The ROSE Scale-Up Study: Informing a decision about ROSE as universal postpartum depression prevention

ROSE 扩大研究：为有关 ROSE 作为通用产后抑郁症预防的决定提供信息

• 批准号: 10679085
• 负责人: JENNIFER E JOHNSON
• 金额: $ 122.8万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 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 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10679085
• 关键词: Address; Adult; Birth; Clinic; Communities; Counseling; Data; Decision Making; Effectiveness; Electronic Health Record; Enrollment; Ensure; Equity; Evidence based intervention; Evidence based program; Face; Family; General Population; Health system; Healthcare; Home visitation; Incidence; Individual; Infant; Intervention; Interview; Judgment; Licensing; Low income; Measures; Medicaid; Mental Health; Minority; Mothers; Names; Not Hispanic or Latino; Outcome; Perinatal Care; Persons; Postpartum Depression; Pregnancy; Pregnant Women; Prenatal care; Prevention; Prevention approach; Prevention trial; Process; Provider; Public Health; Randomized; Randomized, Controlled Trials; Recommendation; Reporting; Risk; Risk Assessment; Risk Factors; Sampling; Screening procedure; Services; Stigmatization; Structure; Surveys; Testing; Time; Training; United States Preventative Services Task Force; Woman; Work; community setting; cost; cost outcomes; depression prevention; depressive symptoms; effectiveness evaluation; effectiveness trial; enhanced care; ethnic diversity; ethnic minority; evidence base; flexibility; functional improvement; health care settings; implementation barriers; implementation facilitators; implementation strategy; implementation study; implementation trial; indicated prevention; novel; peripartum depression; pregnant; prenatal; prevent; preventive intervention; programs; racial diversity; racial minority; randomized trial; relative effectiveness; scale up; screening; selective prevention; single episode major depressive disorder; social stigma; tool; treatment as usual; trial enrollment; universal prevention

Project Summary/Abstract Postpartum depression (PPD) is a common and impactful public health problem, which can have severe and lasting consequences for the mother and infant, and sometimes the entire family. The Reach Out, Stand Strong, Essentials for New Mothers (ROSE) program is an evidence-based intervention that prevents half of cases of postpartum depression and was one of two interventions recommended by the US Preventive Services Task Force in 2019. All effectiveness trials of ROSE and of the other recommended PPD prevention intervention included only low-income women a single risk factor that doubles incidence of PPD. Thus, the existing evidence base for PPD prevention consists primarily of women at increased risk for PPD. Based on data from the PIs’ current implementation study of ROSE (R01 MH114883), many healthcare and community agencies in this implementation trial (78%) find it is more feasible for them to provide or offer ROSE to every woman as part of their standard work flow (i.e., provide it as universal prevention), than it is to create a screening and referral process for at risk women (i.e., an indicated or selective prevention approach). In addition to being more feasible for agencies, universal prevention may also be advantageous because the cost of a screening false negative (resulting in a preventable case of PPD; $32,000) far exceeds the cost of ROSE delivery ($50-$300/woman). Effectiveness of ROSE among low-income women at risk for PPD is known (ROSE prevents ~50% of PPD cases). To inform a recommendation about using ROSE as universal vs. selective or indicated prevention, we need to determine the effectiveness of ROSE among general populations of women, including women screening negative for PPD risk (defined in various ways). Thus, this project will assess ROSE effectiveness across PPD risk levels and across prevention approaches in a sample of 2,320 women from a large regional health system (based in Detroit, MI). Each proposed aim gathers a piece of information missing that is needed to guide decision-making about ROSE as universal prevention. We will assess ROSE as universal, selective, and indicated prevention in terms of: (1) ROSE effectiveness relative to a control for each prevention approach in preventing PPD and improving functioning; (2) cost- outcome, (3) equity, and (4) scalability of each prevention approach; and (5) mechanisms of ROSE effects across PPD risk levels. We will integrate results to advise about ROSE as universal prevention. This definitive PPD prevention trial will show how best to get an evidence-based program to those who need it in settings where they receive perinatal care by addressing a pragmatic and novel question (should ROSE be universal prevention?) and by examining equity and cost-outcome of universal vs. other prevention approaches.

项目摘要/摘要 产后抑郁症(PPD)是一种常见的、影响深远的公共卫生问题，其严重的 对母亲和婴儿，有时对整个家庭都有持久的影响。伸手，站立 STROSE，Essentials for New Motors(ROSE)计划是一项基于证据的干预措施，可以预防一半的 产后抑郁症的病例，是美国预防中心建议的两种干预措施之一 2019年服务业特别工作组。ROSE和其他推荐的PPD预防的所有有效性试验 干预措施仅包括低收入妇女，这是导致产后抑郁发病率翻倍的单一危险因素。因此， 预防产后抑郁的现有证据主要包括产后抑郁风险增加的妇女。基于 数据来自PIS当前对ROSE(R01 MH114883)、许多医疗保健和社区的实施研究 在这项实施试验中，机构(78%)发现他们提供或提供玫瑰到每个 妇女作为其标准工作流程的一部分(即，将其作为普遍预防提供)，而不是创建 对高危妇女进行筛查和转介的程序(即有针对性或有选择性的预防办法)。在……里面 除了对机构来说更可行之外，普遍预防也可能是有利的，因为成本 筛查假阴性(导致可预防的PPD病例；32,000美元)远远超过ROSE的成本 快递(50-300美元/位)。已知ROSE在有PPD风险的低收入女性中的有效性 (ROSE可预防约50%的产后抑郁病例)。通知有关将ROSE用作通用应用程序与 有选择性或有针对性的预防，我们需要确定ROSE在普通人群中的有效性 妇女，包括筛查PPD风险阴性的妇女(以各种方式定义)。因此，这个项目将 在2,320个样本中评估不同PPD风险水平和不同预防方法的ROSE有效性 来自大型地区卫生系统的妇女(总部设在密歇根州底特律)。每一个提议的目标都收集了一块 缺少关于ROSE作为普遍预防的决策所需的信息。 我们将从以下几个方面评估ROSE的普遍性、选择性和指示性预防：(1)ROSE有效性 关于预防产后抑郁和改善功能的每种预防方法的控制；(2)成本-- 结果；(3)公平；(4)每种预防方法的可扩展性；和(5)玫瑰效应的机制 所有产后抑郁风险水平。我们将综合结果，对ROSE作为普遍预防提供建议。这是决定性的 PPD预防试验将向那些在环境中需要它的人展示如何最好地获得基于证据的计划 在那里，他们通过解决一个务实而新颖的问题(ROSE是否应该是普遍的)来接受围产期护理 预防？)并通过检查普遍预防方法与其他预防方法的公平性和成本结果。