Development of a Text Intervention for Perinatal Depression

大约每7个怀孕的人中就有1个人患有抑郁症，同样数量的人也面临着这种毁灭性的痛苦。 产后患病。围产期抑郁的下游影响增加了其代价，增加了患 早产；母子依恋受损；对婴儿发育的不利影响；以及 减少母乳喂养的开始/持续时间。美国预防服务工作组发现，一些主要的 抑郁发作(MDE)可以通过采用以下原则的咨询策略来避免 人际治疗(IPT)和认知行为治疗(CBT)。他们还观察同行的价值 支持，这可以减少围产期抑郁。这些干预的一个可能的共享机制是 增强自我效能感，这在应激事件的背景下至关重要，如怀孕和 为人父母。然而，实际实施干预措施以增强自我效能感和减少抑郁 风险是具有挑战性的。生殖健康提供者有有限的时间和培训来治疗抑郁症 预防计划。同样，围产期的个体可能不会意识到参与预防的必要性。 计划或难以找到或提供行为干预的提供者。技术可以帮助您 通过为围产期怀孕提供教育、支持和治疗干预，这些挑战 个人。与基于Web的应用程序(APP)不同，短信干预(TMI)可以主动提供 卫生信息和信息，即使对那些从事预防性干预动机有限的人也是如此。 手机的使用率激增，95%的孕妇(包括85%的少数民族人口) 报告使用移动电话通过短信进行交流。TMIS还可以筛查围产儿 在一般医疗环境之外的个人抑郁症，并提供一般同伴支持。与最终用户 在整个过程中，我们将构建一个多组件TMI(称为Text4Mom)，该TMI将屏幕和 对围产期个体进行MDE风险分类。该系统将从IPT和CBT中提取内容；它将 向有风险的围产儿发送带有相关视频内容链接的定制短信 抑郁发作。由同行导航员配备的按需安全聊天功能将补充 用于增强支持的文本消息。该系统将包括预先填充的内容，供同行剪切和粘贴 转化为给参与者的短信，这将支持同行并减轻他们的培训负担。这个系统 将应用程序的一些最好的组件(视频、定制、聊天)整合为一个通用的用户- 友好的短信平台。开发完成后，我们将进行试点随机试验，以测试 TMI能够提高自我效能感的目标，降低抑郁症状和MDE的风险。 我们将查询研究领域标准(RDoC)的“Lost”和“Threat”结构，并进行初步评估 有效性和实施情况(评估同伴聊天的可行性、可接受性、使用和效益 特征)通过试点随机临床试验。

About 1 in 7 pregnant individuals experience depression, with roughly the same number facing this devastating illness after delivery. The downstream effects of perinatal depression adds to its toll with increased risk of preterm birth; impairments in maternal-child attachment; adverse effects on infant development; and decreased breastfeeding initiation/duration. The US Preventative Services Task Force finds that some major depressive episodes (MDEs) can be averted with counseling strategies that employ principles from interpersonal therapy (IPT) and cognitive behavioral therapy (CBT). They also observe the value of peer support, which can decrease perinatal depression. A possible shared mechanism for these interventions is enhancement of self-efficacy, which is critical in the setting of stressful events such as pregnancy and parenting. However, practical implementation of interventions to enhance self-efficacy and reduce depression risk is challenging. Reproductive health providers have limited time and training to deliver depression prevention programs. As well, perinatal individuals may not appreciate the need to participate in a prevention program or have difficulty finding or affording providers of behavioral interventions. Technology can assist with these challenges by providing education, support and therapeutic interventions to perinatal pregnant individuals. Unlike web-based applications (apps), text messaging interventions (TMIs) can proactively deliver health information and messages, even to those with limited motivation to engage in preventative interventions. Mobile phone use has exploded with >95% of pregnant individuals (including >85% of the minority population) reporting use of a mobile phone to communicate via short text messages. TMIs can also screen perinatal individuals for depression outside the general medical setting and provide general peer support. With end-user input throughout the process, we will build a multi-component TMI (called Text4Moms) that screens and triages perinatal individuals for risk of a MDE. This system will draw content from both IPT and CBT; it will send tailored text messages with links to relevant video content to perinatal individuals at risk for a depressive episode. An on-demand secure chat function staffed by a peer navigator will complement the text messages for enhanced support. The system will include pre-populated content for peers to cut and paste into text messages for participants, which will support peers and decrease their training burden. This system leverages some of the best components of an app (video, tailoring, chat) into a common and user- friendly text messaging platform. After development, we will conduct a pilot randomized trial to test the ability of the TMI to enhance the target of self-efficacy and decrease depressive symptoms and risk of a MDE. We will query Research Domain Criteria (RDOC) constructs of “loss” and “threat,” and will evaluate preliminary effectiveness and implementation (assessment of feasibility, acceptability, use and benefit of the peer chat feature) through a pilot randomized clinical trial.