Project REACH: Preventing Postpartum Depression in Adolescent Mothers

描述(由申请人提供)：在美国，每年有超过40万名婴儿出生于青春期母亲，其中约26%-36%的母亲患有产后抑郁症(PPD)，这是一种与严重的社会和健康发病率相关的疾病。产后抑郁使青春期母亲及其子女在生活中本已具有挑战性的时期面临风险，这种困难可能是这些年轻母亲及其子女结局不佳的一个主要决定因素。青春期母亲的抑郁可能会影响她们是否为自己和婴儿从事促进健康的行为。尽管在这一弱势群体中产生积极的公共卫生影响的潜力是巨大的，但迄今为止的研究并未侧重于预防青少年母亲的产后抑郁。REACH项目适用于PA 09-174中概述的研究目标：孕期妇女的心理健康和产后针对性干预研究，以发展关于“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，特别是能够适应普通医疗或团体环境的干预措施。”此外，这项申请专门针对因年龄小、低收入和不同的族裔/种族背景而特别容易患产后抑郁症的妇女群体。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来改善青少年母亲及其子女的健康状况。为了实现这一目标，将对预防青春期母亲产后抑郁的可行和可接受的循证计划在服务于不同孕妇群体的产前环境中的有效性进行评估。REACH项目的具体目标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，针对那些可能在青少年母亲的产后抑郁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)。这项高度结构化的干预措施在怀孕期间分五次进行，其中一次是产后助推器。参与者在产后6周、3个月、6个月和12个月接受抑郁评估。除了产后抑郁的结果，REACH项目还建议评估干预对母子纽带和健康促进行为的影响。协作的跨学科研究团队是唯一有资格领导这一应用程序的团队，因为他们成功地开发并试行了创新的行为预防计划，以预防青少年母亲的产后抑郁。通过仔细的评估和改进，REACH项目已经为与综合产前护理计划的合作而量身定做；如果被发现是有效的，REACH有可能在产前实践中广泛传播和被接受。

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.