Biobehavioral perspectives on social connectedness and the âMindful Momsâ intervention for marginalized pregnant women with depression

项目总结/摘要 背景：在美国，近20%的女性经历过临床上显著的抑郁症状 在怀孕或产后期间。虽然治疗抑郁症的方法存在， 尽管有抗抑郁药和心理治疗，但许多妇女由于担心污名化而仍然没有得到充分或未得到治疗， 副作用和成本，特别是边缘化妇女（少数民族，社会经济地位低）。此夕h 标准的抑郁症治疗并不涉及社会联系，而社会联系是一个潜在的可改变因素 与抑郁症状有关通过安全、无风险的方法， 药物，可获得的治疗，解决社会联系在怀孕期间， 妇女是一个迫切的临床和研究优先事项。初步数据：来自我们研究的初步证据 研究小组展示了一种在围产期抑郁症背景下解决社会联系的有希望的途径： 我们在NICHD资助的一项研究（R15HD086835，Kinser）中试行了"正念妈妈"干预; 一周的干预包括一个简短的激励性讨论，关于症状自我管理加上基于小组的 有意识的身体活动（产前瑜伽）课程。研究结果为方案可行性提供了支持， 干预的可接受性，定性研究结果使我们假设，社会联系发挥作用， 在症状管理中发挥关键作用。此外，我们已经确定了与以下因素独特相关的表观遗传模式： 产后抑郁症;我们将评估这些DNA甲基化模式的相似性与社会相关性。 连通性和产后抑郁症，作为社会连通性机制的探索。研究 设计：使用基于个人和家庭自我管理理论的概念框架， 本项双组纵向随机对照试验的目的是评估这种方法的效果和机制。 自我管理的方法，在边缘化的妇女与抑郁症状（n = 200），相比，积极的 控制第一个具体目标是评估各组对抑郁症状严重程度、焦虑和 随着时间的推移感受到的压力。第二个具体目标是理解社会联系的作用， 小组分配对抑郁症状影响的调节作用。第三个具体目标是确定 全基因组DNA甲基化模式与感知的社会联系水平相关。潜在 影响：成功完成我们的目标将为社会联系提供重要的见解， 机制，以减少抑郁症状在很大程度上研究不足，历史上被边缘化的人口， 妇女此外，如果证明有效，“正念妈妈”可能是一个低成本，可持续和可翻译的选择 用于干预围产期抑郁症状。

PROJECT SUMMARY/ABSTRACT Background: Nearly 20% of women in the United States experience clinically significant depressive symptoms during pregnancy or the postpartum period. Although treatments exist for depressive symptoms such as antidepressants and psychotherapy, many women remain under- or un-treated due to concerns about stigma, side effects, and costs, particularly marginalized women (minority, low socioeconomic status). Further, the standard depression treatments do not address social connectedness, which is a potentially modifiable factor involved in depressive symptoms. A focus on adequate symptom management through safe, non- pharmacologic, accessible therapies that address social connectedness during pregnancy in marginalized women is an urgent clinical and research priority. Preliminary Data: Preliminary evidence from our research team shows a promising pathway for addressing social connectedness in the context of perinatal depression: we have piloted the “Mindful Moms” intervention in a NICHD-funded study (R15HD086835, Kinser); the 12- week intervention involves a brief motivating discussion about symptom self-management plus group-based mindful physical activity (prenatal yoga) sessions. Study findings provide support of protocol feasibility and intervention acceptability, with qualitative findings leading us to hypothesize that social connectedness plays as a key role in symptom management. Also, we have identified epigenetic patterns uniquely related to postpartum depression; we will evaluate the similarity of these DNA methylation patterns related to social connectedness and postpartum depression, as an exploration of mechanisms of social connectedness. Study Design: Using a conceptual framework based upon Individual and Family Self-Management Theory, the overall goal of this two-arm longitudinal randomized controlled trial is to evaluate the effects and mechanisms of this self-management approach in marginalized women with depressive symptoms (n=200), compared to an active control. The first Specific Aim is to evaluate effects by group on depressive symptom severity, anxiety, and perceived stress over time. The second Specific Aim is to understand the role of social connectedness as a moderator of the effects of group assignment on depressive symptoms. The third Specific Aim is to identify genome-wide DNA methylation patterns associated with levels of perceived social connectedness. Potential Impact: The successful completion of our aims will provide important insights into social connectedness as a mechanism to decrease depressive symptoms in a largely understudied, historically marginalized population of women. Further, if proven efficacious, “Mindful Moms” may be a low-cost, sustainable, and translatable option for intervention in perinatal depressive symptoms.