Preventing Postpartum Depression: A Dyadic Approach Adjunctive to Obstetric Care

项目总结/摘要 在美国每年近400万的活产婴儿中，大约有56万，即14%， 妇女在产后的头四个月内会患上抑郁症。后果是巨大的： 妇女的生活质量下降，情绪受到严重影响。PPD预测母婴减少 在社交情感和认知发展方面，对一些人来说，结果很差。依靠标准 药物和心理干预，PPD治疗不足，部分原因是妇女不愿意 由于与精神卫生保健有关的耻辱而寻求治疗， 医疗保健预约，以及母乳喂养时不愿意服用药物。PPD的风险因素包括 相对来说，轮廓清晰。尽管产前抑郁症状是最可靠的 PPD的预测因子、循证、预防性干预措施很少。在预防性干预措施中， 利用生育期独特的二元取向或将服务嵌入产科护理。到 为了解决PPD预防和治疗方面的巨大知识缺口，我们开发了（R21 MH 092665 -01） 并在一项初步随机对照试验（RCT）中测试了一种名为PREPP（实用）的新干预措施 有效的产后育儿资源），并根据有希望的公布数据，我们建议进行 一个更大的RCT PREPP招募有PPD风险的孕妇，涵盖妊娠晚期至6- 产后一周检查它包括四次与产科（OB）相关的面对面“指导”会议。 产前和产后的预约，还有一次电话咨询。PREPP包括（a）正念和自我- 反思技能，（B）父母养育技能和（c）心理教育。对于这个项目，我们有三个研究 目的是在214例妊娠晚期妇女的PREPP与强化治疗的临床RCT中实现 (ages 18-35）在妊娠期和产后6、12和16周评估2次PPD风险：（1）降低 妇女在怀孕期间的痛苦（2）确定改善产妇情绪的维持， 婴儿行为的差异（3）确定PREPP对母亲产生积极影响的一些途径- 婴儿二分体PREPP在PPD的新概念和设计方面具有创新性，以克服 PPD治疗。PPD的传统临床方法将个人作为重点，并改善他们的 症状在PREPP中，PPD被视为母婴二分体的潜在疾病， 通过母亲的预防性心理和行为变化来处理-从 这会影响到她和孩子。PREPP证明了医疗保健创新的先锋，旨在 通过将行为健康服务与初级卫生保健相结合，增加金属卫生保健的使用。的 拟议的研究意义重大，因为它有望促进PPD的治疗和预防， 产生关于产后头几个月母婴口腔影响的新知识。

PROJECT SUMMARY/ABSTRACT Of the nearly 4 million live births each year in the United States, approximately 560,000, or 14% of these women will develop depression within the first four months postpartum. The consequences are substantial: diminished quality of life and significant emotional suffering for women. PPD predicts diminished mother–infant bonding and poor outcomes in social–emotional and, for some, cognitive development. Relying on standard pharmacologic and psychological interventions, PPD is undertreated in part because women are reluctant to seek treatment due to the stigma associated with mental health care, logistical barriers to attending added health care appointments, and disinclination to take medications while breastfeeding. Risk factors for PPD are relatively well delineated. Even though prenatal depressive symptoms are some of the most reliable predictors, evidenced–based, preventive interventions for PPD are rare. Of the preventative interventions, few leverage the unique dyadic orientation of the childbearing period or imbed services in obstetrical care. To address the huge knowledge gap in the prevention and treatment of PPD, we developed (R21MH092665–01) and tested in a preliminary randomized control trial (RCT) a new intervention called PREPP (Practical Resources for Effective Postpartum Parenting) and, following promising published data, we propose to conduct a larger RCT of this treatment. PREPP enrolls pregnant women at risk for PPD, spans late pregnancy to the 6– week postpartum check up. It consists of four in–person `coaching' sessions adjunctive to obstetrical (OB) prenatal and postnatal appointments, and one phone session. PREPP includes (a) mindfulness and self– reflection skills, (b) parenting skills and (c) psycho–education. For this proposed project, we have three study aims to be realized in a PREPP vs Enhanced Treatment as Usual RCT of 214, 3rd trimester pregnant women (ages 18–35) at risk for PPD assessed 2x in pregnancy and at 6, 12, and 16 weeks postpartum: (1) Reduce women's distress during pregnancy (2) Determine the maintenance of improved maternal mood and differences in infant behavior (3) Identify some of the pathways by which PREPP positively affects the mother– infant dyad. PREPP is innovative in its novel conceptualization of PPD and design to overcome barriers to PPD treatment. The traditional clinical approach to PPD has as a focus the individual and improving their symptoms. In PREPP, PPD is viewed as a potential disorder of the mother–infant dyad, which can be approached through preventive psychological and behavioral changes in the mother — commencing before birth — that affect her and the child. PREPP exemplifies the vanguard of health care innovations aiming to increase metal health care uptake by integrating behavioral health services with primary health care. The proposed research is significant because it is expected to advance the treatment and prevention of PPD, and generate new knowledge about mother–infant behav-ioral influences during the first months of postnatal life.