Reducing Depressive Symptoms in Low-Income Mothers

描述（由申请人提供）：抑郁症状在低收入母亲中更为普遍，严重和持久，这是复杂的生活问题，贫乏的资源和贫困的社会支持的函数。除了限制母亲对婴儿/幼儿的情感可用性外，抑郁症状还通过剥夺母亲的学习和职业培训精力，减少母亲对孩子的丰富计划的使用，阻止这些母亲摆脱贫困。这对最年幼的儿童-婴儿和幼儿-尤其有害，因为他们在发育上最脆弱。使用2组，重复测量实验设计，本研究将测试一个简短的（5个月）干预，使用修改的人际心理治疗，以帮助母亲有效地发挥作用，在抑郁症状的存在，管理生活问题，使用社会支持和父母他们的婴儿或幼儿。这项研究将在五个早期开端儿童丰富计划中进行，其中4个在北卡罗来纳州，1个在纽约。来自这些项目的母亲，如果有抑郁症状（流行病学研究中心抑郁量表（CES-D）评分为16分或更高），并且有6周到30个月大的婴儿或幼儿参加了早期启蒙活动，将参加。226名母亲将被随机分配到治疗组和常规护理/注意对照组，并在四个收集点测量效果（基线，14周，22周和26周）使用抑郁症的汉密尔顿评分销售，抑郁症的结构化临床访谈（SCID），分析录像的非结构化，家庭母婴/幼儿互动，日常压力指数，社会支持和EHS服务的使用。三个中介（自我效能，积极应对和寻求社会支持）和调节器（产妇特征[年龄，教育，收入]，产妇健康和产妇负担[子女数量，儿童保健责任，交通，资源获取努力，工作压力和债务]）将被分析对干预结果的影响。迄今为止，对高危母亲采取的此类控制性干预措施很少。这项拟议的研究将通过专门针对抑郁症状的干预措施以及现有的早期儿童干预计划来解决这一差距。通过帮助这些母亲更好地利用早期开端资源，干预措施的积极效益可以保持，从而为儿童和母亲带来持久的效益。

DESCRIPTION (provided by applicant): Depressive symptoms are more prevalent, severe and persistent in low-income mothers as a function of complex life problems, lean resources and poor social support. In addition to limiting the mother's emotional availability to her infant/toddler, depressive symptoms block these mothers' escape from poverty by robbing their energy for school and job training, and diminishing their use of available enrichment programs for their child. This is especially insidious for the very youngest children - infants and toddlers - because they are the most developmentally vulnerable. Using a 2-group, repeated measures experimental design, this study will test a brief (5 month) intervention using a modification of Interpersonal Psychotherapy to help mothers effectively function in the presence of depressive symptoms, manage life issues, use social support and parent their infant or toddler. The study will take place in five Early Head Start child enrichment programs, 4 in North Carolina and 1 in New York. Mothers from these programs who have depressive symptoms (score 16 or greater on the Center for Epidemiological Studies Depression Scale (CES-D) and who have infants or toddlers between 6 weeks and 30 months old who are enrolled in Early Head Start will participate. The 226 mothers will be randomized to treatment and usual care/attention control groups and the effects will be measured over four collection points (baseline, 14 weeks, 22 and 26 weeks) using the Hamilton Rating Sale for Depression, Structured Clinical Interview for Depression (SCID), analysis of videotaped unstructured, in-home mother-infant/toddler interactions, Everyday Stressors Index, social support and use of EHS services. Three mediators (self-efficacy, proactive coping and social support seeking) and moderators (maternal characteristics [age, education, income], maternal health and maternal burden [number of children, child healthcare responsibilities, access to transportation, resource acquisition effort, job strain and debt]) will be analyzed for effect on the intervention outcomes. Few controlled interventions with high-risk mothers such as these have been done to date. The proposed study will address this gap by bringing an intervention specifically for depressive symptoms alongside of an already-existing early child intervention program. By helping these mothers better utilize Early Head Start resources, the positive benefits of the intervention can be maintained and thus result in lasting benefit for the child as well as the mother.