Improving Preterm Outcomes by Safeguarding Maternal Mental Health

描述（由申请人提供）：早产儿出生时存在健康和发育不良的生物风险;孕产妇抑郁症在这一人群中不成比例地常见，并且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的公共卫生重要性，并特别呼吁采取新的产后干预策略， 实现这一目标。R 01申请的前提是，预防母亲抑郁症和优化母亲功能将最终改善早产儿的发育结果。它是在两个新生儿重症监护室（NICU）的早产儿母亲中成功完成R 03资助的问题解决教育（PSE）试点试验之后。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，从而预防抑郁症。我们现在提出了一项定制干预的随机试验- NICU-PSE -通过简短的激励策略增强核心试点模型，以最大限度地提高干预依从性，并将六次干预会议中的三次用于早产儿家庭面临的特定挑战，在试点中确定：照顾者负担，导航复杂的婴儿随访服务，以及长期婴儿住院后家庭的社会重新融合。我们将在三个NICU-波士顿医学中心、塔夫茨医学中心和马萨诸塞州大学医学中心-对325名早产儿低收入母亲进行随机对照试验。在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，通过这些指标，母亲抑郁症理论上会影响幼儿。具体来说，我们的目标是降低重度抑郁发作的发生率，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后续护理循证质量指标的坚持;改善母亲对掌握的看法，减少他们对照顾者负担和社会孤立的看法;提高母亲对婴儿线索的敏感性。通过我们的干预，我们假设早产儿的母亲将发展更强的解决问题的能力，并感知更少的压力。这将导致抑郁症的负担减轻。干预母亲也将体验到功能的改善，表现在更好地坚持新生儿重症监护室的后续护理，以及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，旨在由未经广泛培训的学士学位从业者在早产后2至4个月内提供。我们的最终目标是传播适用于所有早产儿低收入家庭的安全有效的干预措施。

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.