Project REACH: Preventing Postpartum Depression in Adolescent Mothers

描述（由申请人提供）：美国每年有超过40万名青少年母亲分娩，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。产后抑郁症使青春期母亲及其子女在生活中本已充满挑战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局的主要决定因素。青春期母亲的抑郁症可能会影响她们是否为自己和婴儿从事促进健康的行为。迄今为止的研究还没有把重点放在预防青春期母亲产后抑郁症上，尽管这对这一弱势群体可能产生巨大的积极公共卫生影响。REACH项目的申请满足了PA 09-174中概述的研究目标：“怀孕和产后妇女的心理健康”，目标是进行干预研究，以发展关于“围产期情绪障碍的心理抑郁治疗”的系统知识，并“为这些情况开发新的行为干预措施，特别是可适应一般医疗或群体环境的干预措施”。此外，该应用程序特别针对女性群体，因为她们年轻，低收入和不同的民族/种族背景，特别容易患产后抑郁症。REACH项目（放松、鼓励、欣赏、沟通、帮助）的长期目标是通过预防产后抑郁症来改善青春期母亲及其子女的健康状况。为了实现这一目标，一个可行和可接受的以证据为基础的预防青春期母亲产后抑郁症的项目将在产前环境中为不同的孕妇群体服务，评估其有效性。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）与教学性注意力控制计划相比是否能降低青春期母亲PPD的风险。REACH项目以人际心理治疗为基础，针对那些可能在青春期母亲产后障碍发展中起重要作用的因素（即缺乏社会支持、角色转换和生活压力源）。这种高度结构化的干预在怀孕期间分为五个阶段，其中一个是产后加强阶段。在产后6周、3个月、6个月和12个月对参与者进行抑郁评估。除了PPD结果外，REACH项目还建议评估干预对母婴关系和健康促进行为的影响。跨学科合作研究团队是唯一有资格领导这一应用的人，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，以预防青春期母亲的产后抑郁症。经过仔细的评估和完善，REACH项目已被定制为与综合产前护理计划合作；而且，如果被发现是有效的，REACH有可能在产前实践中广泛传播和接受。

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.