Evaluating maternal depression among adolescent and adult women in Kenya

评估肯尼亚青少年和成年妇女的孕产妇抑郁情况

• 批准号: 10051313
• 负责人: Anna M Larsen
• 金额: $ 4.6万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-16 至 2022-12-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10051313
• 关键词: 15 year old; 20 year old; Adolescence; Adolescent; Adult; Africa South of the Sahara; Age; Area; Child Health; Childbirth; Clinical; Cluster randomized trial; Cohort Studies; Country; Cross-Sectional Studies; Data; Development; Diagnostic; Educational Background; Emotional; Epidemiology; Equation; Evaluation; Frequencies; Future; Health Professional; High Prevalence; High-Risk Pregnancy; Hormonal; Hormonal Change; Income; Individual; Infant; Infant Health; Intervention; Kenya; Life Cycle Stages; Link; Loneliness; Longitudinal Studies; Low Birth Weight Infant; Marital Status; Maternal Health; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Monitor; Mothers; Performance; Perinatal; Physiological; Positioning Attribute; Postnatal Care; Postpartum Period; Postpartum Women; Pregnancy; Pregnancy in Adolescence; Pregnancy loss; Pregnant Women; Premature Birth; Prevalence; Procedures; Psychosocial Factor; Reporting; Research; Research Personnel; Research Project Grants; Risk; Sample Size; Self Efficacy; Severities; Social support; South Africa; Symptoms; Time; Training; Visit; Woman; adolescent health; adverse childhood events; adverse outcome; age group; antenatal; antepartum depression; cohort; critical period; depressive symptoms; epidemiology study; experience; high risk; improved; infant morbidity/mortality; infant outcome; instrument; intimate partner violence; longitudinal analysis; low and middle-income countries; maternal depression; mental training; neonatal death; novel; parity; perceived stress; perinatal outcomes; peripartum depression; pre-doctoral; pregnant; pregnant teen; prospective; psychosocial; screening; stillbirth; systematic review; tool; young woman

ABSTRACT This F31 project aims to advance understanding of the manifestation and trajectory of maternal depression among adolescent women (age 15-19) compared to adults throughout pregnancy and postpartum, and to develop a risk score to identify pregnancies at high risk for adverse perinatal outcomes. Approximately 13% of peripartum women worldwide report mental health issues, predominantly depression. Adolescence is a period of substantial developmental and hormonal changes which add to physiologic and psychosocial changes in pregnancy. Frequency of depression among adolescent pregnant and postpartum women is up to 30% higher than their adult and non-pregnant counterparts. Perinatal depression among adolescents has not been rigorously characterized in a large-scale, longitudinal study. Almost all adolescent pregnancies (95%) worldwide occur in low- and middle-income countries (LMICs), yet few data exist on maternal depression among adolescents in these settings. A recent systematic review found higher prevalence of maternal depression in LMICs (16% in pregnancy, 20% in postpartum) than in high-income country settings (HICs). Several studies in HICs have linked depression and adolescence to preterm birth and low birthweight, yet critical gaps remain in understanding implications of maternal depression on perinatal outcomes within SSA where the burden of infant morbidity and mortality is highest worldwide. The proposed F31 research project leverages data collected in an ongoing randomized cluster trial (PrIMA Study, R01AI125498, MPI: John-Stewart/Baeten) among adolescent and adult pregnant Kenyan women (≥15 years old) who are followed through 9-months postpartum. We are screening >4000 Kenyan women (median age: 24 years, ~25% age <20 years) longitudinally via antenatal/postnatal care (ANC/PNC) for depressive symptoms. In Aim 1, we will use data from initial ANC, 6 weeks PNC, and 9 months PNC to longitudinally compare maternal depression among adolescent versus adult women, identifying predictors, symptoms, and changes in prevalence and severity to inform future interventions. In Aim 2 we will develop and validate an empiric risk score to predict adverse perinatal outcomes that incorporates depressive score in pregnancy and other maternal factors (e.g., adolescent age). Results from Aim 2 will contribute a clinical prediction tool to inform who may need intensified monitoring to avert adverse perinatal outcomes like preterm birth and low birthweight. This large-scale study to longitudinally compare depression among adolescents and adults from pregnancy through 9 months postpartum will contribute a novel clinical prediction tool using depression score to predict perinatal outcomes. This research plan will provide the F31 candidate rigorous predoctoral training including 1) quantitative analysis of longitudinal data, 2) experience developing and internally validating a risk score, and 3) content-area expertise in maternal depression, an area critical to closing gaps in maternal, adolescent, and child health.

抽象的 该 F31 项目旨在增进对孕产妇抑郁症表现和轨迹的了解 与成年人相比，青春期女性（15-19 岁）在整个怀孕和产后期间， 制定风险评分，以确定不良围产期结局高风险的妊娠。大约 13% 全世界围产期妇女都有心理健康问题，主要是抑郁症。青春期是一个时期 显着的发育和荷尔蒙变化，增加了生理和心理社会的变化 怀孕。青少年孕妇和产后妇女患抑郁症的频率高出 30% 比成年和未怀孕的同行。青少年围产期抑郁症尚未得到严格的研究 大规模纵向研究的特征。全世界几乎所有青少年怀孕（95%）都发生在 低收入和中等收入国家 (LMIC)，但关于青少年孕产妇抑郁症的数据却很少 这些设置。最近的一项系统回顾发现，中低收入国家的孕产妇抑郁症患病率较高（16% 妊娠期（20% 产后））高于高收入国家 (HIC)。几项针对高收入国家的研究表明 抑郁症和青春期到早产和低出生体重，但认识上仍存在重大差距 SSA 内母亲抑郁症对围产期结局的影响，其中婴儿发病率和 死亡率是全世界最高的。拟议的 F31 研究项目利用了正在进行的一项研究中收集的数据 青少年和成人随机整群试验（PrIMA 研究，R01AI125498，MPI：John-Stewart/Baeten） 产后 9 个月进行随访的肯尼亚孕妇（≥15 岁）。我们正在筛选 >4000 名肯尼亚女性（中位年龄：24 岁，约 25% 年龄 <20 岁）通过产前/产后护理进行纵向研究 (ANC/PNC) 针对抑郁症状。在目标 1 中，我们将使用初始 ANC、6 周 PNC 和 9 个月的数据 PNC 纵向比较青少年与成年女性的孕产妇抑郁症，确定 预测因素、症状以及患病率和严重程度的变化，为未来的干预措施提供信息。在目标 2 中，我们将 制定并验证经验性风险评分，以预测包括抑郁在内的不良围产期结局 怀孕和其他母亲因素（例如青少年年龄）的得分。目标 2 的结果将有助于临床 预测工具，告知谁可能需要加强监测，以避免早产等不良围产期结局 出生和低出生体重。这项大规模研究纵向比较青少年和青少年的抑郁症 从怀孕到产后 9 个月的成年人将使用以下方法贡献一种新颖的临床预测工具 抑郁评分可预测围产期结局。该研究计划将为F31候选者提供严格的 博士前培训包括1）纵向数据的定量分析，2）经验开发和内部 验证风险评分，以及 3) 孕产妇抑郁症的内容领域专业知识，这一领域对于缩小孕产妇抑郁症方面的差距至关重要 孕产妇、青少年和儿童健康。