CARE Intervention for Depressed Mothers & Their Infants

描述(申请人提供)：产后抑郁症(PPD)，一种常见的分娩并发症，危及母亲与婴儿反应的能力。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。尽管这一问题具有临床意义，但有关与产后抑郁相关的母婴关系障碍的治疗信息有限。这项随机临床试验的总体目标是通过促进抑郁的母亲和他们的婴儿之间的反应互动来减轻PPD对婴儿发育的负面影响。具体目的是测试以关系为中心的有效沟通和关系(关怀)干预在提高母婴关系有效性、增加婴儿线索的清晰度和对父母的反应性、减轻产后3个月、6个月和9个月父母养育压力方面的有效性。这项拟议的研究建立在以下初步研究的基础上：(A)论证了筛查妇女产后抑郁的可行性，以及(B)测试了护士提供的指导干预的有效性，以促进抑郁的母亲和她们的婴儿之间的反应。在这项研究中，护理干预旨在教会抑郁的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相关的退缩和侵入性母婴互动行为。护士将对大约1500名产后妇女进行产后抑郁筛查，随机将至少116名符合条件的参与者分配到治疗组或对照组，并通过诊断性面谈确认抑郁状态。采用重复测量设计，在产后6周、3、6和9个月收集数据。标准化工具将评估抑郁症状和育儿压力；对录制的母婴互动进行盲目编码将衡量母婴关系的有效性和婴儿的行为反应。护理干预将在6周以及产后2、3、4、6个月的家访期间进行，教母亲解读婴儿的行为暗示并做出有效的反应。R-ANOVA和R-MANOVA将被用来检验研究假设和回答研究问题。期望结果有助于了解循证护理实践模式，以治疗与产后抑郁相关的母婴关系问题。

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depressed mothers to recognize and interpret Infants' engagement and disengagement cues, and to coach mothers to alter withdrawn and intrusive maternal-infant interactive behaviors that are associated specifically with PPD.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.