Preventing Postpartum Depression: A Dyadic Approach Adjunctive to Obstetric Care

项目总结/摘要 在美国每年近400万的活产婴儿中，大约有56万，即14%， 妇女在产后的头四个月内会患上抑郁症。后果是巨大的： 妇女的生活质量下降，情绪受到严重影响。PPD预测母婴减少 在社交情感和认知发展方面，对一些人来说，结果很差。依靠标准 药物和心理干预，PPD治疗不足，部分原因是妇女不愿意 由于与精神卫生保健有关的耻辱而寻求治疗， 医疗保健预约，以及母乳喂养时不愿意服用药物。PPD的风险因素包括 相对来说，轮廓清晰。尽管产前抑郁症状是最可靠的预测因素， 基于证据的PPD预防性干预措施很少。在预防性干预措施中， 对生育期的独特二元定位或产科护理中的嵌入式服务。解决 在PPD预防和治疗方面存在巨大的知识缺口，我们开发了（R21MH 092665 - 01）并在 一项初步的随机对照试验（RCT），一项名为PREPP的新干预措施（实用资源， 有效的产后育儿），并根据有希望的已发表数据，我们建议进行更大的随机对照试验 这种治疗。PREPP招募有PPD风险的孕妇，涵盖妊娠晚期至6周 产后检查它包括四个人的'教练'会议与产科（OB）产前 产后预约和一次电话咨询PREPP包括（a）正念和自我反思 技能，（B）养育技能和（c）心理教育。就这项建议计划而言，我们有三个研究目的， 在214例妊娠晚期妇女（年龄： 18 - 35）在妊娠期和产后6、12和16周评估2次PPD风险：（1）减少妇女的 （2）确定维护改善产妇情绪和婴儿差异 行为（3）识别PREPP对母婴二分体产生积极影响的一些途径。prepp 在PPD的新概念和克服PPD治疗障碍的设计方面具有创新性。的 传统的PPD临床治疗方法以个人为重点，改善他们的症状。在PREPP中， 产后抑郁症被认为是一种潜在的母婴疾病，可以通过预防来治疗。 母亲的心理和行为变化-从出生前开始-影响到她和 孩子PREPP证明了医疗保健创新的先锋，旨在增加金属医疗保健的吸收 通过将行为健康服务与初级卫生保健相结合。这份行政补充文件旨在 由于COVID-19疫情，完成原定目标的资金被搁置。

PROJECT SUMMARY/ABSTRACT Of the nearly 4 million live births each year in the United States, approximately 560,000, or 14% of these women will develop depression within the first four months postpartum. The consequences are substantial: diminished quality of life and significant emotional suffering for women. PPD predicts diminished mother–infant bonding and poor outcomes in social–emotional and, for some, cognitive development. Relying on standard pharmacologic and psychological interventions, PPD is undertreated in part because women are reluctant to seek treatment due to the stigma associated with mental health care, logistical barriers to attending added health care appointments, and disinclination to take medications while breastfeeding. Risk factors for PPD are relatively well delineated. Even though prenatal depressive symptoms are some of the most reliable predictors, evidenced–based, preventive interventions for PPD are rare. Of the preventative interventions, few leverage the unique dyadic orientation of the childbearing period or imbed services in obstetrical care. To address the huge knowledge gap in the prevention and treatment of PPD, we developed (R21MH092665–01) and tested in a preliminary randomized control trial (RCT) a new intervention called PREPP (Practical Resources for Effective Postpartum Parenting) and, following promising published data, we propose to conduct a larger RCT of this treatment. PREPP enrolls pregnant women at risk for PPD, spans late pregnancy to the 6– week postpartum check-up. It consists of four in–person ‘coaching’ sessions adjunctive to obstetrical (OB) prenatal and postnatal appointments, and one phone session. PREPP includes (a) mindfulness and self– reflection skills, (b) parenting skills and (c) psycho–education. For this proposed project, we have three study aims to be realized in a PREPP vs Enhanced Treatment as Usual RCT of 214, 3rd trimester pregnant women (ages 18–35) at risk for PPD assessed 2x in pregnancy and at 6, 12, and 16 weeks postpartum: (1) Reduce women’s distress during pregnancy (2) Determine the maintenance of improved maternal mood and differences in infant behavior (3) Identify some of the pathways by which PREPP positively affects the mother– infant dyad. PREPP is innovative in its novel conceptualization of PPD and design to overcome barriers to PPD treatment. The traditional clinical approach to PPD has as a focus the individual and improving their symptoms. In PREPP, PPD is viewed as a potential disorder of the mother–infant dyad, which can be approached through preventive psychological and behavioral changes in the mother — commencing before birth — that affect her and the child. PREPP exemplifies the vanguard of health care innovations aiming to increase metal health care uptake by integrating behavioral health services with primary health care. This administrative supplement seeks funds to complete the original aims stalled as a consequence of the COVID-19 pandemic.