IPT for major depression following perinatal loss

最近经历过围产期损失的妇女中重度抑郁症（MDD）的发病率 （包括早、晚期死胎和早期新生儿死亡）是匹配人群中MDD发生率的3倍。 社区妇女的样本。情绪困难可以持续长达4年后损失，并可能恶化， 随后怀孕。围产期死亡后的自杀率相对于有活婴的母亲更高。PTSD 是一种常见的并发症;围产期损失后的PTSD率是活婴儿母亲的7倍。尽管 认识到围产期损失后的MDD是一个重要的公共卫生问题， 损伤，而像往常一样治疗是不够的，唯一的治疗开发和测试，这一点 人口是我们团队在该提案试点工作中进行的随机试验的一部分。这项研究创造了 第一本治疗围产期损失后任何精神疾病的手册。该手册结构清晰，易于理解， 并使用人际心理治疗（IPT）的原则，以解决围产期损失的情况下，如 解决如何应对损失的冲突，悲伤和在缺乏社会支持的情况下请求支持 规范如何做到这一点，审查损失事件，并解决错误和角色能力的问题。它 可以由不了解IPT的供应商使用。我们的初步试验随机分配了50名患有MDD的女性， 围产期损失组IPT或组应对抑郁症（CWD），一个基于证据的认知行为 治疗不侧重于围产期损失或社会支持。IPT可行且可接受， 治疗满意度评分和PTSD恢复率显著更高（p = .001）（在54%的患者中， 与CWD相比，IPT中的PTSD样本; p = 0.009）。组间效应量的置信区间 有利于IPT减少治疗期间的抑郁症状，以及改善模式特异性 目标（社会支持，悲伤症状），随访。鉴于这些令人鼓舞的发现，拟议的R 01将 进行了一项完全有效的随机疗效研究，比较IPT治疗围产期丢失后MDD与CWD的疗效， 274名女性样本。该试验将是第一个完全有效的随机试验，用于治疗任何精神疾病。 围产期损失后的疾病。它提出了国家儿童健康与发展委员会的优先事项，即改善妇女的健康， 以及怀孕后。鉴于贫困增加了围产期死亡的风险，非洲妇女的围产期死亡率， 美国妇女是白色妇女的两倍，试验地点在弗林特和底特律，密歇根州 （贫困率高的少数民族占多数的城市）增加了试验的重要性。成果将包括 从MDD恢复的时间，抑郁症状，PTSD症状，从PTSD恢复的时间，社会支持， 幸福悲伤和对怀孕的恐惧这些成果具有很大的传播和吸收潜力： 我们已经收到并满足了160多个免费的、未出版的IPT治疗手册的请求。这 这项研究将为治疗一个脆弱和研究不足的人群提供证据基础， 历史上最小化，改善这些妇女及其家庭的结果。

The rates of major depressive disorder (MDD) among women who have recently experienced perinatal loss (including early and late fetal death and early neonatal death) are 3 times the rates of MDD among matched samples of community women. Mood difficulties can persist up to 4 years after the loss and can worsen with subsequent pregnancies. Suicide rates after perinatal loss are higher relative to mothers of living infants. PTSD is a common co-occurrence; PTSD rates after perinatal loss are 7 times that of mothers of living infants. Despite recognition that MDD following perinatal loss is an important public health concern, that it causes significant impairment, and that treatment as usual has been inadequate, the only treatment developed and tested for this population was part of a randomized trial conducted by our team in pilot work for this proposal. That study created the first manual for treating any psychiatric disorder after perinatal loss. The manual is structured, easy-to-follow, and uses interpersonal psychotherapy (IPT) principles to address the circumstances perinatal loss, such as resolving conflicts over how to respond to the loss, grieving and requesting support in the absence of social norms about how to do so, reviewing the loss event, and resolving questions of fault and role competence. It can be used by providers who do not know IPT. Our pilot trial randomized 50 women with MDD following perinatal loss to group IPT or to group Coping with Depression (CWD), an evidence-based cognitive behavioral treatment which did not focus on perinatal loss nor social support. IPT was feasible and acceptable, with significantly higher (p = .001) treatment satisfaction scores and PTSD recovery rates (among the 54% of the sample with PTSD; p = .009) in IPT than in CWD. Confidence intervals around between-groups effect sizes favored IPT for reductions in depressive symptoms during treatment as well as for improvement in mode-specific targets (social support, grief symptoms), over follow-up. Given these promising findings, the proposed R01 will conduct a fully-powered randomized efficacy study comparing IPT for MDD following perinatal loss to CWD in a sample of 274 women. The trial will be the first fully-powered randomized trial of treatment for any psychiatric disorder following perinatal loss. It addresses NICHD priority to improve the health of women before, during, and after pregnancy. Given that poverty increases risk of perinatal loss and that rates of perinatal loss for African- American women are double those for White women, the location of the trial in Flint and Detroit, Michigan (minority-majority cities with high rates of poverty) increases the significance of the trial. Outcomes will include time to recovery from MDD, depressive symptoms, PTSD symptoms, time to recovery from PTSD, social support, well-being, grief, and fear of subsequent pregnancies. Results have high potential for dissemination and uptake: we have received and fulfilled more than 160 requests for the free, unpublished IPT treatment manual. This study will provide an evidence base for treating a vulnerable and understudied population whose distress has historically been minimized, improving outcomes for these women and their families.