Systems of Care for New Moms: Integrating Depression Treatment

新妈妈护理系统：整合抑郁症治疗

• 批准号: 7684793
• 负责人: LUIS H ZAYAS
• 金额: $ 23.94万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-11 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7684793
• 关键词: Address; Advanced Practice Nurse; Beck depression inventory; Care given by nurses; Caring; Child; Client; Clinical; Communities; Consultations; Data; Decision Making; Depression screen; Development; Disadvantaged; Effectiveness; Effectiveness of Interventions; Evidence based treatment; Face; Family; Focus Groups; Goals; Health; Healthcare; Healthcare Systems; Home environment; Home visitation; Intervention; Interview; Knowledge; Location; Low income; Manuals; Maternal and Child Health; Measures; Mental Health; Mental Health Services; Methodology; Minority; Modification; Mothers; Nurse Practitioners; Nurse Psychotherapist; Nurses; Organizational Change; Outcome; Parenting behavior; Pathway interactions; Patient Preferences; Patients; Pharmaceutical Preparations; Pilot Projects; Policies; Postpartum Period; Primary Health Care; Process; Productivity; Protocols documentation; Provider; Psychiatric Nursing; Public Health; Qualitative Methods; Questionnaires; Randomized; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Research; Research Infrastructure; Research Personnel; Research Project Grants; Risk Assessment; Screening procedure; Services; Severities; Social Functioning; Societies; Specialist; Staging; Stigmata; Stress; Structure; Supervision; Surveys; Symptoms; System; Testing; Translating; Upper arm; Woman; base; care systems; case finding; compare effectiveness; cost; depressed; depression; evidence base; improved; indexing; informant; information gathering; maternal depression; medical specialties; meetings; post intervention; problem solving therapy; programs; social stigma; sound; therapy development; treatment as usual; trial comparing

DESCRIPTION (provided by applicant): Maternal depression in the postpartum period is a significant public health matter, particularly among poor urban minority women with limited access to mental health services. Through research we know how to treat depression. What we do not know is how to translate effective depression treatments into community non- specialty mental health settings beyond office-based primary care. Nurse home visitation programs provide an opportunity to efficiently increase access to depression treatment for low income disadvantaged mothers. This study explores the co-location of depression treatment (Problem Solving Therapy) within nurse home visitation and the organizational changes needed to maintain access to evidence-based treatment. Problem Solving Therapy (PST) is suited to use by non-specialists and for in-home use. The brevity of the intervention (4-8 sessions) and its non-pathologizing approach should be acceptable to low income minority women. Through multiple methodologies, this study will gather information from women and their providers to determine what system and treatment modifications are needed to effectively deliver acceptable depression treatment in home visitation programs as they strive to implement policy directives to identify and treat mothers with depression. An expert panel, which blends local and global knowledge will provide advice on decisions regarding the intervention adaptation. Once these adaptation decisions are made a small group of experts will adapt a PST manual for use in home visitation. We will then carry out a small three-arm randomized trial comparing the effectiveness, acceptability, and practicality of PST provided by home visitation RNs, by a psychiatric advance practice RN usual care (referral to mental health specialty care). Forty two women will be matched and randomized into the three study conditions. Outcomes will be measured using both quantitative and qualitative methods. Depression outcomes will be measured using the Beck depression Inventory and PHQ-9 at 6 and 12 months post intervention. The Parenting Stress Index will be used to measure parental functioning. Women in the usual care condition will be tracked to assess barriers to their accessing depression treatment once referred. A sub-set of mothers and will be interviewed regarding the acceptability and practicality of receiving PST at home either from their regular nurse or a psychiatric advanced practice nurse. Nurse home visitors will be interviewed to assess the acceptability and practicality of their delivery of PST to mothers on their caseloads. Effect sizes and information on the acceptability and practicality of the intervention to both mothers and nurses will be used to prepare a full scale R01. PST delivered through home visitation holds promise for providing access to effective and acceptability depression treatment for poor urban minority mothers. Significantly, our study has the potential to provide home visitation agencies with a viable means of access to effective and acceptable depression treatment for mothers in the face of policy mandates for depression screening. 7. * Project Narrative Depression in the postpartum is a major public health problem, not only because of lost productivity and social functioning for the mother, but because of devastating health, mental health, and developmental consequences for the child, its effects on family functioning, and overall costs to society. Even mild depression in new mothers has been shown to impact on the establishment of mother-child bonding, while effective depression treatment for mothers can significantly improve outcomes for both mother and child. The postpartum period is a window of opportunity in which to address depression in women because they are more likely to come into contact with the health care system.

描述（由申请人提供）：产后期的产妇抑郁症是一个重要的公共卫生问题，特别是在获得心理健康服务有限的贫困城市少数民族妇女中。通过研究，我们知道如何治疗抑郁症。我们不知道的是，如何将有效的抑郁症治疗转化为社区非专业精神卫生环境，而不仅仅是基于办公室的初级保健。护士家访计划提供了一个机会，有效地增加获得抑郁症治疗的低收入弱势母亲。本研究探讨了抑郁症治疗（问题解决疗法）在护士之家探视和组织的变化，以保持获得循证治疗的共同定位。问题解决疗法（PST）适合非专业人士和家庭使用。干预的简短性（4-8次）及其非病理性方法应该是低收入少数民族妇女可以接受的。通过多种方法，本研究将从妇女及其提供者那里收集信息，以确定在家访计划中有效提供可接受的抑郁症治疗所需的系统和治疗修改，因为他们努力实施政策指令，以识别和治疗患有抑郁症的母亲。一个融合了当地和全球知识的专家小组将就有关干预措施适应的决定提供咨询意见。一旦作出了这些调整决定，一个专家小组将调整一份家庭探视使用的PST手册。然后，我们将进行一项小型三臂随机试验，比较由家访RN提供的PST的有效性，可接受性和实用性，由精神科高级实践RN常规护理（转介到精神卫生专业护理）。42名女性将被匹配并随机分配到三种研究条件中。将使用定量和定性方法衡量成果。在干预后6个月和12个月，将使用贝克抑郁量表和PHQ-9测量抑郁结局。育儿压力指数将用于衡量父母的功能。将跟踪处于通常护理条件下的妇女，以评估她们一旦转诊就无法获得抑郁症治疗的障碍。一个子集的母亲，并将接受采访的可接受性和实用性接受PST在家里无论是从他们的常规护士或精神科高级实践护士。护士之家的访客将被采访，以评估他们的母亲提供PST的可接受性和实用性，他们的案件。将使用效应量和关于干预对母亲和护士的可接受性和实用性的信息来准备全量表R 01。通过家访提供的PST有望为贫困的城市少数族裔母亲提供有效且可接受的抑郁症治疗。值得注意的是，我们的研究有可能为家访机构提供一种可行的手段，使母亲在面对抑郁症筛查的政策授权时获得有效和可接受的抑郁症治疗。7. * 产后抑郁症是一个重大的公共卫生问题，不仅是因为母亲丧失了生产力和社会功能，而且还因为对儿童的破坏性健康，心理健康和发育后果，对家庭功能的影响以及社会的总体成本。即使是新妈妈的轻度抑郁也会影响母子关系的建立，而对母亲有效的抑郁治疗可以显着改善母亲和孩子的结果。产后期是解决妇女抑郁症的机会之窗，因为她们更有可能接触到医疗保健系统。