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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

基本信息

批准号：
9267173
负责人：
Erik Orlando Fernandez y Garcia
金额：
$ 17.84万
依托单位：
UNIVERSITY OF CALIFORNIA AT DAVIS
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-06-01 至 2019-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9267173
关键词：
Address Adopted Affect California Caring Center for Translational Science Activities Child Child Care Child Mental Health Child Rearing Child health care Childhood Clinic Clinical Clinical Sciences Cognitive Communities Cultural Diversity Data Data Analyses Data Base Management Depressed mood Depression screen Development Disadvantaged Dose Effectiveness Environment Evaluation Faculty Focus Groups Future Goals Group Interviews Health Health Care Research Health Personnel Health Policy Health Services Research Healthcare Imagery Improve Access Individual Intention Intervention Interview K-Series Research Career Programs Knowledge Language Link Major Depressive Disorder Mental Depression Mental Health Mental Health Services Mentors Methods Mothers Motivation Outcome Parents Participant Patients 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 Reproducibility Research Research Design Research Infrastructure Research Personnel Research Project Grants Research Training Resources Site 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 experimental study health disparity improved intergenerational leadership development maternal depression motivational enhancement therapy negative affect pediatric department pediatrician physical conditioning preference prevent programs public health relevance responsible research conduct theories treatment as usual uptake

项目摘要

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.

描述（由申请人提供）：抑郁症的母亲养育幼儿是常见的和治疗不足。抑郁症使母亲变得虚弱，对他们的养育产生负面影响，并与孩子的心理，行为和身体健康问题有关。识别和治疗患有抑郁症的母亲可以改善母亲的福祉及其子女的心理和整体健康。儿科访问提供了一个潜在的重要机会进行干预。母亲可能比自己更经常看到孩子的儿科医生，这些医生可以激励母亲寻求有效的，未被充分利用的，正式的抑郁症护理，通过沟通如何从抑郁症中恢复与儿童福祉。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，其中包括经过验证的孕产妇抑郁症筛查，以及随后的抑郁症教育和寻求护理的动机信息，这些信息强调了孕产妇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愿和尝试寻求抑郁症护理。[We然后专业地将干预翻译成西班牙语，作为通过在未来的研究中进行改进来增加干预的普遍性的第一步。与作为一揽子措施进行测试的情况一样，我们缺乏经验证据来证明试点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）使用定性数据完善试点测试干预[和西班牙语翻译]的组成部分，（2）使用析因实验评估这些拟议的改进对抑郁症筛查阳性母亲的抑郁症护理寻求的影响。由此产生的干预措施将通过仅包括那些实验上发现最有效的精制成分来暂时优化。这种临时优化的干预措施将有更高的可能性证明可重现的有效性，可能加快实施的速度。[The最终优化的干预措施将改善孕产妇抑郁症护理，成为未来基于儿科的孕产妇抑郁症筛查和有效的基于社区的孕产妇心理健康护理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国家领导者，特别是对弱势环境中的患者，通过为儿科提供者制定干预措施，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，以改善有效但未充分使用的孕产妇抑郁症治疗的获得和使用。我的短期职业目标是获得产妇抑郁症[影响不同人群]和寻求护理干预优化策略的专业知识，并通过（1）更好地了解母亲对基于儿科的产妇抑郁症干预措施的偏好和（2）生产临时优化的基于儿科的干预措施，以增加产妇抑郁症寻求护理。这些目标将通过以下方面的进一步培训和指导来实现：（1）定性研究的设计、实施和分析;（2）设计和分析用于优化多组分干预措施的适应性和因子随机对照试验的数据;（3）[基于社区、文化上适当的]孕产妇心理健康服务[和研究];以及（4）作为儿科医生研究人员的机构和国家职业发展。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：儿科及其相关的多个儿科诊所网站的部门;美国国立卫生研究院临床和转化科学中心;[减少健康差异中心;]医疗保健政策和研究中心;研究生水平的课程在定性研究，赠款写作，健康信息学和职业发展作为临床研究员;数据库管理和统计规划和分析的基础设施;在负责任的研究行为的培训计划;和经验丰富的研究人员指导初级教师，无论是跨部门和儿科系内的重点。ucd有着悠久的合作研究和培训历史，直接关系到这个职业发展奖的目标。