Optimizing a Pediatric Intervention to Increase Maternal Depression Care-Seeking

描述(由申请者提供)：母亲养育年幼孩子的抑郁症很常见，而且没有得到充分治疗。抑郁使母亲虚弱，对她们的育儿方式产生负面影响，并与她们孩子的心理、行为和身体健康问题有关。识别和治疗患有抑郁症的母亲既改善了母亲的幸福感，也改善了她们孩子的心理和整体健康。儿科就诊为干预提供了一个潜在的重要机会。母亲可能会比自己更频繁地去看孩子的儿科提供者，这些提供者可以通过传播抑郁症的康复与儿童健康的关系来激励母亲寻求有效的、未得到充分利用的正规抑郁症护理。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措施，包括有效的母体抑郁症筛查，以及随后的抑郁症教育和寻求护理的激励信息，强调母体抑郁症护理对儿童的好处。初步测试表明，与接受常规护理的母亲相比，接受干预的抑郁症筛查阳性母亲有更大的意图和尝试寻求抑郁护理。[然后，我们专业地将干预翻译成西班牙语，作为通过在未来的研究中改进来增加干预的普遍性的第一步。]与通常将干预措施作为一揽子措施进行测试的情况一样，我们缺乏关于试点干预措施哪些组成部分产生最大效果的经验证据。因此，我们建议采用快速周期干预改进方法。我们将：(1)使用定性数据改进试点测试干预措施的组成部分[和西班牙语翻译]，以及(2)使用析因实验评估这些建议的改进对抑郁症筛查阳性母亲寻求抑郁症护理的影响。由此产生的干预措施将暂时优化，只包括那些被发现在实验上最有效的精炼成分。这种暂时优化的干预措施将有更高的概率展示可重复的有效性，潜在地加快实施的速度。[最终优化的干预措施将改善产妇抑郁护理，因为它是未来以儿科为基础的产妇抑郁筛查和有效的以社区为基础的产妇精神卫生保健计划之间的综合系统中的重要环节。]我的长期职业目标是成为改善代际心理健康的全国领导者，特别是为处境不利的患者制定干预措施，指导父母为自己和孩子提供有效的[综合]心理和行为健康护理。我的中期职业目标是开发以儿科为基础的干预措施，以改善有效但未得到充分利用的孕产妇抑郁疗法的获得和接受。我的短期职业目标是获得母亲抑郁[影响不同人群]和寻求护理干预优化策略方面的专业知识，并通过(1)更好地了解母亲对以儿科为基础的母亲抑郁干预措施的偏好和(2)产生临时优化的基于儿科的干预措施来增加母亲寻求母亲抑郁的护理，从而推动该领域的发展。这些目标将通过以下方面的进一步培训和指导来实现：(1)定性研究的设计、实施和分析；(2)自适应和因素随机对照试验的数据设计和分析，这些试验用于优化具有多种成分的干预措施；(3)[基于社区的、文化上适当的]产妇心理健康服务[和研究]；(4)机构和国家的儿科医生-研究员职业发展。这项拟议的研究将在加州大学戴维斯分校(UCD)进行。UCD支持拟议工作的研究和培训环境包括：儿科及其相关的多个儿科诊所站点；NIH临床和转换科学中心；[减少健康差距中心；]医疗保健政策和研究中心；研究生水平的课程，定性研究、补助金撰写、健康信息学和作为临床医生-研究员的职业发展；数据库管理和统计规划和分析的基础设施；负责进行研究的培训计划；以及强调有经验的研究人员指导系间和儿科系内的初级教员。UCD在与这一职业发展奖的目标直接相关的合作研究和培训方面有着悠久的历史。

DESCRIPTION (provided by applicant): 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 probabilit 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.