Improving Preterm Outcomes by Safeguarding Maternal Mental Health

描述(由申请人提供)：早产儿出生时健康和发育结果不佳的生物学风险；产妇抑郁在这一人群中不成比例地常见，并已知会加剧这些结果。在其2006年的报告《早产》中，医学研究所指出了优化早产儿发育结果对公共卫生的重要性，并特别呼吁采取新的产后干预策略来 实现这一目标。R01的应用是基于这样一个前提，即预防产妇抑郁和优化产妇功能最终将改善早产儿的发育结果。在此之前，在两个新生儿重症监护病房(NICU)成功完成了由R03资助的针对早产儿母亲的问题解决教育(PSE)试点试验。PSE是一种认知行为策略，旨在向接受者传授技能，以减少压力对个人功能的影响，从而防止抑郁。我们现在建议进行一项量身定制的干预措施的随机试验-NICU-PSE-它用简短的激励策略来增强核心试点模式，以最大限度地遵守干预措施，并将六次干预中的三次用于试点中确定的早产儿家庭面临的具体挑战：照顾者负担、导航复杂的婴儿后续服务，以及在婴儿长期住院后家庭重新融入社会。我们将对波士顿医学中心、塔夫茨医学中心和马萨诸塞大学医学中心三个NICU中的325名早产低收入母亲进行随机对照试验。在为期12个月的随访中，我们将评估NICU-PSE对早产儿母亲的一系列结局指标的影响，以及一系列代表特定风险机制的指标，根据这些机制，母亲抑郁被理论上影响到幼儿。具体地说，我们的目标是减少严重抑郁发作的发生率，改善抑郁症状轨迹；并改善一般和父母的功能。我们还旨在提高对NICU后续护理的循证质量指标的遵守；改善母亲对掌握情况的看法，减少她们对照顾者负担和社会孤立的看法；并提高母亲对婴儿暗示的敏感度。通过我们的干预，我们假设早产儿的母亲将发展出更强的解决问题的技能，并感受到较少的压力。这将减轻抑郁症状的负担。干预母亲还将体验到功能的改善，表现为更好地坚持NICU后续护理，并减少对照顾者负担和社会孤立的看法。NICU-PSE是一种可复制的干预措施，旨在由本科水平的从业者在早产后2至4个月内提供，而无需进行广泛的培训。我们的最终目标是传播适用于所有有早产儿的低收入家庭的安全和有效的干预措施。

DESCRIPTION (provided by applicant): Preterm infants are born at biological risk for poor health and developmental outcomes; maternal depression is disproportionately common among this population, and is known to exacerbate these outcomes. In its 2006 report, Preterm Birth, the Institute of Medicine stated the public health importance of optimizing the developmental outcomes of preterm infants, and specifically called for novel postnatal intervention strategies to accomplish this goal. This R01 application is based on the premise that preventing maternal depression and optimizing maternal functioning will ultimately improve the developmental outcomes of preterm infants. It follows the successful completion of an R03-funded pilot trial of Problem Solving Education (PSE) among mothers of preterm infants in two neonatal intensive care units (NICUs). PSE is a cognitive behavioral strategy that aims to impart recipients with skills to reduce the impact of stress on personal functioning, and thereby prevent depression. We now propose a randomized trial of a tailored intervention - NICU-PSE - which augments the core pilot model with brief motivational strategies to maximize intervention adherence, and devotes three of six intervention sessions to specific challenges faced by families of preterm infants, identified in the pilot: caregiver burden, navigating complex infant follow-up services, and social reintegration of the family following prolonged infant hospitalization. We will conduct an RCT of 325 low-income mothers with preterm infants in three NICUs - Boston Medical Center, Tufts Medical Center, and University of Massachusetts Medical Center. Over 12-months of follow-up, we will assess the effects of NICU-PSE on a series of outcomes measures for mothers of preterm infants, and a series of measures that represent specific risk mechanisms by which maternal depression is theorized to impact young children. Specifically, we aim to decrease the incidence of major depressive episode and improve depressive symptom trajectories; and improve general and parental functioning. We also aim to improve adherence to evidence-based quality indicators for NICU follow-up care; improve mothers' perceptions of mastery, and decrease their perceptions of caregiver burden and social isolation; and improve mothers' sensitivity to infant cues. Through our intervention, we hypothesize that mothers of preterm infants will develop stronger problem solving skills and perceive less stress. This will lead to a decreased burden of depressive symptomatology. Intervention mothers will also experience improved functioning, manifested in better adherence to NICU follow- up care, and decreased perceptions of caregiver burden and social isolation. NICU-PSE is a replicable intervention, designed to be delivered within two to four months of preterm delivery by bachelor level practitioners without extensive training. Our ultimate goal is to disseminate a safe and effective intervention applicable to all low-income families with preterm infants.