Treating Maternal Depression in an Urban Community-Based Pediatric Asthma Clinic: Targeting Maternal Mood, Child Asthma Outcomes, and Health Disparities

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PROJECT SUMMARY/ABSTRACT: This proposal details a 5-year plan to provide Dr. Rachel Margolis with the knowledge and skills to become an independent clinical and translational researcher focused on promoting health equity by improving pediatric asthma outcomes. Research Plan: Striking socioeconomic and racial/ethnic disparities persist in pediatric asthma, particularly among under-resourced, Black children in urban settings. Evidence demonstrates that structural and psychosocial risk factors contribute to these disparities. Maternal depression is one prevalent and potentially modifiable risk factor. While there is evidence that treating maternal depression may improve child health outcomes, mothers from under-resourced communities face significant barriers to community-based treatment of depression. Integrated care (i.e., the delivery of mental health care within the context of other ongoing medical care in a physical health care setting) offers an exciting and under- explored option. It has been associated with reduced maternal depression and improved child health in pediatric primary care. However, the feasibility, acceptability, and efficacy of embedding maternal depression treatment into community-based pediatric asthma care needs to be demonstrated. Enhanced Brief Interpersonal Psychotherapy (IPT-B) is a promising depression treatment for under-resourced mothers that has proven efficacious among similar women in other settings, but it has not been studied within ongoing pediatric asthma care. To maximize the success of Enhanced IPT-B in an asthma clinic setting, it is necessary to identify and address potential mother and provider-level barriers to integrated depression care. Stakeholder engagement with mothers and asthma clinic staff can facilitate the process of understanding and mitigating these barriers. Thus, the overall goal of this proposal is to use stakeholder input to integrate and evaluate maternal depression treatment in a community-based asthma clinic providing care to predominately under-resourced, Black children with asthma. The Specific Aims are to: 1) Engage stakeholders in determining the most effective and acceptable model for integrating Enhanced IPT-B for mothers into community-based pediatric asthma care; 2) Determine the feasibility, acceptability, and preliminary efficacy of Enhanced IPT-B on decreasing maternal depressive symptoms in a specific community-based pediatric asthma clinic through a pilot RCT; and 3) Determine the preliminary efficacy of the intervention on improving child asthma care and health outcomes. Training Plan: Through didactic coursework and mentored research experiences with her multidisciplinary team of mentors/advisors, Dr. Margolis will develop advanced qualitative and mixed methods skills, learn clinical trial design with a focus on behavioral interventions for under-resourced and racial/ethnic minority families, and gain advanced implementation science skills. Dr. Margolis will emerge from her K01 training and research experience as an independent behavioral scientist committed to enhancing health equity.