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

项目摘要/摘要 每10名儿童中至少有1人患有母性抑郁症。成年后的抑郁症就是其中之一 在导致残疾的主要原因中，当它发生在有孩子的妇女中时，抑郁症也会带来3- 子女内化和外化行为问题的风险增加6倍。儿童行为 反过来，问题又会增加随后发生母性抑郁症的风险。相互交织的交易关系 母亲抑郁与儿童行为问题呼唤母子心理健康一体化 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运行。 例如，依恋和生物行为追赶(ABC)是一个有经验支持的10节课 以提高母亲敏感性为重点的家访育儿干预。ABC降低了儿童的 行为问题，但它不能治疗母亲的抑郁症。同样，母亲和婴儿在经验上也是- 支持认知行为干预治疗抑郁症，重点改善母亲的负面情绪 思维和行为的激活。母亲和婴儿减少了围产期的母亲抑郁，但它不会 治疗儿童的行为问题。同时解决产妇和儿童福祉的方案是必不可少的。 建议的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子女行为问题的干预措施。族(n= 240名母亲及其2至4岁的孩子)将随机接受10次ABC或10次 ABC D的会议在他们的家里。ABC D是ABC的扩展版本，它另外还处理母亲 使用适合幼儿母亲的母亲和婴儿的抑郁症状。这样做的具体目的是 建议的项目是：目标1-评估ABC和ABC D对减轻母亲抑郁的疗效 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一个函数，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 减少母亲的负面思维，增加母亲的行为活跃度，并改善母亲的 敏感度。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量身定做的精确干预做出贡献 家庭的级别。建议的项目对减轻农村居民的负担具有很高的公共卫生意义。 母亲的抑郁和孩子的行为问题，以及扰乱 随着时间的推移，让它们永久化。

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.