Treatment Initiation for New Episodes of Depression in Pregnant Women

项目摘要 高达12%的孕妇有一个新的抑郁症发作，即一个事件或复发性抑郁症 怀孕期间出现症状。未经治疗的产前抑郁症的影响包括不健康的 母亲的行为（例如，减少自我照顾，吸烟，物质使用，自我伤害）和情绪和 后代的行为问题。通过筛选确定的产后抑郁或抑郁评分升高 工具，增加早产（PTB），低出生体重（LBW）和小于胎龄儿的风险 (SGA)分娩，并与产后3个月前停止母乳喂养有关。面对面 心理治疗和抗抑郁药物可以改善许多抑郁症患者的抑郁症状， <50%的新抑郁症发作的孕妇开始接受这些治疗。虽然有些障碍， 开始抗抑郁药和心理治疗是已知的，其他因素还没有得到很好的描述，特别是 考虑到抑郁症的严重程度此外，抗抑郁药和心理治疗对 围产期结局，包括PTB，LBW，SGA，以及患有 在解释了抑郁严重程度的混杂因素后，新的抑郁发作是未知的。 考虑到影响开始抗抑郁药或心理治疗决定的重要因素 以及需要进一步的证据，说明与妊娠期避孕有关的围产期风险和益处。 抗抑郁药的使用和心理治疗的孕妇，这项研究的目的是确定预测因素， 心理治疗和抗抑郁药对妊娠期新发抑郁症的围产期影响 同时考虑到抑郁的严重程度。我们将在一个种族和民族多元化的多- 网站使用电子健康数据，从一个子集的妇女调查数据丰富的人口。 在有新的抑郁症发作的孕妇中，我们将评估影响抑郁症的因素。 倾向于开始心理治疗或抗抑郁药;在研究治疗时，考虑这些是至关重要的 方面的影响.我们将描述使用替代抑郁症管理方法的模式（例如，互联网- 基于心理治疗，同伴支持小组，补充和替代医学），并将评估 心理治疗或抗抑郁药的开始是否与这些做法有关， 抑郁症的严重程度我们将量化心理治疗和抗抑郁药的影响（包括剂量，时间， 和使用持续时间）对PTB、LBW、SGA和继续母乳喂养的影响 开始心理治疗或抗抑郁药和抑郁症的严重程度。 我们处于独特的地位，可以克服先前研究中的混杂和小尺寸的限制， 超过8,000名孕妇的抑郁症严重程度和母亲合并症数据。我们的研究将是 为了解抑郁症孕妇使用的心理健康干预措施提供信息， 将为怀孕期间最佳抑郁症管理的决策提供信息。

PROJECT SUMMARY Up to 12% of pregnant women have a new episode of depression, ie, an incident or recurrent depressive episode with symptom onset during pregnancy. Effects of untreated antenatal depression include unhealthy maternal behaviors (eg, diminished self-care, smoking, substance use, self-harm) and emotional and behavioral problems in offspring. Antenatal depression or elevated depression scores, identified by screening instruments, increase the risk of preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) birth, and are associated with breastfeeding discontinuation before 3 months postpartum. In-person psychotherapy and antidepressant medication improve depression symptoms in many with depression, yet <50% of pregnant women with new episodes of depression initiate these treatments. Although some barriers to initiating antidepressants and psychotherapy are known, other factors have not been well described, especially after accounting for depression severity. Furthermore, the impact of antidepressants and psychotherapy on perinatal outcomes, including PTB, LBW, SGA, and breastfeeding continuation among pregnant women with new episodes of depression after accounting for confounding by depression severity is unknown. Given the importance of factors influencing the decision to initiate antidepressant or psychotherapy treatment during pregnancy and the need for further evidence on the perinatal risks and benefits associated with antidepressant use and psychotherapy in pregnant women, the goal of this study is to identify predictors and perinatal effects of psychotherapy and antidepressant use for new episodes of depression during pregnancy while accounting for depression severity. We will conduct this study in a racially and ethnically diverse multi- site population using electronic health data, enriched with survey data from a subset of women. Among pregnant women with new episodes of depression, we will evaluate factors that influence the propensity to initiate psychotherapy or antidepressants; accounting for these is crucial when studying treatment effects. We will describe patterns of use of alternative depression management approaches (eg, Internet- based psychotherapy, peer support groups, and complementary and alternative medicine) and will evaluate whether initiation of psychotherapy or antidepressants is associated with these practices while accounting for depression severity. We will quantify the impact of psychotherapy and antidepressants (including dose, timing, and duration of use) on PTB, LBW, SGA, and breastfeeding continuation accounting for the propensity to initiate psychotherapy or antidepressants and depression severity. We are uniquely positioned to overcome limitations of confounding and small size in prior studies given our data on depression severity and maternal comorbidity for more than 8,000 pregnant women. Our study will be informative for understanding the mental health interventions utilized by pregnant women with depression and will inform decision making on optimal depression management during pregnancy.