CARE Intervention for Depressed Mothers & Their Infants

对抑郁母亲的 CARE 干预

• 批准号: 7032226
• 负责人: June Andrews Horowitz
• 金额: $ 33.95万
• 依托单位: BOSTON COLLEGE
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-03-15 至 2008-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7032226
• 关键词: behavior therapy; child rearing; clinical research; counseling; education evaluation /planning; health education; human subject; human therapy evaluation; infant human (0-1 year); mother child interaction; nursing intervention; patient oriented research; postpartum depression; women' s health

DESCRIPTION (provided by applicant): Postpartum depression, (PPD), a commonly experienced childbirth complication, jeopardizes mothers' ability to interact responsively with their infants. Onset during the critical period of the first months of infants' lives threatens the maternal-infant relationship and adversely affects infant development. Despite the clinical significance of the problem, limited information exists on the treatment of maternal-infant relational disturbances associated with PPD. The overall goal of this randomized clinical trial is to mitigate negative effects of PPD on infants' development by promoting responsive interaction between depressed mothers and their infants. The specific aim is to test the efficacy of the relationship-focused Communicating And Relating Effectively (CARE) intervention in increasing maternal-infant relational effectiveness, increasing infant clarity of cues and responsiveness to parent, and reducing parenting stress for the treatment group at 3-months, 6-months, and 9-months after delivery. This proposed study builds on preliminary studies that: (a) demonstrated the feasibility of screening women for postpartum depression, and (b) tested the efficacy of a coaching intervention delivered by nurses to promote responsiveness between depressed mothers and their infants. In this study, the CARE intervention is designed to teach depressed mothers to recognize and interpret Infants' engagement and disengagement cues, and to coach mothers to alter withdrawn and intrusive maternal-infant interactive behaviors that are associated specifically with PPD. Nurses will screen approximately 1,500 postpartum women for PPD, randomly assign a minimum of 116 eligible participants to either the treatment or control group, and confirm depression status with a diagnostic interview. Using a repeated measures design, data will be collected at 6-weeks, and 3, 6, and 9 months postpartum. Standardized instruments will evaluate depression symptoms and parenting stress; blind coding of videotaped maternal-infant interaction will measure maternal-infant relational effectiveness and infant behavioral responses. The CARE intervention will be conducted during home visits at 6-weeks, and 2, 3, 4, 6 months postpartum by teaching mothers to interpret their infants' behavioral cues and to respond effectively. R-ANOVA and R-MANOVA will be used to test the study hypotheses and to answer the research question. Outcomes are expected to contribute to knowledge of evidence-based nursing practice models for the treatment of maternal-infant relational problems associated with PPD.

描述（由申请人提供）：产后抑郁症（PPD）是一种常见的分娩并发症，会损害母亲与婴儿互动的能力。在婴儿生命最初几个月的关键时期发病会威胁母婴关系并对婴儿发育产生不利影响。尽管该问题具有临床意义，但有关治疗与产后抑郁症相关的母婴关系障碍的信息有限。这项随机临床试验的总体目标是通过促进抑郁母亲与其婴儿之间的反应性互动来减轻 PPD 对婴儿发育的负面影响。具体目的是测试治疗组在产后 3 个月、6 个月和 9 个月时，以关系为中心的有效沟通和关系 (CARE) 干预措施在提高母婴关系有效性、提高婴儿对线索的清晰度和对父母的反应能力以及减轻育儿压力方面的效果。这项拟议的研究建立在初步研究的基础上，这些研究：（a）证明了对妇女进行产后抑郁症筛查的可行性，（b）测试了护士提供的指导干预措施对促进抑郁母亲及其婴儿之间反应的有效性。在这项研究中，CARE 干预旨在教导抑郁母亲识别和解释婴儿的参与和脱离暗示，并指导母亲改变与产后抑郁症相关的孤僻和侵入性母婴互动行为。护士将对大约 1,500 名产后妇女进行 PPD 筛查，将至少 116 名符合条件的参与者随机分配到治疗组或对照组，并通过诊断访谈确认抑郁状况。采用重复测量设计，将在产后 6 周、3、6 和 9 个月收集数据。 标准化仪器将评估抑郁症状和养育压力；对录像母婴互动进行盲编码将测量母婴关系的有效性和婴儿的行为反应。 CARE 干预将在产后 6 周以及产后 2、3、4、6 个月的家访期间进行，教会母亲解读婴儿的行为线索并做出有效反应。 R-ANOVA 和 R-MANOVA 将用于检验研究假设并回答研究问题。预计结果将有助于了解治疗产后抑郁症相关母婴关系问题的循证护理实践模型。