2/2 - Online Collaborative Learning Intervention to Prevent Perinatal Depression

描述（由申请人提供）：产后抑郁症（PPMD）是常见的，发生在大约7%的妇女在分娩后的前三个月。PPMD可能对妇女产生深远的影响，降低生活质量，增加情绪困扰和降低生育能力，并可能增加婴儿发育障碍的风险。越来越多的研究表明，心理治疗可以有效降低PPMD的发病率。此外，绝大多数妇女在怀孕或哺乳期间更喜欢心理治疗而不是药物治疗。然而，存在着许多阻碍妇女获得面对面服务的障碍。 互联网在向围产期妇女提供预防服务方面具有巨大潜力。虽然尚未在该人群中调查此类干预措施，但已经评估了两大类互联网干预措施。个人互联网干预（IIIs），为患者提供 通过访问基于网络的自我管理技能培训计划，已被证明可以有效地减少一般人群的抑郁症，特别是在通过电子邮件或电话辅导提供一些人力支持的情况下。互联网支持小组似乎是围产期妇女常用的。然而，随机对照试验发现它们在减少抑郁症方面无效。关于使用问责制来提高坚持率和应用在线协作学习来提高技能获得的理论表明，III和ISG的仔细整合可以在提高两者方面产生协同效应 在线治疗的依从性和结果，以预防抑郁症。因此，使用网络同行来提高依从性和结果，而不是治疗师或教练，将使这种干预具有高度的可扩展性。 我们已经设计、构建并试用了一个在线干预的原型，我们称之为“分享”，它在功能上整合了III和ISG目标 管理情绪和预防抑郁症的技能。由联网的同行共同设定目标和进行支持性监测，旨在提高对该计划的遵守率。共享学习工具旨在通过小组学习过程加强学习。基于一项试验的良好结果，我们提出了一项随机对照试验来评估共享。妊娠第20-28周的女性将随机接受Share或III，作为最低治疗对照。Share有可能为预防抑郁症提供一种新的模式，这种模式是可访问的，高度可扩展的和具有成本效益的。

DESCRIPTION (provided by applicant): Postpartum major depression (PPMD) is common, occurring in approximately 7% of women in the first three months after childbirth. PPMD can have a profound impact for the woman, decreasing quality of life, increasing emotional distress and reducing caregiving capacity, and can increase the risk of disturbances in infant development. A growing number of studies have shown that psychological treatments are effective at reducing the incidence of PPMD. In addition, women overwhelmingly prefer psychological treatment to medication while pregnant or breast feeding. However, numerous barriers exist that prevent women from accessing face-to-face services. The Internet offers great potential in extending preventive services to women in the perinatal period. While such interventions have not been investigated in this population, two broad classes of internet interventions have been evaluated. Individual Internet Interventions (IIIs), which provide patients with access to web-based self-management skills training programs, have been shown to be effective in reducing depression in general populations, particularly when accompanied by some human support via email or telephone coaching. Internet Support Groups (ISGs) appear to be commonly used by women in the perinatal period. However, randomized controlled trials have found them ineffective at reducing depression. Theories on the use of accountability to improve adherence and the application of online collaborative learning to enhance skill acquisition suggest that a careful integration of III and ISG could have a synergistic effect in improving both adherence and outcomes in online treatments to prevent depression. Thus, use of networked peers to enhance adherence and outcomes, instead of therapists or coaches, would make this intervention highly scalable. We have designed, constructed, and piloted a prototype of an online intervention, which we call "Share" that functionally integrates an III and an ISG targeting skills to manage mood and prevent depression. Shared goal setting and supportive monitoring by networked peers is designed to increase adherence to the program. Shared learning tools are designed to enhance learning through group learning processes. Based on promising results in a pilot, we are proposing an RCT to evaluate Share. Women in weeks 20-28 of their pregnancy will be randomized to receive either Share or an III that will serve as a minimal treatment control. Share has the potential to provide a novel paradigm for the prevention of depression, one that is accessible, highly scalable and cost-effective.