Prevention of Perinatal Depression in Birthing People with a History of Adverse Childhood Experiences: A Type 2 Effectiveness Implementation Trial

预防有童年不良经历史的出生者的围产期抑郁症：2 类有效性实施试验

• 批准号: 10919910
• 负责人: Sheehan David Fisher
• 金额: $ 24万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10919910
• 关键词: Adult; Adverse effects; American; Attention; Belief; Birth; Caring; Case Manager; Childhood; Clinic; Clinical; Cluster randomized trial; Communication; Data; Depressive disorder; Diagnosis; Discipline; Discipline of obstetrics; Dissemination and Implementation; Divorce; Dose; Effectiveness; Eligibility Determination; Enrollment; Equity; Exclusion; Exposure to; Foundations; Generations; Goals; Health Services; Healthcare; Hybrids; Individual; Infrastructure; Infusion procedures; Intervention; Interview; Investigational Therapies; Justice; Life; Life Experience; Low Income Population; Low income; Major Depressive Disorder; Masks; Maternal and Child Health; Measures; Mediator; Medical; Medical Care Team; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Meta-Analysis; Methods; Modeling; Mothers; Outcome; Participant; Pathogenicity; Perinatal; Persons; Population; Postpartum Period; Poverty; Pregnancy; Prevention; Process; Provider; Public Health; Publishing; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recording of previous events; Reporting; Research; Research Personnel; Research Training; Risk; Self Efficacy; Services; Sexual abuse; Social support; Structural Racism; Structure; Symptoms; Third Pregnancy Trimester; Trauma; Treatment Protocols; United States; adverse childhood events; adverse outcome; anxiety symptoms; care systems; childhood adversity; collaborative care; cost; depression prevention; depressive symptoms; design; effectiveness evaluation; effectiveness trial; effectiveness/implementation design; effectiveness/implementation trial; emotional abuse; evidence base; experience; follow-up; implementation evaluation; implementation intervention; implementation outcomes; implementation strategy; improved; improved outcome; intergenerational; interpersonal therapy; meetings; multidisciplinary; neglect; obstetric care; offspring; patient registry; perinatal period; peripartum depression; physical abuse; pregnant; prevent; prevention service; preventive intervention; primary care setting; primary outcome; programs; public health insurance; randomized effectiveness trial; randomized trial; randomized, clinical trials; reproductive; response; screening; secondary outcome; service intervention; service programs; social adversity; socioeconomics; stress symptom; therapy design; traumatic event; treatment as usual

PROJECT SUMMARY Prevention of perinatal depression represents an opportunity to optimize maternal and child health outcomes. However, dissemination and implementation of evidence-based prevention interventions, such as Reach Out, Stand Strong, Essentials for New Mothers (ROSE), are challenged by the complexity of multidisciplinary engagement. The collaborative care model (CCM) is an evidence-based health services intervention designed to integrate mental health care into somatic healthcare contexts and bridge care across medical disciplines. Accordingly, the CCM represents an ideal and pragmatic infrastructure to support the delivery of ROSE within obstetric clinics. Adverse childhood experiences (ACEs) are physical, sexual, and emotional abuses incurred in childhood. A striking 16% of adults in the United States were exposed to at least 4 ACEs, and the burden of ACEs is disproportionately borne by historically and socioeconomically excluded populations. Exposure to ACEs is perniciously associated with somatic and mental health outcomes in adulthood, including perinatal depression. Perinatal depression, in turn, is associated with adverse outcomes in birthing people and their offspring. Mitigation of the intergenerational adverse effects of ACEs, via prevention of perinatal depression, is an essential component of a reproductive justice-focused public health strategy. Built on the foundations of interpersonal therapy (IPT), ROSE is a pertinent evidence-based approach for low- income birthing people with a history of ACEs. ROSE's emphasis on the enhancement of support structures may protect against the impact of ACEs on mental health via overcoming pathogenic beliefs that interfere with healthy interpersonal functioning. This mechanism is particularly salient during the transition to new parenthood as social support can decrease the risk of perinatal depression. The infusion of trauma-informed care into the ROSE intervention, including focused attention on obstetric triggers of trauma and communication of these risks across the multi-disciplinary health care team, alongside implementation of this intervention within the CCM defines Trauma-informed ROSE InterventiOn (TRIO). This project, “Prevention of Perinatal Depression in Birthing People with a History of Adverse Childhood Experiences: A Type 2 Effectiveness Implementation Trial”, aims, via a hybrid type 2 randomized trial, to evaluate TRIO, compared to enhanced treatment as usual. Aim 1 will evaluate wither TRIO improves perinatal depression (both symptom trajectories and dichotomized perinatal depression) among low-income pregnant people with a history of ACEs. Aim 2 will evaluate mechanisms by which TRIO may improve perinatal depression. Aim 3 will examine the acceptability, appropriateness, cost, feasibility, and fidelity of TRIO. This proposal will generate key data to inform the conduct of a full-scale cluster randomized trial of TRIO that will answer the key questions of how to effectively and equitably prevent perinatal depression.

项目摘要 预防围产期抑郁症是优化孕产妇和儿童健康结果的一个机会。 然而，传播和实施“伸出援手”等循证预防干预措施， Stand Strong，Essentials for New Mothers（ROSE），受到多学科复杂性的挑战。 订婚协作护理模式（CCM）是一种基于证据的卫生服务干预措施， 将精神卫生保健纳入躯体卫生保健环境，并在医学学科之间建立桥梁。 因此，CCM代表了一个理想和务实的基础设施，以支持在 产科诊所。 不良童年经历（ACE）是指儿童时期遭受的身体、性和情感虐待。一 美国16%的成年人暴露于至少4种ACE，ACE的负担是 在历史上和社会经济上受到排斥的人口不成比例地承担着这一责任。接触ACE是 与成年期的身体和精神健康结果有害相关，包括围产期抑郁症。 反过来，围产期抑郁症与分娩者及其后代的不良结局有关。 通过预防围产期抑郁症来减轻ACE的代际不良影响是至关重要的 这是以生殖公正为重点的公共卫生战略的一个组成部分。 建立在人际治疗（IPT）的基础上，ROSE是一种针对低血糖的相关循证方法。 有ACE病史的人的收入ROSE强调加强支持结构， 通过克服干扰健康的致病信念，防止ACE对心理健康的影响 人际功能这种机制在向新的父母身份过渡期间特别突出， 支持可以降低围产期抑郁症的风险。将创伤知情护理注入ROSE 干预措施，包括重点关注产科创伤的触发因素，并将这些风险传达到各个部门。 多学科医疗保健团队，以及在CCM内实施这一干预措施， 创伤知情ROSE干预（TRIO）。 这个项目，“预防有不良童年史的人的围产期抑郁症 经验：2型有效性实施试验”，旨在通过混合2型随机试验， TRIO，与常规强化治疗相比。目的1评价TRIO是否改善围生期抑郁症 (both症状轨迹和二分围产期抑郁症）在低收入孕妇中， ACE的历史目的2将评估TRIO可能改善围产期抑郁症的机制。目标3将 检查TRIO的可接受性、适当性、成本、可行性和保真度。该提案将产生关键 数据，以告知TRIO的全面随机分组试验的进行，该试验将回答以下关键问题 如何有效和公平地预防围产期抑郁症。