Treatment Initiation for New Episodes of Depression in Pregnant Women

项目总结 多达12%的孕妇有新的抑郁症发作，即偶发或反复发作的抑郁症 在怀孕期间出现症状的发作。未经治疗的产前抑郁的影响包括不健康 母性行为(例如，减少自我照顾、吸烟、吸毒、自残)和情绪和 后代的行为问题。产前抑郁或抑郁评分升高，通过筛查确定 仪器，增加早产(PTB)、低出生体重(LBW)和小于胎龄儿的风险 (SGA)出生，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改善了许多抑郁症患者的抑郁症状，但 有新的抑郁症发作的孕妇中有50%开始进行这些治疗。尽管存在一些障碍， 启动抗抑郁药物和心理治疗是已知的，其他因素还没有很好地描述，特别是 在考虑了抑郁症的严重程度后。此外，抗抑郁药物和心理治疗对 围产儿结局，包括肺结核、LBW、SGA和继续母乳喂养的孕妇 新的抑郁症发作后，由抑郁症严重程度造成的混乱是未知的。 考虑到影响决定开始抗抑郁药物或心理治疗的因素的重要性 在怀孕期间，以及需要进一步证据表明与以下疾病相关的围产期风险和益处 在孕妇中抗抑郁药物的使用和心理治疗，本研究的目标是确定预测因素和 心理治疗和抗抑郁药物使用对妊娠期新发抑郁的围产儿影响 同时考虑了抑郁症的严重程度。我们将在种族和民族多元化的多- 网站人口使用电子健康数据，丰富了来自妇女子集的调查数据。 在有新的抑郁症发作的孕妇中，我们将评估影响 倾向于开始心理治疗或抗抑郁药物；在研究治疗时，考虑到这些是至关重要的 效果。我们将描述替代抑郁症治疗方法的使用模式(例如，互联网- 以心理治疗、同伴支持小组、补充和替代医学为基础)，并将评估 是否开始心理治疗或抗抑郁药物与这些做法有关，同时解释 抑郁症的严重程度。我们将量化心理治疗和抗抑郁药物的影响(包括剂量、时机、 和使用时间)对PTB、LBW、SGA和母乳喂养持续时间的影响 开始心理治疗或抗抑郁药物和抑郁严重程度。 我们处于独特的地位，可以克服先前研究中的混淆和小尺寸的限制，因为我们的 关于8000多名孕妇的抑郁症严重程度和母亲共病的数据。我们的研究将是 有助于了解患有抑郁症的孕妇使用的心理健康干预措施 将为怀孕期间最佳抑郁治疗的决策提供信息。

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.