间延长至18个月，以确定复发率。关于家访对抑郁母亲及其子女的长期有效性，有各种各样的证据，这些关键结果如果得到充分证明，将显著提高家访对公共卫生的影响。因此，该研究还试图检验IH-CBT和抑郁症康复对父母和孩子的影响。具体来说，将通过最初的筛查和随后的重度抑郁症诊断招募220名参加家访的母亲。受试者将被随机分配到IH-CBT +家访或PCT +家访组。IH-CBT和PCT将分15期实施，治疗后1个月和2个月分别进行两次强化治疗。在治疗前、治疗后以及治疗后6个月、12个月和18个月的随访中，将对抑郁症、精神疾病、适应功能、社会支持、养育子女和儿童功能进行测量。假设IH-CBT在以下方面优于PCT:(1)抑郁症的恢复；(2)复发和复发的风险；(3)增加社会支持和减少整体精神症状。此外，从抑郁症中康复的母亲在养育子女和母子关系方面会有所改善，与未康复的母亲及其后代相比，她们的孩子会在认知、社交、情感和生理方面取得更好的成绩。

DESCRIPTION (provided by applicant): Home visitation is a prevention program for sociodemographically high risk, first-time mothers and their children that is designed to optimize maternal lifecourse and child trajectories. Research indicates that maternal depression (1) is a significant problem in home visitation with up to 45% of mothers experiencing clinically elevated symptoms while only 14% receive treatment, and (2) can significantly interfere with the efficacy of home visitation. Moreover, maternal depression negatively impacts mother-child interactions and child functioning thus potentially precluding the dyad from fully benefiting from home visitation. To address the high rate of maternal depression in existing home visitation programs, In-Home Cognitive Behavior Therapy (IH-CBT) was developed through an R34 grant as a treatment for mothers in home visitation experiencing depression postpartum. IH-CBT consists of the core features of CBT that have been adapted to address the unique needs and challenges of mothers receiving home visitation. Findings from the R34 indicate that IH-CBT is highly effective at reducing depression, with 66.7% of depressed mothers no longer obtaining a diagnosis of MDD at the end of treatment in contrast to a rate of 24.3% in mothers receiving home visitation alone. In addition, mothers receiving IH-CBT reported increased social support and reduction in other psychiatric symptoms, much of which was maintained at 3 month follow-up. This study seeks to replicate IH-CBT with a larger sample, compare the treatment to a more rigorous control condition (Present-Centered Therapy-PCT), and extend follow-up to 18 months in order to determine relapse rate. There is mixed evidence regarding the long-term effectiveness of home visitation on depressed mothers and their children-critical outcomes that, if adequately demonstrated, would significantly enhance the public health implications of home visitation. Accordingly, the study also seeks to examine the impact of IH-CBT and recovery from depression on parenting and children. Specifically, 220 mothers who are enrolled in home visitation will be recruited through initial screening and subsequent diagnosis of MDD. Subjects will be randomly assigned to IH-CBT + home visitation or PCT + home visitation. Both IH-CBT and PCT will be implemented in 15 sessions with two booster sessions provided 1 and 2 months after treatment. Measures of depression, psychiatric comorbidity, adaptive functioning, social support, parenting, and child functioning will be administered at pre-treatment, post- treatment and at 6, 12 and 18 month follow-ups after post-treatment. It is hypothesized that IH-CBT will be superior to PCT in (1) recovery from depression, (2) risk of relapse and recurrence, and (3) increasing social support and reducing overall psychiatric symptomatology. In addition, mothers who recover from depression will show improvements in parenting and the mother-child relationship, and their children will achieve improved cognitive, social, emotional, and biologic outcomes, relative to non-recovered mothers and their offspring. PUBLIC HEALTH RELEVANCE: Maternal depression is prevalent in home visitation, leading to negative outcomes for children and mothers and preventing them from fully benefiting from services. In-Home Cognitive Behavior Therapy (IH-CBT) has the potential to reach mothers who otherwise would go untreated, enhance the impacts of home visitation, and improve developmental trajectories of young children. Results from this study will have profound public health implications through demonstrating the effectiveness of a readily disseminated treatment for sociodemographically high-risk mothers and their children.