Prevention of Perinatal Depression in Birthing People with a History of Adverse Childhood Experiences: A Type 2 Effectiveness Implementation Trial

预防有童年不良经历史的出生者的围产期抑郁症：2 类有效性实施试验

• 批准号: 10523685
• 负责人: Sheehan David Fisher
• 金额: $ 24万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10523685
• 关键词: Adult; Adverse effects; American; Attention; Belief; Birth; Caring; Case Manager; Categories; Childhood; Clinic; Clinical; Cluster randomized trial; Communication; Data; Depressive disorder; Diagnosis; Discipline; Discipline of obstetrics; Dissemination and Implementation; Divorce; Dose; Effectiveness; Enrollment; Exposure to; Foundations; Generations; Goals; Health Services; Healthcare; Hybrids; Individual; Infrastructure; Infusion procedures; Intervention; Interview; Investigational Therapies; Justice; Life; Life Experience; Location; Low income; Major Depressive Disorder; Masks; Maternal and Child Health; Measures; Mediator of activation protein; Medical; Medical Care Team; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Meta-Analysis; Methods; Modeling; Mothers; Outcome; Participant; Pathogenicity; Perinatal; Persons; Population; Postpartum Period; Poverty; Pregnancy; Prevention; Process; Provider; Public Health; Publishing; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Recording of previous events; Reporting; Research; Research Personnel; Research Training; Risk; Self Efficacy; Services; Sexual abuse; Social support; Structural Racism; Structure; Symptoms; Third Pregnancy Trimester; Trauma; Treatment Protocols; United States; adverse childhood events; adverse outcome; anxiety symptoms; base; childhood adversity; collaborative care; cost; depression prevention; depressive symptoms; design; effectiveness evaluation; effectiveness implementation design; effectiveness implementation study; effectiveness implementation trial; effectiveness trial; emotional abuse; evidence base; experience; follow-up; implementation evaluation; implementation intervention; implementation outcomes; implementation strategy; improved; improved outcome; intergenerational; interpersonal therapy; meetings; multidisciplinary; neglect; obstetric care; offspring; patient registry; perinatal period; peripartum depression; physical abuse; pregnant; prevent; prevention service; preventive intervention; primary care setting; primary outcome; programs; public health insurance; randomized effectiveness trial; randomized trial; reproductive; response; screening; secondary outcome; service intervention; social adversity; socioeconomics; stress symptom; therapy design; traumatic event; treatment as usual

PROJECT SUMMARY Prevention of perinatal depression represents an opportunity to optimize maternal and child health outcomes. However, dissemination and implementation of evidence-based prevention interventions, such as Reach Out, Stand Strong, Essentials for New Mothers (ROSE), are challenged by the complexity of multidisciplinary engagement. The collaborative care model (CCM) is an evidence-based health services intervention designed to integrate mental health care into somatic healthcare contexts and bridge care across medical disciplines. Accordingly, the CCM represents an ideal and pragmatic infrastructure to support the delivery of ROSE within obstetric clinics. Adverse childhood experiences (ACEs) are physical, sexual, and emotional abuses incurred in childhood. A striking 16% of adults in the United States were exposed to at least 4 ACEs, and the burden of ACEs is disproportionately borne by historically and socioeconomically excluded populations. Exposure to ACEs is perniciously associated with somatic and mental health outcomes in adulthood, including perinatal depression. Perinatal depression, in turn, is associated with adverse outcomes in birthing people and their offspring. Mitigation of the intergenerational adverse effects of ACEs, via prevention of perinatal depression, is an essential component of a reproductive justice-focused public health strategy. Built on the foundations of interpersonal therapy (IPT), ROSE is a pertinent evidence-based approach for low- income birthing people with a history of ACEs. ROSE's emphasis on the enhancement of support structures may protect against the impact of ACEs on mental health via overcoming pathogenic beliefs that interfere with healthy interpersonal functioning. This mechanism is particularly salient during the transition to new parenthood as social support can decrease the risk of perinatal depression. The infusion of trauma-informed care into the ROSE intervention, including focused attention on obstetric triggers of trauma and communication of these risks across the multi-disciplinary health care team, alongside implementation of this intervention within the CCM defines Trauma-informed ROSE InterventiOn (TRIO). This project, “Prevention of Perinatal Depression in Birthing People with a History of Adverse Childhood Experiences: A Type 2 Effectiveness Implementation Trial”, aims, via a hybrid type 2 randomized trial, to evaluate TRIO, compared to enhanced treatment as usual. Aim 1 will evaluate wither TRIO improves perinatal depression (both symptom trajectories and dichotomized perinatal depression) among low-income pregnant people with a history of ACEs. Aim 2 will evaluate mechanisms by which TRIO may improve perinatal depression. Aim 3 will examine the acceptability, appropriateness, cost, feasibility, and fidelity of TRIO. This proposal will generate key data to inform the conduct of a full-scale cluster randomized trial of TRIO that will answer the key questions of how to effectively and equitably prevent perinatal depression.

项目总结 预防围产期抑郁是优化孕产妇和儿童健康结果的机会。 然而，传播和实施循证预防干预措施，如联系， 坚定地站起来，新妈妈必备(ROSE)，受到多学科复杂性的挑战 订婚。协作式护理模式(CCM)是一种循证卫生服务干预模式 将精神卫生保健整合到躯体保健环境中，并在医学学科之间架起桥梁。 因此，CCM代表了一个理想和实用的基础设施，以支持ROSE在 产科诊所。 不良童年经历(ACE)是指儿童时期遭受的身体、性和情感虐待。一个 惊人的16%的美国成年人至少接触过4次ACE，而ACE的负担是 不成比例地由历史和社会经济上被排斥的人口承担。暴露于ACEs是 与成年期的躯体和心理健康结局，包括围产期抑郁密切相关。 反过来，围产期抑郁症又与分娩的人及其后代的不良后果有关。 通过预防围产期抑郁，减轻ACE的代际不利影响是至关重要的 这是以生殖正义为重点的公共卫生战略的组成部分。 ROSE建立在人际治疗(IPT)的基础上，是一种针对低血压患者的中肯的循证治疗方法。 有王牌历史的人都有收入。罗斯对加强支撑结构的强调可能 通过克服干扰健康的致病信念来防范ACE对心理健康的影响 人际功能。这一机制在过渡到新父母的过程中尤为突出，因为 支持可以降低围产期抑郁的风险。为玫瑰注入创伤信息的关怀 干预措施，包括重点关注产科创伤的诱因和这些风险的沟通 多学科卫生保健团队，以及在CCM内实施这一干预措施，定义了 创伤知情型玫瑰干预(TRIO)。 该项目名为《在有不良儿童史的分娩人群中预防围产期抑郁》 经验：一项第二类有效性实施试验“，旨在通过第二类混合随机试验评估 三人组，与通常的强化治疗相比。目标1将评估Wyther Trio改善围产期抑郁 (症状轨迹和二分法围产期抑郁)在低收入孕妇中 王牌的历史。目的2将评估TRIO改善围产期抑郁的机制。目标3将 检查三人组的可接受性、适当性、成本、可行性和保真度。该提案将生成密钥 数据用于指导对TRIO进行全面的整群随机试验，该试验将回答以下关键问题 如何有效、公平地预防围产期抑郁症。