Optimizing a Pediatric Intervention to Increase Maternal Depression Care-Seeking

优化儿科干预措施以增加母亲抑郁症就医的机会

• 批准号: 8700234
• 负责人: Erik Orlando Fernandez y Garcia
• 金额: $ 18.06万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8700234
• 关键词: Address; Adopted; Affect; California; Caring; Center for Translational Science Activities; Child; Child Care; Child Mental Health; Child health care; Childhood; Clinic; Clinical; Clinical Sciences; Cognitive; Communities; Data; Data Analyses; Data Base Management; Depressed mood; Depression screen; Development; Disadvantaged; Dose; Effectiveness; Endogenous depression; Environment; Evaluation; Faculty; Focus Groups; Future; Goals; Group Interviews; Health; Health Personnel; Health Policy; Health Services Research; Healthcare; Imagery; Improve Access; Individual; Intention; Intervention; Interview; K-Series Research Career Programs; Knowledge; Language; Leadership; Link; Mental Depression; Mental Health; Mental Health Services; Mentors; Methods; Mothers; Outcome; Parenting behavior; Parents; Participant; Patients; Personal Satisfaction; Population Heterogeneity; Positioning Attribute; Probability; Provider; Psyche structure; Psychological reinforcement; Public Health; Public Health Informatics; Qualitative Methods; Qualitative Research; Randomized Controlled Trials; Recording of previous events; Recovery; Research; Research Design; Research Infrastructure; Research Personnel; Research Project Grants; Research Training; Resources; Site; Solutions; Speed; Symptoms; System; Telephone; Terminology; Testing; Training; Training Programs; Translating; Translations; United States National Institutes of Health; Universities; Visit; Woman; Work; Writing; base; behavioral health; care seeking; career; career development; depression education; depressive symptoms; design; effective intervention; experience; health disparity; improved; intergenerational; maternal depression; motivational enhancement therapy; pediatric department; pediatrician; physical conditioning; preference; prevent; programs; public health relevance; research study; responsible research conduct; theories; treatment as usual; uptake

PROJECT SUMMARY/ABSTRACT Depression in mothers parenting young children is common and undertreated. Depression is debilitating for mothers, negatively affects their parenting, and is associated with mental, behavioral, and physical health problems in their children. Identifying and treating mothers with depression improves both the mothers' well-being and their children's mental and overall health. Pediatric visits offer a potential significant opportunity to intervene. Mothers may see their child's pediatric provider more often than their own, and these providers could motivate mothers to seek effective, underutilized, formal depression care, by communicating how recovery from depression is linked to child well-being. Therefore, in recent pilot work, we developed a pediatric setting-based intervention that includes a validated maternal depression screen, and subsequent depression education and care-seeking motivational messages that emphasize the benefits of maternal depression care for children. Initial testing demonstrated that depression screen-positive mothers receiving the intervention had greater intention and attempts to seek depression care compared to mothers receiving usual care. [We then professionally translated the intervention into Spanish as a first step in increasing the generalizability of the intervention through refinement in future studies.] As is often the case with interventions tested as a package, we lack empirical evidence on which components of the pilot intervention deliver the greatest effects. Therefore, we propose to adopt a rapid-cycle intervention improvement approach. We will: (1) refine the components of the pilot-tested intervention [and a Spanish-language translation] using qualitative data and (2) assess the effects of those proposed refinements on depression screen-positive mothers' depression care- seeking, using factorial experiments. The resulting intervention will be provisionally optimized by including only those refined components found to be most experimentally efficacious. This provisionally optimized intervention will have a higher probability of demonstrating reproducible effectiveness, potentially speeding the way to implementation. [The ultimate optimized intervention will improve maternal depression care by being an essential link in future integrated systems between pediatric-based maternal depression screening and effective community-based programs for maternal mental health care.] My long-term career goal is to become a national leader in improving intergenerational mental health, particularly for patients in disadvantaged settings, by developing interventions for pediatric providers to guide parents to effective, [integrated] mental and behavioral health care for themselves and their children. My medium-term career goal is to develop pediatric-based interventions for improving access to and uptake of effective but underused maternal depression therapies. My short-term career goals are to acquire expertise in maternal depression [affecting diverse populations] and in care-seeking intervention optimization strategies, and to advance the field by (1) better understanding mothers' preferences for pediatric-based maternal depression interventions and (2) producing a provisionally optimized pediatric-based intervention to increase maternal depression care-seeking. These goals will be achieved through further training and mentoring in (1) qualitative research design, implementation, and analysis; (2) design and analysis of data from adaptive and factorial randomized-controlled trials used in the optimization of interventions with multiple components; (3) [community-based, culturally appropriate] maternal mental health services [and research]; and (4) institutional and national career progression as a pediatrician-researcher. The proposed research will be conducted at the University of California, Davis (UCD). The research and training environment at UCD supporting the proposed work includes: the Department of Pediatrics and its associated multiple pediatric clinic sites; the NIH Clinical and Translational Science Center; [the Center for Reducing Health Disparities;] the Center for Healthcare Policy and Research; graduate level courses in qualitative research, grant writing, health informatics, and career development as a clinician-researcher; infrastructure for database management and statistical planning and analysis; a training program in the responsible conduct of research; and an emphasis on experienced researchers mentoring junior faculty, both interdepartmentally and within the Department of Pediatrics. UCD has a long history of collaborative research and training directly relevant to the aims of this Career Development Award.

项目总结/摘要 在养育幼儿的母亲中，抑郁症很常见，而且治疗不足。抑郁症是 使母亲衰弱，对他们的养育产生负面影响，并与精神，行为和 孩子的身体健康问题。识别和治疗患有抑郁症的母亲， 母亲的幸福以及子女的心理和整体健康。儿科访视提供了潜在的重要 有机会介入。母亲可能会看到他们的孩子的儿科提供者比自己更频繁，这些 提供者可以激励母亲寻求有效的，未充分利用的，正式的抑郁症护理， 抑郁症的康复与儿童健康的关系因此，在最近的试点工作中，我们开发了一种 基于儿科环境的干预，包括经验证的母亲抑郁筛查，以及随后的 抑郁症教育和寻求护理的动机信息，强调产妇的好处， 抑郁症儿童护理 初步测试表明，接受干预的抑郁症筛查阳性母亲 与接受常规护理的母亲相比，寻求抑郁症护理的意愿和尝试更大。[We然后 专业翻译成西班牙语的干预作为第一步，增加了普遍性， 在未来的研究中通过改进进行干预。作为一揽子试验的干预措施往往如此， 我们缺乏经验证据来证明试点干预措施的哪些组成部分产生了最大的效果。 因此，我们建议采用快速循环的干预改善方法。我们将：（1）完善 使用定性数据的试点测试干预措施的组成部分[和西班牙语翻译]，以及（2） 评估这些改进措施对抑郁症筛查阳性母亲的抑郁症护理的影响， 寻找，使用因子实验。由此产生的干预措施将暂时优化， 发现这些精制组分在实验上最有效。这个临时优化的 干预将有更高的可能性证明可重复的有效性，可能会加快 执行的方式。[The最终优化的干预措施将改善孕产妇抑郁症护理， 未来基于儿科的孕产妇抑郁症筛查与 有效的以社区为基础的产妇心理保健方案。 我的长期职业目标是成为改善代际心理健康的国家领导者， 特别是对于处于不利环境中的患者，通过为儿科提供者制定干预措施， 父母为自己和孩子提供有效的[综合]精神和行为健康护理。我 中期职业目标是开发以儿科为基础的干预措施，以改善获得和吸收 有效但未被充分利用的母亲抑郁症疗法。我的短期职业目标是获得专业知识， 产妇抑郁症[影响不同人群]和寻求护理干预优化策略， 并通过（1）更好地了解母亲对基于儿科的孕产妇 抑郁症干预和（2）产生一个临时优化的儿科为基础的干预，以增加 母亲抑郁症寻求护理。这些目标将通过以下方面的进一步培训和指导来实现： 定性研究的设计、实施和分析;（2）设计和分析自适应和 用于优化多组分干预措施的析因随机对照试验;（3） [以社区为基础的、文化上适当的]产妇心理健康服务[和研究];以及（4）机构 和国家职业发展的儿科研究员。 拟议的研究将在加州大学戴维斯分校（UCD）进行。研究 和培训环境在UCD支持拟议的工作包括：儿科系及其 相关的多个儿科诊所网站; NIH临床和转化科学中心; [该中心 减少健康差距;]医疗保健政策和研究中心;研究生水平的课程， 定性研究，赠款写作，健康信息学和职业发展作为一个临床研究员; 数据库管理和统计规划与分析的基础设施; 负责任的研究行为;并强调经验丰富的研究人员指导初级教师， 部门间和儿科内部。UCD有着悠久的合作研究历史 与本职业发展奖的目标直接相关的培训。