Randomized trial of telehealth group intervention to reduce perinatal depressive symptoms in diverse populations

远程医疗团体干预减少不同人群围产期抑郁症状的随机试验

• 批准号: 10063055
• 负责人: GWEN A LATENDRESSE
• 金额: $ 50.71万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-12-26 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10063055
• 关键词: Address; Affect; Antidepressive Agents; Anxiety; Area; Breast Feeding; Cellular Phone; Child Development; Cognitive Therapy; Communities; Control Groups; Detection; Effectiveness; Electronics; Enrollment; Ensure; Ethnic Origin; Ethnic group; European; Family; Feedback; Generalized Anxiety Disorder; Geographic Locations; Geography; Goals; Health Professional; Health Promotion; Healthcare; Hispanics; Home; Hour; Impaired cognition; Intervention; Left; Location; Low Birth Weight Infant; Measures; Mental Depression; Mental Health; Mental Health Services; Methods; Mothers; Nonpharmacologic Therapy; Online Systems; Parents; Participant; Population; Population Heterogeneity; Postpartum Depression; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Premature Birth; Prenatal care; Provider; Randomized; Randomized Controlled Trials; Recommendation; Research; Resources; Rural; Rural Population; Self Management; Services; Subgroup; Tablets; Technology; Time; Transportation; Use Effectiveness; Utah; Variant; Woman; Work; acceptability and feasibility; adverse outcome; antepartum depression; attentional control; base; care providers; child bearing; comorbidity; cost; cost effective; effectiveness evaluation; experience; geographic difference; group intervention; health care delivery; health care service; laptop; mindfulness; minority communities; perinatal depressive symptom; perinatal mental health; perinatal outcomes; peripartum depression; post intervention; pregnant; randomized trial; response; rural residence; rural setting; screening; social stigma; standard care; standard of care; symptom science; telehealth; urban dwelling; urban setting

Perinatal depression (PD) affects 12-15% of women and contributes to adverse outcomes, e.g. preterm birth, low birth weight, and impaired cognitive development of the child. Screening optimizes the detection of PD, but does not reduce barriers to mental health services (MHS) encountered by women who screen positive. A known shortage of MHS across the nation is a significant barrier, particularly in low resource and rural settings. Telehealth is a promising approach to reducing barriers, but there is little research on the effectiveness of telehealth to reduce perinatal depressive symptoms (PDS). There is high potential for telehealth to deliver effective, lower cost MHS to childbearing women, particularly those in low resource settings. The proposed project is a randomized controlled trial among women with mild to moderate PDS. The project aims to evaluate; 1) the effectiveness of a group mental health videoconference intervention (VCI) to reduce PDS across pregnancy and postpartum, and (2) differences in PDS between diverse groups of childbearing women: rural and urban-dwelling, and Hispanic and predominantly North European Descent (NED) populations. We hypothesize that women participating in the VCI will have significantly lower PDS across pregnancy and postpartum than women in an equivalent attention control (AC) group, and the results will differ between diverse groups. A total of 192 women will be enrolled; 48 in each study group. Participants are randomly assigned to study groups: VCI + standard of care, or AC + standard of care. Sessions are delivered via Utah Telehealth Network (UTN). Women in both groups attend weekly one-hour group sessions for 8 weeks using any electronic device (laptop, tablet, smart phone) from their own home. PDS is measured at 3 time points in pregnancy and 3 time points in postpartum. Our study is the first to use a VCI to engage women in a facilitated group approach to reducing PDS, and to evaluate the impact among diverse groups. The approach is cost effective and reduces barriers to access to MHS, particularly for women living in low-resource, and minority communities, and those without adequate transportation, childcare, or work release time. The VCI can be replicated in any setting (e.g. rural or urban), and can be adapted to the needs of diverse communities. The study advances the field by establishing whether a group telehealth intervention reduces PDS, and whether this differs based on the population. If effective and implemented broadly, far fewer women and families would suffer the negative consequences of depression. The proposed project is in line with NINR's high priority areas, including the use of technology to promote health, and a focus on self-management and symptom science.

围产期抑郁(PD)影响12%-15%的妇女，并导致不良后果，如早产、 低出生体重，损害儿童的认知发展。筛查优化了帕金森病的检测，但 不会减少筛查呈阳性的妇女获得精神卫生服务(MHS)的障碍。一个 众所周知，全国卫生保健服务的短缺是一个重大障碍，特别是在资源匮乏和农村地区。 远程医疗是一种很有前途的减少障碍的方法，但关于远程医疗的有效性的研究很少 远程保健，以减少围产期抑郁症状(PDS)。远程医疗的潜力很大， 向育龄妇女提供有效、低成本的医疗保健服务，特别是那些处于低资源环境中的妇女。 拟议的项目是一项针对患有轻中度PDS的女性的随机对照试验。该项目 旨在评估：1)团体心理健康视频会议干预(VCI)的有效性，以减少 妊娠和产后的PDS，以及(2)不同生育组间的PDS的差异 妇女：农村和城市居民、西班牙裔和主要是北欧后裔(NED) 人口。我们假设，参与VCI的女性的PDS将显著降低 在怀孕和产后，与同等注意力控制(AC)组的女性相比， 不同群体的结果会有所不同。总共将有192名女性参加；每个研究组48人。 参与者被随机分配到研究组：VCI+护理标准，或AC+护理标准。 课程通过犹他州远程医疗网络(UTN)提供。两组中的女性每周参加一小时的 在家里使用任何电子设备(笔记本电脑、平板电脑、智能手机)进行为期8周的小组会议。 在孕期3个时间点和产后3个时间点测量PDS。 我们的研究是第一次使用VCI让女性参与到促进小组方法中来减少PDS， 并评估不同群体之间的影响。该方法具有成本效益，并减少了 获得保健服务，特别是生活在低资源和少数族裔社区的妇女，以及那些没有机会的妇女 有足够的交通工具、托儿所或工作时间。VCI可以在任何环境中复制(例如，农村或 城市)，并可适应不同社区的需要。这项研究通过建立 群体远程保健干预是否降低了PDS，以及这是否会因人群而异。如果 有效并广泛实施，将会有更少的妇女和家庭遭受负面影响 抑郁症的后果。拟议的项目符合NINR的高度优先领域，包括 利用技术促进健康，注重自我管理和症状科学。