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

点击翻译按钮获取中文摘要

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.