Dyadic Intervention for Women at Risk for Postpartum Depression and their Infants

对有产后抑郁症风险的妇女及其婴儿的二元干预

• 批准号: 7873266
• 负责人: janice goodman
• 金额: $ 28.91万
• 依托单位: MGH INSTITUTE OF HEALTH PROFESSIONS
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7873266
• 关键词: 1 year old; Address; Adult; Adverse effects; Affect; Age-Months; Analysis of Variance; Anxiety; Birth; Child; Child Development; Cognitive; Consultations; Control Groups; Depressed mood; Development; Early treatment; Educational Intervention; Feasibility Studies; Functional disorder; Future; Goals; Group Homes; Home environment; Home visitation; House Call; Infant; Intervention; Measures; Mediating; Mental Depression; Mental Health; Monitor; Mothers; Nurses; Outcome; Parenting behavior; Parents; Participant; Personal Satisfaction; Postpartum Depression; Postpartum Period; Pregnancy; Prevention; Protocols documentation; Public Health; Randomized; Registered nurse; Research; Risk; Sampling; Schedule; Security; Staging; Stress; Telephone; Testing; Time; Training; Treatment Efficacy; Visit; Woman; base; depressive symptoms; design; effective intervention; experience; follow-up; improved; infant outcome; insight; intervention effect; maternal depression; maternal stress; neglect; novel; post intervention; prevent; primary outcome; public health relevance; randomized trial; response; secondary outcome; self esteem; social; treatment as usual

DESCRIPTION (provided by applicant): This application is in response to PA-09-175 Women's Mental Health in Pregnancy and the Postpartum Period. The goal of this exploratory/development (R21) project is to further develop, pilot test, and refine a novel dual-focused mother-infant intervention to prevent/decrease maternal postpartum depression (PPD) and improve aspects of mother-infant relationships and child development outcomes. Approximately 10-15% of women experience PPD after the birth of a baby, with serious negative consequences for maternal well-being, the mother-infant relationship, and subsequent child development. Most current PPD treatments focus exclusively on maternal outcomes, neglect the mother-infant relationship, and thus do not result in improvements in relationship or child outcomes. No study has yet addressed the dual problems of maternal depression and mother-infant relationship dysfunction in an integrated way. The proposed project innovatively addresses this critical research gap by targeting PPD and the associated mother-infant relationship dysfunction concurrently in a theoretically and clinically based early dyadic intervention that consists of: (a) an insight- oriented and supportive relationship-based mother-infant psychotherapeutic component utilizing the infant as an integral part of the therapy, and (b) a developmentally-based infant-oriented component designed to enhance maternal sensitive responsiveness and promote positive mother-infant interactions. Our specific aims are to: (1) Develop the intervention protocol and refine it as appropriate after testing its feasibility with 5 mother-infant dyads; (2) Assess the efficacy of the intervention on the primary outcomes of prevention or reduction of PPD and enhancing the quality of mother-infant interaction at post-intervention, 6 months, and 1 year postpartum follow-ups; and (3) Explore the effects of the intervention on secondary outcomes of maternal anxiety, parenting stress, maternal self-esteem, maternal attachment to the infant, child attachment security, and child cognitive development at post-intervention and follow-up time points. After developing the intervention and refining it based on expert consultation and findings from the initial feasibility testing, we will test its efficacy using a sample of 60 women determined to be at-risk for PPD due to elevated depression scores at 1 week postpartum and their infants. Dyads will be randomly assigned to the intervention or control group. The home-based intervention will consist of 8 mother-infant sessions delivered by specially trained nurses over the first 3 months postpartum. Control group will receive a short educational intervention followed by usual care plus maternal depression monitoring by phone on a schedule comparable to the intervention visits. Maternal and mother-infant outcomes will be measured at baseline, post-intervention, and at two follow- up points. Infant outcomes will be assessed at 1 year of age. Repeated measures analysis of variance will be used to determine intervention effects. If successful, findings from this study will inform the development of a future R01 proposal to conduct a larger randomized trial of the intervention. PUBLIC HEALTH RELEVANCE: Postpartum depression (PPD) is a major public health concern that affects approx 10-15% of mothers with serious negative consequences for not only the mothers, but also the mother-infant relationship and child development. The goal of the proposed project is to develop and assess the feasibility and efficacy of a novel dual-focused mother-infant intervention by specially trained nurses to prevent/decrease maternal postpartum depression and associated mother-infant relationship dysfunction. If shown to be effective, this intervention would provide a new early-stage treatment option for PPD that would hold great benefit for mothers and infants and could be easily adapted for widespread public use for at-risk mother-infant dyads.

描述(申请人提供)：本申请是针对PA-09-175《妇女孕期和产后心理健康》而提出的。这一探索性/发展性(R21)项目的目标是进一步开发、试点测试和改进一种新的双重点母婴干预措施，以预防/减少产妇产后抑郁(PPD)，并改善母婴关系和儿童发育结果的各个方面。大约10%-15%的妇女在婴儿出生后经历产后抑郁，对母亲的福祉、母婴关系和随后的儿童发育造成严重的负面后果。目前的产后抑郁治疗大多只关注母亲的结局，忽视母婴关系，因此不能改善关系或改善孩子的结局。还没有研究以一种综合的方式解决母亲抑郁和母婴关系障碍的双重问题。拟议的项目创新性地解决了这一关键的研究空白，在基于理论和临床的早期二元干预中同时针对产后抑郁和相关的母婴关系障碍，该干预包括：(A)以洞察力和支持性关系为基础的母婴心理治疗部分，将婴儿作为治疗的组成部分；(B)以发育为基础的婴儿部分，旨在增强母亲的敏感反应和促进积极的母婴互动。我们的具体目标是：(1)制定干预方案，并在对5对母婴进行可行性测试后进行适当的修改；(2)评估干预对预防或减少产后抑郁的主要结果的有效性，并在干预后、6个月和1年的产后随访中提高母婴互动的质量；以及(3)探讨干预对母亲焦虑、育儿压力、母亲自尊、母亲对婴儿的依恋、儿童依恋安全和儿童认知发展的影响。在开发了干预措施并根据专家咨询和初步可行性测试的结果进行改进后，我们将使用60名被确定为产后1周抑郁评分升高的PPD高危妇女及其婴儿的样本来测试其有效性。二元组将被随机分配到干预组或对照组。家庭干预将包括8次母婴会议，由受过专门培训的护士在产后的头3个月内进行。对照组将接受短暂的教育干预，然后进行常规护理，并通过电话监测母亲的抑郁，时间安排与干预访问相当。产妇和母婴结局将在基线、干预后和两个随访点进行衡量。婴儿的结局将在1岁时进行评估。将使用重复测量方差分析来确定干预效果。如果成功，这项研究的结果将为未来R01提案的发展提供信息，以进行更大规模的干预随机试验。 公共卫生相关性：产后抑郁症(PPD)是一种主要的公共卫生问题，影响到大约10%-15%的母亲，不仅对母亲，而且对母婴关系和儿童发展都有严重的负面影响。拟议项目的目标是开发和评估由受过专门培训的护士进行的双重点母婴干预的可行性和有效性，以预防/减少产妇产后抑郁和相关的母婴关系障碍。如果被证明是有效的，这种干预将为产后抑郁提供一种新的早期治疗选择，将对母亲和婴儿产生巨大的好处，并可以很容易地适应公众对高危母婴的广泛使用。