1/2-Preventing Perinatal Depression (PRE-D): Developing Tools and Interventions

描述（由申请人提供）：通过两个链接的应用程序，该R34将支持：a）位于学术医疗中心的心理治疗专家（Jarrett）和围产期专家（布兰登）之间的合作/伙伴关系，以及基于网络的教育专家（Shanahan）在私营部门; B）为计划怀孕或怀孕前56天内有重度抑郁症风险的妇女制定创新的、先发制人的预防策略;和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，该计划有可能改变MDD女性在妊娠计划和围产期的循证选择，获取和吸收实践，当她们处于抑郁复发和复发的高风险时。早期的创新，发展的努力是必要的，以提供一个概念验证，作为未来的先决条件，在这一人群中，这往往是在临床试验中代表性不足。风险定义为当前MDD缓解和至少一次明确MDD既往发作。我们将开发一种网络辅助干预，预防性认知疗法（P-CT），以预防或减少从怀孕计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互联网监测（C-AIM）系统，用于监测抑郁症状。 这个R34和相关的新兴研究计划解决NIMH的优先事项：1。制定新的和更好的干预措施，纳入精神疾病患者的不同需求和情况。计划怀孕的弱势妇女选择有限，以减少其风险;本研究旨在通过开发P-CT来满足高危妇女的需求，以增加其基于证据的选择。NIMH呼吁开展研究，以解决PA 09 -174中所述的围产期心理健康问题的现有干预措施和治疗开发的扩展。2.绘制精神疾病的轨迹，以确定何时，何地以及如何干预。我们将绘制MDD在围产期的轨迹，并提供关于何时，何地以及如何干预的初步假设。临床医生辅助的互联网监测旨在促进MDD的早期检测，从而提高抗抑郁药停药或避免用药期间和之后的“观察等待”的安全性。3.加强NIMH支持的研究对公共卫生的影响。将围产期心理健康研究结果从学术环境转化为现实世界的实践是公共卫生的优先事项。在高危群体中使用临床医生辅助的症状互联网监测和基于网络的预防性心理治疗，有可能增加护理的可获得性，并有可能传播到初级保健环境。我们预测，P-CT和C-AIM可以整合在初级保健社区诊所，如果这些选区包括在发展和成功的有效性测试后。

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.