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学高危、首次怀孕的母亲及其子女的预防计划，旨在优化母亲的生活轨迹和孩子的轨迹。研究表明，产妇抑郁(1)是家访中的一个重大问题，高达45%的母亲出现临床症状升高，而只有14%的母亲接受了治疗，(2)可能严重干扰家访的效果。此外，母亲抑郁对母子互动和儿童功能产生负面影响，从而可能使双胞胎无法从家访中充分受益。为了解决现有家访计划中母亲抑郁发生率高的问题，通过一笔R34赠款开发了家庭认知行为疗法(IH-CBT)，作为对家访中经历产后抑郁的母亲的治疗。IH-CBT包括CBT的核心特征，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。来自R34的研究结果表明，IH-CBT在减少抑郁方面非常有效，66.7%的抑郁母亲在治疗结束时不再被诊断为MDD，而单独接受家访的母亲的比率为24.3%。此外，接受IH-CBT的母亲报告说，社会支持增加了，其他精神症状减少了，其中大部分在3个月的随访中保持不变。这项研究试图用更大的样本复制IH-CBT，将治疗与更严格的对照条件(目前中心治疗-PCT)进行比较，并将随访延长至18个月，以确定复发率。关于家访对患有抑郁症的母亲及其子女的长期有效性，有不同的证据--如果得到充分证明，这一关键结果将大大加强家访对公共卫生的影响。因此，这项研究还试图检查IH-CBT和从抑郁中恢复对父母和孩子的影响。具体地说，将通过初步筛查和随后的MDD诊断招募220名登记参加家访的母亲。受试者将被随机分配到IH-CBT+家访或PCT+家访。IH-CBT和PCT将在15个疗程中实施，并在治疗后1个月和2个月提供两个强化疗程。将在治疗前、治疗后以及治疗后6、12和18个月进行抑郁、精神共病、适应功能、社会支持、育儿和儿童功能的测量。假设IH-CBT在(1)从抑郁中恢复，(2)复发和复发的风险，以及(3)增加社会支持和减少总体精神症状方面优于PCT。此外，与未康复的母亲及其子女相比，从抑郁中恢复的母亲将在育儿和母子关系方面有所改善，她们的孩子将获得更好的认知、社会、情感和生物结果。 公共卫生相关性：家访中普遍存在产妇抑郁，这对儿童和母亲造成负面后果，并使他们无法充分受益于服务。居家认知行为疗法(IH-CBT)有可能接触到原本得不到治疗的母亲，增强家访的影响，并改善幼儿的发展轨迹。这项研究的结果将通过证明一种易于传播的治疗方法对社会人口统计学上的高危母亲及其子女的有效性产生深远的公共卫生影响。

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.