An anxiety-focused early prenatal intervention for the prevention of common mental disorders in Pakistan

以焦虑为重点的早期产前干预，以预防巴基斯坦常见的精神障碍

• 批准号: 10254222
• 负责人: PAMELA J SURKAN
• 金额: $ 121.48万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10254222
• 关键词: Address; Affect; Anxiety; Anxiety Disorders; Birth; Budgets; Child; Clinical; Cognitive; Cognitive Therapy; Cost Effectiveness Analysis; Costs and Benefits; Coupled; Data; Decision Making; Development; Early Intervention; Effectiveness; Environment; Evaluation; Evidence based intervention; Exposure to; Fetal Growth; Future; Generalized Anxiety Disorder; Generations; Growth; Health; Health Services Accessibility; High Prevalence; Human; Infant; Interpersonal Violence; Intervention; Late pregnancy; Light; Low Birth Weight Infant; Major Depressive Disorder; Maternity Hospitals; Mediating; Mediation; Mental Depression; Mental Health; Mental disorders; Modification; Mothers; Newborn Infant; Outcome; Pakistan; Personal Satisfaction; Policies; Policy Maker; Population; Postpartum Depression; Postpartum Period; Poverty; Pregnancy; Pregnancy Trimesters; Pregnant Women; Premature Birth; Prevalence; Prevention; Prevention strategy; Preventive; Primary Health Care; Provider; Public Health; Public Hospitals; Public Policy; Randomized; Randomized Controlled Trials; Research; Resource Allocation; Resources; Risk Factors; Second Pregnancy Trimester; Sex Discrimination; Small for Gestational Age Infant; Social support; Symptoms; Testing; Therapeutic Intervention; Third Pregnancy Trimester; Time; Woman; Work; adverse birth outcomes; anxiety reduction; anxiety symptoms; base; caregiving; comparison intervention; cost; cost-effectiveness evaluation; early pregnancy; economic cost; evidence base; evidence based guidelines; experience; fetal; health care service utilization; improved; infant outcome; innovation; intervention effect; low and middle-income countries; low income country; maternal anxiety; maternal condition; maternal depression; neglect; offspring; perceived stress; perinatal outcomes; peripartum depression; postnatal; postnatal period; prenatal; prenatal intervention; prevent; preventive intervention; programs; psychosocial stressors; randomized trial; resilience; scale up; secondary analysis; secondary outcome; social factors; success; therapy development; treatment as usual

SUMMARY: Common mental disorders (CMDs) such as anxiety and depression occur frequently in pregnancy and the postnatal period in lower- and middle income countries (LMICs). Prenatal anxiety, both subthreshold and clinical, adversely affects maternal wellbeing and outcomes among offspring, and is a major predictor of subsequent depression. Preventive approaches have enormous potential to reduce the negative effects of postnatal mental disorders in mothers and improve child outcomes. We propose to create a scalable and sustainable early prevention intervention focusing on anxiety symptoms in pregnant women, to be delivered by non-specialist providers (Aim 1). We will evaluate this preventive intervention through a trial by randomizing 1100 pregnant women from a public hospital in Islamabad Pakistan to either our Cognitive Behavioral Therapy- based (CBT-based) early-in-pregnancy program or to usual care. We will study the effects of the intervention on 1) CMDs in the 3rd trimester of pregnancy and at 6 weeks postpartum (Aim 2) and on 2) fetal and newborn small-for-gestational age (SGA) outcomes (Aim 3). We will also examine if interpersonal violence, perceived stress and social support mediate and/or modify the intervention effects on CMDs and perinatal outcomes (Aim 4). Finally, we will conduct a cost-effectiveness evaluation, comparing costs and healthcare utilization for women in the prenatal intervention and enhanced usual care groups (Aim 5). Focusing on anxiety reduction is a major innovation; anxiety has not been addressed within prenatal intervention packages in LMICs, despite its association with increased postpartum depression and suboptimal fetal and infant outcomes. Pakistan has high prevalence of both women with prenatal anxiety (35% to 49%) and SGA newborns (~47%), providing an ideal research opportunity. Our CBT-based approach, appropriate given its indication for anxiety and depression, is grounded in our preliminary work in this population, where we have previously successfully reduced postpartum depression. Intervening early in pregnancy is a further innovation that is critical for building the evidence base for preventative approaches to reduce maternal CMDs and related perinatal outcomes. Our proposed mediation and effect modification analyses will improve understanding of mechanism(s) of action and help identify subpopulations for programmatic targeting. The use of non-specialized providers and integration within the primary care environment will guide scale up, while incorporating a cost-effectiveness analysis will aid policy-makers in resource allocation decisions. This study will inform the integration of preventive strategies that target anxiety with existing approaches for treatment of perinatal depression to further the evidence-base for transdiagnostic mental health initiatives globally, and will inform policies to support lifelong maternal mental health and resilience across generations.

摘要：焦虑和抑郁等常见的精神障碍（CMD）在怀孕中经常发生 以及中低收入国家（LMIC）的产后时期。产前焦虑，都是亚阈值 临床，对后代的孕产妇福祉和结果有不利影响，并且是 随后的抑郁症。预防方法具有减少负面影响的巨大潜力 母亲的产后精神障碍并改善儿童的结果。我们建议创建一个可扩展的 可持续的早期预防干预措施着重于孕妇的焦虑症状，将由 非专家提供者（AIM 1）。我们将通过随机进行试验评估这种预防性干预 1100名来自巴基斯坦伊斯兰堡一家公立医院的孕妇要么我们的认知行为疗法 - 基于（基于CBT）的早期孕期计划或通常的护理。我们将研究干预的影响 1）CMD在怀孕的第三个三个月和产后6周（AIM 2）和2）胎儿和新生儿 小胎龄（SGA）结果（AIM 3）。我们还将检查是否有人际关系暴力，感知到 压力和社会支持调解和/或修改干预对CMD和围产期结果的影响（AIM 4）。最后，我们将进行成本效益评估，比较成本和医疗保健利用 在产前干预和增强常规护理小组的妇女（目标5）。 专注于减轻焦虑是一项主要的创新。焦虑尚未在产前解决 LMIC的干预包与产后抑郁症和次优的增加相关 胎儿和婴儿的结局。两名患有产前焦虑的妇女的患病率很高（35％至49％） 和SGA新生儿（约47％），提供了理想的研究机会。我们的基于CBT的方法，适当 鉴于其表现出焦虑和抑郁的迹象，我们在我们的初步工作中，我们 以前已经成功减少了产后抑郁症。怀孕初期介入是进一步的 创新对于建立预防方法的证据基础至关重要，以减少母体CMD 和相关的围产期结果。我们提出的调解和效果修改分析将改善 了解动作机制，并有助于确定程序化靶向的亚群。使用 非专业提供者和初级保健环境中的集成将指导规模，而 结合成本效益分析将帮助决策者制定资源分配决策。 这项研究将告知针对焦虑与现有方法的预防策略的整合 围产期抑郁症的治疗以进一步的经诊断心理健康计划的证据基础 在全球范围内，并将告知政策，以支持各代的终身孕产妇心理健康和韧性。

项目成果

Cultural adaptation and psychometric validation of the Pregnancy Experience Scale-Brief version (PES-Brief) in Pakistani women with antenatal anxiety symptoms.

对有产前焦虑症状的巴基斯坦妇女进行妊娠经历量表简报版 (PES-Brief) 的文化适应和心理测量验证。

• DOI: 10.1016/j.ssmmh.2021.100055
• 发表时间: 2022
• 期刊: SSM. Mental health
• 作者: Zaidi,Ahmed;Khan,Aasia;Rowther,Armaan;Nazir,Huma;Perin,Jamie;Rauf,Nida;Mumtaz,Sidra;Naseem,Hina;Atif,Najia;Rahman,Atif;Surkan,PamelaJ;Malik,Abid
• 通讯作者: Malik,Abid

Pregnancy stressors and postpartum symptoms of depression and anxiety: the moderating role of a cognitive-behavioural therapy (CBT) intervention.

妊娠压力源以及产后抑郁和焦虑症状：认知行为疗法（CBT）干预的调节作用。

• DOI: 10.1136/gpsych-2023-101136
• 发表时间: 2024
• 期刊: General psychiatry
• 影响因子: 11.9
• 作者: Sun,Yunxiang;Park,Soim;Malik,Abid;Atif,Najia;Zaidi,Ahmed;Rahman,Atif;Surkan,PamelaJ
• 通讯作者: Surkan,PamelaJ

'Those whom I have to talk to, I can't talk to': Perceived social isolation in the context of anxiety symptoms among pregnant women in Pakistan.

“那些我必须与之交谈的人，我却无法与之交谈”：巴基斯坦孕妇在焦虑症状的背景下感受到的社会孤立。

• DOI: 10.1111/hsc.14019
• 发表时间: 2022
• 期刊: Health & social care in the community
• 影响因子: 2.4
• 作者: Nazir,Huma;Rowther,ArmaanA;Rauf,Nida;Atiq,Maria;Kazi,AsiyaK;Malik,Abid;Atif,Najia;Surkan,PamelaJ
• 通讯作者: Surkan,PamelaJ