2/2-Preventing Perinatal Depression (PRE-D): Developing Tools and Interventions

2/2-预防围产期抑郁症 (PRE-D)：开发工具和干预措施

• 批准号: 8325122
• 负责人: Brian R Shanahan
• 金额: $ 16.67万
• 依托单位: MEDISPIN, INC.
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8325122
• 关键词: Academic Medical Centers; Address; Affect; Antidepressive Agents; Area; Caring; Clinic; Clinical Psychology; Clinical Trials; Cognitive; Cognitive Therapy; Collaborations; Communication; Communities; Conceptions; Contracts; Databases; Development; Diagnostic; Disease remission; Doctor of Philosophy; Early Diagnosis; Education; Effectiveness; Evaluation; Funding; Future; Goals; Grant; Health Personnel; Improve Access; Infant; Internet; Intervention; Knowledge; Lactation; Link; Major Depressive Disorder; Manuals; Measurement; Medical Education; Medical Informatics; Medicine; Mental Depression; Mental Health; Mental disorders; Methods; Monitor; Mothers; National Institute of Mental Health; Online Systems; Outcome; Patient observation; Patients; Perinatal; Personality; Pharmaceutical Preparations; Phase; Planned Pregnancy; Population; Populations at Risk; Postpartum Period; Pregnancy; Preparation; Prevention; Prevention strategy; Preventive; Preventive Intervention; Primary Health Care; Private Sector; Procedures; Protocols documentation; Provider; Psychiatry; Psychotherapy; Public Health; Randomized; Randomized Controlled Trials; Recording of previous events; Recurrence; Relapse; Research; Research Personnel; Research Support; Risk; Robin bird; Safety; Site; Small Business Innovation Research Grant; Specialist; Staging; Symptoms; System; Technology; Testing; Texas; Time; Training; Treatment Protocols; Trust; Universities; Withdrawal; Woman; Women' s Health; Work; base; child bearing; computerized; depressive symptoms; design; evidence base; experience; high risk; innovation; interdisciplinary collaboration; maternal depression; named group; prevent; primary care setting; programs; psychoeducational; psychosocial; public health priorities; safety testing; single episode major depressive disorder; therapy design; therapy development; tool; tool development; treatment strategy; uptake; web site

DESCRIPTION (provided by applicant): Through two linked applications, this R34 would support: a) collaboration/partnership between a psychotherapy expert (Jarrett) and a perinatal specialist (Brandon) located in an academic medical center, and an expert in web-based education (Shanahan) in the private sector; b) development of an innovative, preemptive, preventive strategy for women at risk for major depressive disorder (MDD) who are planning to conceive or who are within the first 56 days of pregnancy; and c) evaluation of the safety, tolerability, acceptability, and feasibility of the intervention. We propose to initiate a program of research that has the potential to transform the evidence-based choices, access, and uptake of practices available to women with MDD during pregnancy planning and the perinatal period, when they are at high risk for depressive relapse and recurrence. Early innovative, developmental efforts are necessary to provide a proof-of-concept as a prerequisite to future, formal tests in this population, which is often underrepresented in clinical trials. Risk is defined by current remission of MDD and at least one previous episode of definite MDD. We will develop a web-assisted intervention, Preventive Cognitive Therapy (P-CT), to prevent or reduce relapse/recurrence from conception planning through delivery and postpartum. We will also create a Clinician-Assisted Internet Monitoring (C-AIM) system for monitoring depressive symptoms. This R34 and the associated emerging research program address the NIMH priorities to: 1. Develop new and better interventions that incorporate the diverse needs and circumstances of people with mental illnesses. Vulnerable women planning to conceive have limited choices in order to reduce their risk; this research seeks to increase their evidence-based choices by developing P-CT to address the needs of at-risk women. The NIMH has called for studies to address the expansion of existing interventions and treatment development for perinatal mental health problems as described in PA09-174. 2. Chart mental illness trajectories to determine when, where, and how to intervene. We will chart the trajectory of MDD during the perinatal period and provide initial hypotheses on when, where, and how to intervene. Clinician-Assisted Internet Monitoring is designed to promote early detection of MDD, thereby increasing the safety of "watchful waiting" during and after antidepressant medication withdrawal or avoidance. 3. Strengthen the public health impact of NIMH-supported research. Moving perinatal mental health research findings from the academic setting into real-world practice is a public health priority. Using clinician-assisted Internet monitoring of symptoms and web-based preventive psychotherapy in at-risk groups has the potential to increase the availability of care, as well as the potential for dissemination into primary care settings. We predict that both P-CT and C-AIM can be integrated within primary care community clinics, if these constituencies are included in development and contingent upon successful tests of effectiveness.

描述(申请人提供)：通过两个相互关联的申请，R34将支持：a)学术医疗中心的心理治疗专家(Jarrett)和围产期专家(Brandon)与私营部门的网络教育专家(Shanahan)之间的合作/伙伴关系；b)为计划怀孕的或怀孕头56天内的严重抑郁障碍(MDD)高危妇女制定创新的、先发制人的预防策略；以及c)评估干预的安全性、耐受性、可接受性和可行性。我们建议启动一项研究计划，有可能改变MDD女性在妊娠计划和围产期可用的循证选择、获取和接受做法，因为此时她们抑郁复发和复发的风险很高。早期创新的发展努力是必要的，以提供概念验证作为未来在这一人群中进行正式测试的先决条件，而这一人群在临床试验中往往代表不足。风险的定义是目前MDD的缓解和至少一次明确的MDD发作。我们将开发一种网络辅助干预，预防性认知疗法(P-CT)，以防止或减少从怀孕规划到分娩和产后的复发/复发。我们还将创建一个临床医生辅助的互联网监测(C-AIM)系统，用于监测抑郁症状。这项R34和相关的新兴研究计划针对NIMH的优先事项：1.开发新的更好的干预措施，纳入精神疾病患者的不同需求和情况。为了降低风险，计划怀孕的弱势妇女的选择有限；这项研究试图通过开发P-CT来满足高危妇女的需求，增加她们基于证据的选择。NIMH呼吁进行研究，以解决现有干预措施的扩展和围产期精神健康问题的治疗开发，如PA09-174所述。2.绘制精神疾病的轨迹图，以确定何时、何地和如何进行干预。我们将绘制MDD在围产期的轨迹图，并提供关于何时、何地和如何干预的初步假设。临床医生辅助互联网监测旨在促进MDD的早期发现，从而增加抗抑郁药物停药或避免期间和之后的“警惕等待”的安全性。3.加强NIMH支持的研究对公共健康的影响。将围产期心理健康研究成果从学术环境转化为现实世界是公共卫生的优先事项。在高危人群中使用临床医生辅助的互联网症状监测和基于网络的预防性心理治疗，有可能增加提供护理的机会，并有可能传播到初级保健环境中。我们预测，P-CT和C-AIM都可以整合到初级保健社区诊所中，如果这些群体包括在发展中，并取决于成功的有效性测试。