Impact of Perinatal Depression treatment on child developmental outcomes

摘要 母亲抑郁症是一种严重的疾病，不仅对抑郁的妇女产生负面影响， 对孩子造成长期的负面影响。特别是，精神健康问题的风险增加， 孩子在整个生命过程中持续存在，并再次传递给下一代。虽然母性 抑郁症的治疗是可用的，在多大程度上，他们因果地改变了孩子的社会情绪， 认知和身体发展轨迹的了解较少。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很好地回答这个重要的问题。 由于后续行动时间不足而产生的问题;在最敏感的 发展阶段;或缺乏适当的比较组。特定干预的成功 取决于多种因素，其中一个关键的可修改因素是干预措施可以改变 抑郁女性的育儿行为。我们的长期目标是确定关键的可改变因素， 从抑郁的母亲到孩子的风险代际传递。本研究的目的是 严格评估从产前开始并持续进行的围产期抑郁干预的影响 产后6个月，对儿童发育的影响。我们将通过合并和全面整合， 与一个资助的围产期抑郁干预集群RCT（共享：U19MH095687）。除了 招募将参加SHARE试验的抑郁症女性，我们还将招募一部分非抑郁症女性， 抑郁症妇女，并随访产后至少36个月的母子配对。注册不 抑郁的母亲使我们能够确定干预在多大程度上可以导致平等 治疗抑郁和非抑郁组之间的关系，以及确定潜在的正外部性 干预组中的非抑郁女性。这些方法将共同提供决定性的证据， 围产期抑郁干预对儿童发育结果的因果影响。我们假设 抑郁症干预将改善儿童的结果相对于对照组，我们将检查 它是否也会导致那些母亲没有抑郁症的孩子的结果趋同 产前我们还将分析潜在的调解人，重点是提高养育质量是否是一个重要因素。 抑郁症干预与儿童结局之间的重要机制。最后，我们将确定如何 参与干预和儿童结果之间的关系因家庭等因素而异， 组成，社会经济地位和暴露于人际暴力。我们期待这一结果 研究为未来围产期抑郁症干预措施的设计提供信息， 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.