Dyadic Intervention for Women at Risk for Postpartum Depression and their Infants

描述（由申请人提供）：本申请是对PA-09-175妇女在怀孕和产后期间的心理健康的回应。这个探索性/发展（R21）项目的目标是进一步开发，试点测试和完善一种新的双重点母婴干预措施，以预防/减少产妇产后抑郁症（PPD），并改善母婴关系和儿童发展结果。大约10-15%的妇女在婴儿出生后经历PPD，对产妇福祉，母婴关系和随后的儿童发育产生严重的负面影响。目前大多数PPD治疗仅关注孕产妇结局，忽视母婴关系，因此不会改善关系或儿童结局。目前还没有研究以综合的方式解决母亲抑郁和母婴关系障碍的双重问题。拟议的项目创新地解决了这一关键的研究差距，通过在理论和临床基础上的早期二元干预中同时针对PPD和相关的母婴关系功能障碍，包括：（a）一种以洞察力为导向的和基于支持性关系的母婴心理治疗成分，利用婴儿作为治疗的组成部分，和（B）基于发育的面向婴儿的组分，其被设计为增强母体敏感反应性并促进积极的母婴相互作用。我们的具体目标是：（1）制定干预方案，并在5对母婴的可行性测试后酌情完善;（2）在干预后、产后6个月和1年随访时评估干预对预防或减少PPD和提高母婴互动质量的主要结局的有效性;（3）在干预后和随访时，探讨干预对母亲焦虑、父母压力、母亲自尊、母亲对婴儿的依恋、儿童依恋安全和儿童认知发展的影响。在制定干预措施并根据专家咨询和初步可行性测试的结果对其进行改进后，我们将使用60名因产后1周抑郁评分升高而被确定为PPD风险的妇女及其婴儿的样本来测试其疗效。将二人组随机分配至干预组或对照组。在产后的前3个月内，家庭干预将包括8次母婴会议，由受过专门培训的护士提供。对照组将接受简短的教育干预，然后进行常规护理，并通过电话监测产妇抑郁症，时间表与干预访视相当。将在基线、干预后和两个随访点测量孕产妇和母婴结局。婴儿结局将在1岁时进行评估。重复测量方差分析将用于确定干预效果。如果成功，这项研究的结果将为未来R 01的发展提供信息，以进行更大规模的干预随机试验。 公共卫生相关性：产后抑郁症（PPD）是一个主要的公共卫生问题，影响了大约10-15%的母亲，不仅对母亲，而且对母婴关系和儿童发育产生严重的负面影响。拟议项目的目标是开发和评估一种新的双重点母婴干预的可行性和有效性，由受过专门训练的护士，以预防/减少产妇产后抑郁症和相关的母婴关系功能障碍。如果被证明是有效的，这种干预措施将提供一个新的早期治疗选择PPD，将持有巨大的利益，为母亲和婴儿，并可以很容易地适应广泛的公共使用的风险母婴二人组。

DESCRIPTION (provided by applicant): This application is in response to PA-09-175 Women's Mental Health in Pregnancy and the Postpartum Period. The goal of this exploratory/development (R21) project is to further develop, pilot test, and refine a novel dual-focused mother-infant intervention to prevent/decrease maternal postpartum depression (PPD) and improve aspects of mother-infant relationships and child development outcomes. Approximately 10-15% of women experience PPD after the birth of a baby, with serious negative consequences for maternal well-being, the mother-infant relationship, and subsequent child development. Most current PPD treatments focus exclusively on maternal outcomes, neglect the mother-infant relationship, and thus do not result in improvements in relationship or child outcomes. No study has yet addressed the dual problems of maternal depression and mother-infant relationship dysfunction in an integrated way. The proposed project innovatively addresses this critical research gap by targeting PPD and the associated mother-infant relationship dysfunction concurrently in a theoretically and clinically based early dyadic intervention that consists of: (a) an insight- oriented and supportive relationship-based mother-infant psychotherapeutic component utilizing the infant as an integral part of the therapy, and (b) a developmentally-based infant-oriented component designed to enhance maternal sensitive responsiveness and promote positive mother-infant interactions. Our specific aims are to: (1) Develop the intervention protocol and refine it as appropriate after testing its feasibility with 5 mother-infant dyads; (2) Assess the efficacy of the intervention on the primary outcomes of prevention or reduction of PPD and enhancing the quality of mother-infant interaction at post-intervention, 6 months, and 1 year postpartum follow-ups; and (3) Explore the effects of the intervention on secondary outcomes of maternal anxiety, parenting stress, maternal self-esteem, maternal attachment to the infant, child attachment security, and child cognitive development at post-intervention and follow-up time points. After developing the intervention and refining it based on expert consultation and findings from the initial feasibility testing, we will test its efficacy using a sample of 60 women determined to be at-risk for PPD due to elevated depression scores at 1 week postpartum and their infants. Dyads will be randomly assigned to the intervention or control group. The home-based intervention will consist of 8 mother-infant sessions delivered by specially trained nurses over the first 3 months postpartum. Control group will receive a short educational intervention followed by usual care plus maternal depression monitoring by phone on a schedule comparable to the intervention visits. Maternal and mother-infant outcomes will be measured at baseline, post-intervention, and at two follow- up points. Infant outcomes will be assessed at 1 year of age. Repeated measures analysis of variance will be used to determine intervention effects. If successful, findings from this study will inform the development of a future R01 proposal to conduct a larger randomized trial of the intervention. PUBLIC HEALTH RELEVANCE: Postpartum depression (PPD) is a major public health concern that affects approx 10-15% of mothers with serious negative consequences for not only the mothers, but also the mother-infant relationship and child development. The goal of the proposed project is to develop and assess the feasibility and efficacy of a novel dual-focused mother-infant intervention by specially trained nurses to prevent/decrease maternal postpartum depression and associated mother-infant relationship dysfunction. If shown to be effective, this intervention would provide a new early-stage treatment option for PPD that would hold great benefit for mothers and infants and could be easily adapted for widespread public use for at-risk mother-infant dyads.