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A novel app-based cognitive behavioral therapy intervention for preventing postpartum depression

一种基于应用程序的新型认知行为治疗干预措施，用于预防产后抑郁症

基本信息

批准号：
10682615
负责人：
Adam Korrick Lewkowitz
金额：
$ 17.99万
依托单位：
WOMEN AND INFANTS HOSPITAL-RHODE ISLAND
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10682615
关键词：
Affect American College of Obstetricians and Gynecologists Area Behavior Biometry Birth Breast Feeding COVID-19 Cellular Phone Child Child Care Childbirth Childhood Client satisfaction Cognitive Cognitive Therapy Consent Control Groups Coping Skills Data Depression screen Development Diagnosis Disparity Education Educational Curriculum Educational process of instructing Equity Evaluation Feedback Focus Groups Funding Goals Health Insurance High Risk Woman Impairment Individual Infant Infant Care Internet Intervention Intervention Studies Interview K-Series Research Career Programs Low income Measures Medical Mental Depression Mental Health Mental Health Services Mental disorders Mentors Mentorship Mothers Outcome Study Parenting Education Perinatal Perinatal Care Persons Phase Physiological Postpartum Depression Postpartum Period Postpartum Women Pregnancy Pregnant Women Prevalence Prevention Preventive Protocols documentation Psychology Questionnaires Randomized Randomized, Controlled Trials Recommendation Recording of previous events Reporting Research Research Methodology Research Personnel Research Project Grants Risk Risk Factors Services Social support Symptoms System Technology Testing Text Messaging Therapeutic Intervention Time Training Transportation United States United States National Institutes of Health United States Preventative Services Task Force Unmarried Visit Woman acceptability and feasibility adaptive intervention aged antenatal barrier to care base cognitive development depressive symptoms design digital health effective intervention efficacy testing ethnic diversity experience falls feasibility trial food insecurity group intervention health equity high risk implementation barriers improved improved outcome innovation innovative technologies insight maternal morbidity multidisciplinary novel obstetric outcomes patient oriented patient oriented research perinatal mental health pilot trial postpartum health prevent primary outcome programs prototype racial diversity randomized trial recruit response screening screening guidelines secondary outcome smartphone application structural determinants telehealth tool trial design usability women of color

项目摘要

The prevalence of depression is high after childbirth: rates of postpartum depression (PPD) are as high as 25% among women without prior PPD or depression but with personal or structural risk factors such as being low- income or a women of color, among others. As such, the American College of Obstetricians and Gynecologists recommends screening women for PPD. However, disparities in postpartum mental health care exist: <60% of women attend post-partum visits where PPD screening occurs, and barriers such as lack of transportation or childcare have been shown to not only reduce rates of postpartum visit attendance but to disproportionately affect low-income women or women of color. In addition, the risk of PPD extends beyond 60 days post-partum, when pregnancy-related federal health insurance often expires. Smartphone applications (apps) may increase equity in postpartum mental health by providing long-term access to mental health treatment to most women. Indeed, in the United States, 96% of those aged 18-29 own a smartphone, and medical apps have been shown to improve obstetric outcomes and increase access to mental health services. Though in-person, cognitive behavioral therapy given through the Mothers and Babies Program (MB) has been shown to reduce PPD by 53% among low-income women of color, the effect of app-provided group MB is unclear. The purpose of this Mentored Patient-Oriented Career Development Award (K23) is to enable the candidate to develop a funded research program to optimize postpartum mental health care for low-income women of color via an innovative technology-based intervention that may decrease their rates of PPD. To achieve this goal, training and mentor- ship are proposed in three key areas: 1) Advanced training in mixed methods research, perinatal psychology, digital health, and biostatistics; 2) Mentorship from a multi-disciplinary team of established researchers; and 3) Protected time to perform patient-oriented research on the feasibility of utilizing app-provided MB as a study intervention for low-income women of color with risk factors for PPD. Two study phases are required. First, focus groups and interviews will optimize the study intervention, which contains MB and parenting education (PE). Those in the intervention group will access MB+PE while those in the control group will access PE to encourage app engagement with both study groups. This is because women in both groups will receive bimonthly Edinburgh Postnatal Depression Scales (EPDS) scores from birth to six months postpartum. The primary outcome of the proposed randomized trial is demonstrated feasibility and acceptability of app-based MB, defined via recruitment and app usage (feasibility), and scores on the System Usability Scale and Client Satisfaction Questionnaire (acceptability). Secondary outcomes include EDPS scores. The proposed trial will provide critical insight into a subsequent R01-supported randomized trial designed to examine the effect of app-based MB on PPD among low-income, racially and ethnically diverse women. If effective, app-based MB has great potential for scalability and could increase postpartum mental health equity for most women.

产后抑郁症的患病率很高：产后抑郁症（PPD）的发病率高达25% 在既往无PPD或抑郁症但有个人或结构性风险因素的女性中，收入或有色人种的女性等等。因此，美国妇产科学院建议对妇女进行PPD筛查。然而，产后心理保健方面存在差距：妇女参加产后检查，进行PPD筛查，以及缺乏交通或儿童保育不仅降低了产后访视率，影响低收入女性或有色人种女性。此外，产后60天后患PPD的风险会延长，与怀孕有关的联邦健康保险经常到期。智能手机应用程序（应用程序）可能会增加通过向大多数妇女提供长期的心理健康治疗，实现产后心理健康的公平。事实上，在美国，18-29岁的人中有96%拥有智能手机，医疗应用程序已经显示出来，改善产科结果，增加获得心理健康服务的机会。虽然在人，认知通过母婴计划（MB）提供的行为疗法已被证明可以减少PPD，在有色人种的低收入女性中，53%的人认为应用程序提供的MB组的效果尚不清楚。这样做的目的辅导病人为导向的职业发展奖（K23）是使候选人能够发展一个资助研究计划，以优化产后心理健康护理的低收入妇女的颜色，通过创新的基于技术的干预，可能会降低他们的PPD率。为了实现这一目标，培训和指导- 船舶建议在三个关键领域：1）混合方法研究，围产期心理学，数字健康和生物统计学; 2）来自多学科研究人员团队的导师;以及3）保护时间，以进行以患者为导向的研究，研究使用应用程序提供的MB作为研究的可行性对有PPD危险因素的有色人种低收入妇女进行干预。需要两个研究阶段。第一、焦点小组和访谈将优化研究干预，其中包括MB和父母教育（PE）。干预组将使用MB+PE，而对照组将使用PE，鼓励应用程序与两个研究小组的互动。这是因为这两个群体中的妇女将获得从出生到产后6个月，每两个月进行一次爱丁堡产后抑郁量表（EPDS）评分。的提出的随机试验的主要结果是证明了基于app的 MB，通过招聘和应用程序使用（可行性）定义，以及系统可用性量表和客户端评分满意度问卷（可接受性）。次要结局包括EDPS评分。拟议的审判将为随后的R 01支持的随机试验提供了重要的见解，该试验旨在检查在低收入、种族和民族多样化的妇女中，基于应用程序的关于PPD的MB。如果有效，基于应用程序的MB 具有很大的可扩展性潜力，可以增加大多数妇女的产后心理健康公平性。

项目成果

期刊论文数量（9）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Association of Perceived Lack of Paternal Support After Stillbirth With Maternal Postpartum Depression or Anxiety.

DOI：
10.1001/jamanetworkopen.2022.31111
发表时间：
2022-09-01
期刊：
JAMA NETWORK OPEN
影响因子：
13.8
作者：
Lewkowitz, Adam K.;Cersonsky, Tess E. K.;Reddy, Uma M.;Goldenberg, Robert L.;Dudley, Donald J.;Silver, Robert M.;Ayala, Nina K.
通讯作者：
Ayala, Nina K.

Antenatal Depression and Cesarean Delivery Among Recently-Delivered Nulliparous Women in Rhode Island.

罗德岛州最近分娩的未产妇的产前抑郁症和剖腹产。

DOI：
发表时间：
2022
期刊：
Rhode Island medical journal (2013)
影响因子：
0
作者：
Ayala,NinaK;Lewkowitz,AdamK;Gjelsvik,Annie;Monteiro,Karine;Amanullah,Siraj
通讯作者：
Amanullah,Siraj

The relationship between body mass index and perceived control over labor.

DOI：
10.1186/s12884-023-06063-w
发表时间：
2023-10-25
期刊：
BMC pregnancy and childbirth
影响因子：
3.1
作者：
通讯作者：

Unplanned Operative Delivery is Associated with Decreased Perception of Control over Labor.

计划外的手术分娩与分娩控制感的下降有关。

DOI：
10.21203/rs.3.rs-2849715/v1
发表时间：
2023
期刊：
Research square
影响因子：
0
作者：
Whelan,AnnaR;Recabo,Olivia;Ayala,NinaK;Clark,MelissaA;Lewkowitz,AdamK
通讯作者：
Lewkowitz,AdamK

Body Mass Index and Perceived Labor Control: Could weight stigma explain differences in birth experience?

体重指数和感知的分娩控制：体重耻辱可以解释出生经历的差异吗？

DOI：
10.21203/rs.3.rs-3142767/v1
发表时间：
2023
期刊：
Research square
影响因子：
0
作者：
Whelan,AnnaR;Polnaszek,BrockE;Recabo,Olivia;Clark,MelissaA;Lewkowtiz,AdamK;Ayala,NinaK
通讯作者：
Ayala,NinaK