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（由申请人提供）：本申请是针对 PA-09-175 女性妊娠期和产后心理健康的回应。该探索/开发（R21）项目的目标是进一步开发、试点测试和完善一种新颖的双焦点母婴干预措施，以预防/减少母亲产后抑郁症（PPD）并改善母婴关系和儿童发展结果。大约 10-15% 的女性在婴儿出生后经历产后抑郁症，对母亲的健康、母婴关系以及随后的儿童发育产生严重的负面影响。目前大多数 PPD 治疗仅关注母亲结局，忽视母婴关系，因此不会改善关系或儿童结局。目前还没有研究以综合的方式解决母亲抑郁和母婴关系功能障碍的双重问题。拟议的项目通过在基于理论和临床的早期二元干预中同时针对产后抑郁症和相关的母婴关系功能障碍，创新性地解决了这一关键的研究空白，该干预措施包括：（a）以洞察力为导向和支持性关系为基础的母婴心理治疗部分，利用婴儿作为治疗的一个组成部分，以及（b）以发育为基础的婴儿导向部分，旨在 增强母亲的敏感反应能力，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5个母婴组合测试其可行性后酌情完善； (2) 在干预后、产后6个月和1年的随访中评估干预措施对预防或减少产后抑郁以及提高母婴互动质量等主要结局的效果； (3) 探讨干预后和随访时间点干预对母亲焦虑、养育压力、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等次要结果的影响。在根据专家咨询和初步可行性测试结果开发和完善干预措施后，我们将使用 60 名因产后 1 周抑郁评分升高而被确定为有产后抑郁症风险的女性及其婴儿作为样本，测试其功效。双人组将被随机分配到干预组或对照组。家庭干预将包括 8 次母婴课程，由经过专门培训的护士在产后前 3 个月内提供。对照组将接受短暂的教育干预，然后是常规护理以及通过电话进行产妇抑郁症监测，其时间表与干预访问相当。将在基线、干预后和两个随访点测量孕产妇和母婴结局。婴儿的结局将在 1 岁时进行评估。重复测量方差分析将用于确定干预效果。如果成功，这项研究的结果将为未来 R01 提案的制定提供信息，以进行更大规模的随机干预试验。 公共健康相关性：产后抑郁症 (PPD) 是一个主要的公共健康问题，影响着大约 10-15% 的母亲，不仅对母亲、而且对母婴关系和儿童发育产生严重的负面影响。该项目的目标是开发和评估由经过专门培训的护士进行的新型双焦点母婴干预措施的可行性和有效性，以预防/减少产妇产后抑郁症和相关的母婴关系功能障碍。如果被证明有效，这种干预措施将为产后抑郁症提供一种新的早期治疗选择，这将为母亲和婴儿带来巨大益处，并且可以很容易地广泛应用于高危母婴组合。