Impact of Perinatal Depression treatment on child developmental outcomes

摘要 产妇抑郁症是一种严重的疾病，不仅对抑郁症妇女产生负面影响，而且还 对她的孩子造成长期的负面影响。具体而言，心理健康问题的风险增加 孩子在生命历程中持续存在，并再次遗传给下一代。虽然是母性 抑郁症治疗是可行的，它们会在多大程度上改变孩子的社会情感， 认知和身体发展轨迹尚不清楚。重要的是，随机对照 比较多种抑郁症干预措施的试验还没有足够的能力来回答这个重要问题 由于随访期不足而产生的问题；在最敏感的时期之后开始干预 发育时期；或缺乏适当的比较组。特定干预措施的成功 取决于多种因素，其中一个关键的可改变因素是干预措施可以改变现状的程度 抑郁女性的养育行为。我们的长期目标是确定关键的可修改因素 风险从抑郁的母亲传给孩子的代际传递。这项研究的目标是 严格评估从产前开始并持续进行的围产期抑郁症干预措施的影响 产后 6 个月，关于儿童发育。我们将通过结合并充分整合来实现这一目标 一项资助的围产期抑郁症干预集群随机对照试验（分享：U19MH095687）。除了 在招募将参加 SHARE 试验的抑郁女性的同时，我们还将招募一部分非抑郁女性。 抑郁症妇女，并在产后至少 36 个月内对母子二人进行随访。报名非 抑郁的母亲使我们能够确定干预措施可以在多大程度上实现对等 在接受治疗的抑郁症组和非抑郁症组之间进行比较，并确定潜在的正外部性 干预组中的非抑郁女性。总之，这些方法将产生决定性的证据 围产期抑郁症干预对儿童发育结果的因果影响。我们假设 相对于对照组，抑郁症干预将改善儿童的结局，我们将研究 是否也会导致那些母亲没有抑郁的孩子的结果趋于一致 产前。我们还将分析潜在的中介因素，重点关注提高养育质量是否是一个 连接抑郁干预和儿童结局的重要机制。最后，我们将确定如何 参与干预与儿童结局之间的关系因家庭等因素而异 构成、社会经济地位和遭受人际暴力的机会。我们期待这个结果 研究为未来围产期抑郁症干预措施的设计提供信息，这些干预措施将具有最大的保护作用 对后代的影响。

Abstract Maternal depression is a serious disorder that not only negatively impacts the depressed woman but also has long-lasting negative consequences on her child. Specifically, the increased risk of mental health problems in the child persists over the lifecourse and is again transmitted to the next generation. Although maternal depression treatments are available, the degree to which they causally shift the child's socio-emotional, cognitive, and physical development trajectory is less well understood. Importantly, randomized controlled trials comparing multiple depression interventions have not been well equipped to answer this important question due to insufficient follow-up periods; the interventions beginning after the most sensitive developmental periods; or lack of appropriate comparison groups. The success of a given intervention depends on multiple factors, with a key modifiable factor being the extent to which an intervention can alter the parenting behaviors of the depressed woman. Our long term objective is to identify key modifiable factors in the intergenerational transmission of risk from a depressed mother to her child. The goal of this study is to rigorously evaluate the impact of a perinatal depression intervention that starts prenatally and continues through 6 months post-partum, on child development. We will achieve this by combining, and fully integrating, with a funded perinatal depression intervention clustered RCT (SHARE: U19MH095687). In addition to enrolling the depressed women who will participate in the SHARE trial, we will also enroll a subset of non- depressed women, and follow-up the mother-child dyads for at least 36 months post-partum. Enrolling the not depressed mothers enables us to determine the extent to which the intervention can lead to equivalence between the treated depressed and non-depressed groups as well as to identify potential positive externalities to non-depressed women in the intervention arm. Together, these approaches will yield decisive evidence of the causal impact of a perinatal depression intervention on child developmental outcomes. We hypothesize that depression intervention will improve child outcomes relative to the control group, and we will examine whether it will also result in the convergence of outcomes to those children whose mothers were not depressed prenatally. We will also analyze potential mediators focusing on whether improved parenting quality is an important mechanism linking the depression intervention and child outcomes. Finally, we will determine how the relationship between participating in the intervention and child outcomes varies by factors such as family composition, socioeconomic status, and exposure to interpersonal violence. We expect the results of this research to inform the design of future perinatal depression interventions that will have the greatest protective impact on future generations.