Project REACH: Preventing Postpartum Depression in Adolescent Mothers

描述（由申请人提供）：在美国，每年有超过40万名新生儿是青少年母亲，其中约26-36%的母亲患有产后抑郁症（PPD），这是一种与重大社会和健康发病率相关的疾病。产后抑郁症使青少年母亲及其子女在其生活中已经具有挑战性的时期处于危险之中，这种困难可能是这些年轻母亲及其子女不良结果的主要决定因素。青少年母亲的抑郁可能会影响她们是否为自己和婴儿采取促进健康的行为。迄今为止的研究并没有集中在预防青少年母亲的产后抑郁症，尽管对这一脆弱人群产生积极的公共卫生影响的潜力是巨大的。REACH项目的申请涉及PA 09-174中概述的研究目标：妇女在怀孕和产后期间的心理健康，目标是进行干预研究，以开发有关“围产期情绪障碍的心理社会抑郁治疗”的系统知识，并“为这些情况开发新的行为干预措施，特别是可以适应一般医疗或团体环境的干预措施。“此外，这一应用程序专门针对妇女人口特别容易受到产后抑郁症，因为他们年轻，低收入和不同的民族/种族背景。REACH项目（放松、鼓励、欣赏、交流、帮助）的长期目标是通过预防产后抑郁症改善青少年母亲及其子女的健康状况。为了实现这一目标，一个可行的和可接受的循证计划，以防止PPD在青少年母亲将在产前设置服务于不同人群的孕妇的疗效进行评估。REACH项目的具体目的是进行一项随机对照试验，以评估干预（REACH项目）与教导性注意力控制计划相比是否降低了青少年母亲患PPD的风险。REACH项目以人际心理治疗为基础，针对可能在青少年母亲PPD发展中发挥重要作用的因素（即，社会支持不足、角色转换和生活压力）。高度结构化的干预是在怀孕期间提供五个会议与一个产后助推器会议。参与者在产后6周，3个月，6个月和12个月进行抑郁症评估。除了PPD结果，REACH项目还建议评估干预措施对母婴关系和健康促进行为的影响。协作跨学科研究团队是唯一有资格领导这一应用，因为他们已经成功地开发和试点测试了创新的行为预防计划，以防止青少年母亲的PPD。通过仔细的评估和完善，REACH项目已经与一个综合的产前护理计划进行了合作;如果发现是有效的，REACH有可能在产前实践中广泛传播和接受。 公共卫生相关性：REACH项目的特点是重点关注一种新型的、高度结构化的干预措施，这种干预措施有可能降低青少年母亲患产后抑郁症的风险和相关的发病率。这项研究的结果将为预防产后抑郁症的干预措施提供信息，并深入了解青少年母亲抑郁症与母子关系和健康促进行为之间的关系。该应用程序有可能产生很大的影响，为产前临床护理提供信息，以及为这一脆弱和研究不足的人群进行未来的预防研究。

DESCRIPTION (provided by applicant): More than 400,000 births in the US each year are to adolescent mothers and approximately 26-36% of these mothers experience postpartum depression (PPD), a condition associated with significant social and health morbidity. PPD puts adolescent mothers and their children at risk during an already challenging time in their lives and this hardship may be a major determinant of poor outcomes for these young mothers and their children. Depression in adolescent mothers may influence whether they engage in health-promoting behaviors both for themselves and their infants. Research to date has not focused on preventing PPD in adolescent mothers even though the potential for a positive public health impact is tremendous in this vulnerable population. The Project REACH application addresses the research objective outlined in PA 09-174: Women's Mental Health in Pregnancy and the Postpartum Period targeting intervention research to develop systematic knowledge about "psychosocial depression treatments for perinatal mood disorders" and "to develop new behavioral interventions for these conditions, in particular interventions that can be adapted to general medical or group settings." Further, this application specifically targets a population of women particularly vulnerable to PPD because of their young age, low-income and diverse ethnic/racial backgrounds. The long-term objective of Project REACH (Relax, Encourage, Appreciate, Communicate, Help) is to improve health outcomes for adolescent mothers and their children by preventing PPD. To accomplish this goal, a feasible and acceptable evidence-based program to prevent PPD in adolescent mothers will be evaluated for efficacy in a prenatal setting serving a diverse population of pregnant women. The Specific Aim of Project REACH is to conduct a randomized controlled trial to evaluate whether the intervention (Project REACH) compared with a didactic attention-control program reduces the risk of PPD in adolescent mothers. Project REACH is based on Interpersonal Psychotherapy and targets those factors that may play a significant role in the development of PPD in adolescent mothers (i.e., poor social support, role transitions and life stressors). The highly structured intervention is delivered as five sessions during pregnancy with one postpartum booster session. Participants are evaluated for depression at 6-weeks, 3-month, 6-months and 12-months postpartum. In addition to PPD outcomes, Project REACH proposes to assess the impact of the intervention on maternal-child bonding and health promoting behaviors. The collaborative interdisciplinary research team is uniquely qualified to lead this application as they have successfully developed and pilot tested the innovative behavioral prevention program to prevent PPD in adolescent mothers. Through careful evaluation and refinement, Project REACH has been tailored for collaboration with an integrated prenatal care program; and, if found to be efficacious, REACH has the potential for broad dissemination and acceptability in prenatal practice. PUBLIC HEALTH RELEVANCE: Project REACH is distinguished by the focus on a novel, highly structured intervention that has the potential to reduce the risk of PPD and associated morbidity in adolescent mothers. Results from this study will inform interventions to prevent PPD and provide insight into the associations between adolescent maternal depression and maternal-child bonding and health promoting behavior. This application has the potential for high impact, informing prenatal clinical care delivery as well as future prevention research for this vulnerable and understudied population.