Impact of Perinatal Depression treatment on child developmental outcomes

围产期抑郁症治疗对儿童发育结果的影响

• 批准号: 8842151
• 负责人: Joanna Maselko
• 金额: $ 43.37万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8842151
• 关键词: Asia; Attention; Behavioral Mechanisms; Child; Child Development; Child Rearing; Cognitive; Collaborations; Communities; Control Groups; Depressed mood; Development; Disease; Emotional; Enrollment; Exposure to; Family; Feasibility Studies; Funding; Future; Future Generations; Goals; Health; Individual; International; Interpersonal Violence; Intervention; Intervention Trial; Knowledge; Lead; Life; Life Cycle Stages; Link; Mediating; Mediator of activation protein; Mental Depression; Mental Health; Mothers; National Institute of Mental Health; Outcome; Pakistan; Perinatal; Policy Maker; Postpartum Period; Randomized; Randomized Controlled Trials; Relative (related person); Research; Resources; Risk; Role; Sampling; Social Environment; Socioeconomic Status; Time; United States National Institutes of Health; Woman; antepartum depression; arm; base; comparison group; cost; cost effective; design; experience; follow-up; improved; innovation; insight; intergenerational; intervention effect; maternal depression; next generation; novel; offspring; peripartum depression; psychologic; success; transmission process; trial comparing

DESCRIPTION (provided by applicant): 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 life course 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.

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，而且对她的孩子产生长期的负面影响。具体来说，儿童心理健康问题的风险增加持续超过 生命周期，并再次传递给下一代。虽然母亲抑郁症的治疗是可用的，但他们在多大程度上因果地改变孩子的社会情感，认知和身体发育轨迹还不太清楚。重要的是，比较多种抑郁症干预措施的随机对照试验还没有很好地回答这个重要问题，因为随访期不足;干预措施在最敏感的发育期之后开始;或者缺乏适当的比较组。一个特定干预的成功取决于多种因素，其中一个关键的可变因素是干预可以在多大程度上改变抑郁症女性的育儿行为。我们的长期目标是确定代际传递中的关键可变因素 一个抑郁的母亲对她的孩子的风险。本研究的目标是严格评估产前开始并持续到产后6个月的围产期抑郁症干预对儿童发育的影响。我们将通过结合并完全整合一项受资助的围产期抑郁干预集群RCT（SHARE：U19 MH 095687）来实现这一目标。除了招募将参与SHARE试验的抑郁女性外，我们还将招募一部分非抑郁女性，并对母子二人组进行产后至少36个月的随访。登记不抑郁的母亲，使我们能够确定在何种程度上的干预可以导致治疗抑郁症和非抑郁症组之间的等效性，以及确定潜在的正外部性，以非抑郁症的妇女在干预arm. Together，这些方法将产生决定性的证据的因果关系的影响围产期抑郁症干预对儿童发育的结果。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收敛的结果，以那些孩子的母亲产前没有抑郁症。我们还将分析潜在的调解人，重点是改善父母的质量是否是一个重要的机制联系抑郁症干预和儿童的结果。最后，我们将确定参与干预和儿童结果之间的关系如何因家庭组成，社会经济地位和人际暴力暴露等因素而变化。我们希望这项研究的结果能够为未来围产期抑郁症干预措施的设计提供信息，这些干预措施将对后代产生最大的保护作用。