Efficacy of an integrated intervention to treat maternal depression and children’s behavior problems: A transactional perspective

项目概要/摘要 每10个孩子中至少有1个患有母亲抑郁症。成年期的抑郁症是一种 残疾的主要原因，当它发生在有孩子的妇女，抑郁症也进行了3- 后代内化和外化行为问题的风险增加6倍。儿童行为 这些问题反过来又会增加母亲随后患抑郁症的风险。相互交织的交易关系 母亲抑郁与儿童行为问题之间的关系呼唤母子一体化的心理健康 干预措施。然而，综合方案很少;成人和儿童心理健康治疗方案 通常在狭窄的筒仓中操作。 例如，依恋和生物行为追赶（ABC）是一个受支持的10个会话 家访育儿干预，重点是提高母亲的敏感性。ABC降低儿童的 行为问题，但它不治疗母亲抑郁症。同样，母亲和婴儿是一个经验- 支持抑郁症的认知行为干预，重点是改善母亲的消极情绪， 思维和行为激活。母亲和婴儿减少围产期产妇抑郁症，但它没有 治疗儿童的行为问题。解决孕产妇和儿童福祉的方案至关重要。 该项目是一项随机对照试验，以评估综合治疗的疗效。 双重治疗母亲抑郁症状和后代行为问题的干预。家庭（n = 240名母亲和她们2-4岁的孩子）将被随机分为两组，一组接受10次ABC治疗，另一组接受10次ABC治疗。 ABC+D在家里ABC+D是ABC的扩展版本， 抑郁症状使用母亲和婴儿适应幼儿的母亲。具体目标是 建议的项目是：目标1 -评估ABC和ABC+D减少孕产妇抑郁症的疗效 症状和儿童行为问题。我们还将确定产妇死亡率下降的程度， 抑郁症状是儿童行为问题减少的函数，反之亦然，目标2 -测试 ABC+D对母亲抑郁和儿童行为问题的影响是否通过以下途径介导： 减少母亲的消极思维，增加母亲的行为激活，并改善母亲的 灵敏度主要结果是母亲的抑郁症状和儿童的行为问题。 我们的长期目标是为针对心理健康问题的精确干预做出贡献， 家庭的水平。该项目对减轻农民负担具有重要的公共卫生意义。 母亲抑郁症和儿童的行为问题，并破坏交易关系， 使它们随着时间的推移而延续。

PROJECT SUMMARY/ABSTRACT At least 1 in every 10 children is exposed to maternal depression. Depression during adulthood is one of the leading causes of disability, and when it occurs among women with children, depression also carries a 3- to 6-fold increase in risk for offspring internalizing and externalizing behavior problems. Children's behavior problems, in turn, elevate risk for subsequent maternal depression. The intertwined, transactional relations between maternal depression and children's behavior problems call for integrated maternal-child mental health interventions. However, integrated programs are scarce; adult and child mental health treatment programs typically operate in narrow silos. For example, Attachment and Biobehavioral Catch-up (ABC) is an empirically-supported 10-session home-visiting parenting intervention that focuses on improving maternal sensitivity. ABC reduces children's behavior problems, but it does not treat maternal depression. Similarly, Mothers and Babies is an empirically- supported cognitive behavioral intervention for depression that focuses on improving mothers' negative thinking and behavioral activation. Mothers and Babies reduces perinatal maternal depression, but it does not treat children's behavior problems. Programs that address both maternal and child well-being are essential. The proposed project is a randomized controlled trial to evaluate the efficacy of an integrated intervention that dually treats maternal depressive symptoms and offspring behavior problems. Families (n = 240 mothers and their 2-to-4 year-old children) will be randomized to receive 10 sessions of ABC or 10 sessions of ABC+D in their home. ABC+D is an expanded version of ABC that additionally treats maternal depressive symptoms using Mothers and Babies adapted for mothers of toddlers. The specific aims of this proposed project are: Aim 1 – Evaluate the efficacy of ABC and ABC+D for reducing maternal depressive symptoms and child behavior problems. We will also determine the extent to which reductions in maternal depressive symptoms are a function of reductions in child behavior problems and vice versa, and Aim 2 – Test whether the effects of ABC+D on maternal depression and child behavior problems are mediated through decreases in maternal negative thinking, increases in maternal behavioral activation, and improved maternal sensitivity. Primary outcomes are maternal depressive symptoms and children's behavior problems. Our long-term goal is to contribute to precise interventions that are tailored to mental health problems at the level of the family. The proposed project has high public health significance for reducing the burden of maternal depression and children's behavior problems and for disrupting the transactional relations that perpetuate them over time.