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