Responsive eHealth Intervention for Perinatal Depression in Healthcare Settings

项目摘要 围产期抑郁症（至少14-20%的孕妇和产后妇女经历过）被认为是 最常见的分娩并发症，并具有极其严重的后果，包括 孕妇/新妈妈及其家庭遭受重大痛苦，对婴儿的不利影响 发展不幸的是，有许多障碍，使妇女很难与围产期抑郁症 获得基于诊所的心理健康治疗，参与率很低。治疗吸收受限于 心理障碍（耻辱感，失败感和尴尬）;知识障碍（贫困） 了解围产期抑郁症对婴儿健康的影响，不确定在哪里得到治疗）; 基础设施障碍（害怕护理提供者的负面判断，避免处方药 农村环境中的物理障碍（护理提供者太少，后勤服务不可接受） 对时间、交通和儿童保育的要求）;以及提供者层面的障碍（技能不足，害怕承担责任， 缺乏治疗选择，报销不足）。为了满足这一需求，我们获得了NIMH的资助， （R 01 MH 084931）开发和测试MomMoodBooster程序（MMB），这是一个基于Web的创新程序， 产后抑郁症（PPD）的治疗。基于认知行为疗法（CBT）和 结合多媒体建模和吸引人的活动，MMB旨在使妇女能够识别 他们的思想和行为模式，并制定一个个人行动计划，使有益的变化。MMB 也有一个管理网站，供项目经理和支持电话教练使用 以监测参与者的整体进展。在我们的SBIR第一阶段赠款（R43 MH 109191）中，我们开始了一项 重新设计MMB，使其能够更有效地用作PPD治疗产品， 实际的医疗保健提供组织。具体来说，我们增强了底层数据库体系结构 (and相关的管理网站界面），使多个组织更容易在多个 设置使用MMB。在我们建议的SBIR第二阶段，我们建议完成制定 适合医疗保健组织工作流程和人员配备的商业就绪产品（MMB 2.0）。 具体而言，我们建议完成数据库架构及其管理站点的增强， 扩大MMB，包括产前以及产后抑郁症的妇女，并提供MMB使用新的 响应式设计技术，以便女性能够与任何可通过互联网访问的 计算机设备（台式机、笔记本电脑、平板电脑、智能手机）。最后，我们计划使用2组随机对照 一项在大型医疗机构中评价MMB 2.0与常规治疗相比的疗效的试验。

PROJECT SUMMARY Perinatal depression (experienced by at least 14-20% of pregnant and postpartum women) is recognized as the most common complication of childbirth and as having extremely serious consequences, including significant suffering for pregnant women/new mothers and their families, and adverse impacts on infant development. Unfortunately, there are many barriers that make it difficult for women with perinatal depression to access clinic-based mental health treatments, and participation is low. Treatment uptake is limited by psychological barriers (stigma, feelings of failure, and embarrassment); knowledge barriers (poor understanding about impact of perinatal depression on infant health, uncertainty about where to get treatment); infrastructure barriers (fear of negative judgment from care providers, avoidance of prescription medications while breastfeeding); physical barriers in rural settings (too few care providers, unacceptable logistical demands on time, transportation, and childcare); and provider-level barriers (inadequate skills, fear of liability, dearth of treatment options, and inadequate reimbursement). To address this need, we obtained NIMH funding (R01MH084931) to develop and test the MomMoodBooster program (MMB), an innovative Web-based program for treating postpartum depression (PPD). Based on cognitive behavioral therapy (CBT) and incorporating multimedia modeling and engaging activities, MMB is designed to enable women to identify patterns in their thoughts and behaviors and to develop a personal action plan to make helpful changes. MMB also has an administrative website designed for use by both project managers and supportive phone coaches to monitor the overall progress of participants. In our SBIR Phase I grant (R43MH109191), we began a redesign of MMB so that it could be used more effectively as a product for delivering PPD treatment by practical healthcare delivery organizations. Specifically, we enhanced the underlying database architecture (and the related administration website interface) to make it easier for multiple organizations in multiple settings to use MMB. In our proposed SBIR Phase II, we propose to complete the process of making a commercial-ready product (MMB 2.0) that fits the workflow and staffing of healthcare organizations. Specifically, we propose to finish the enhancement of the database architecture and its administrative site, to expand MMB to include prenatal as well as postpartum depressed women, and to deliver MMB using a new responsive design technology so that women will be able to use it interchangeably with any internet-accessible computer device (desktop, laptop, tablet, smartphone). Finally, we plan to use a 2-arm randomized controlled trial to evaluate the efficacy of MMB 2.0 compared to treatment as usual in a large healthcare setting.