A Dyadic Approach to Perinatal Depression Treatment in Primary Care

项目摘要 10%至20%的妇女在围产期（怀孕至产后一年）患有抑郁症， 特别是低收入的少数民族妇女，但许多人没有得到适当的心理健康。 治疗低育儿自我效能和受损的母婴互动有助于健康相关的 负担和负面的孕产妇和儿童结果。然而，这些育儿问题并没有得到解决， 基于初级保健的围产期抑郁症治疗。我们的团队开发了以用户为中心的设计 技术，一个简短的版本的证据为基础的促进第一关系（PFR）养育干预： PFR-B。我们现在建议测试一个全面的围产期抑郁症治疗-母婴和双 护理（MInD）-包括围产期协作护理中的PFR-Brief，这是一种基于证据的干预措施， 围产期抑郁症卫生部将对初级保健机构中妇女的需求作出反应， 服务不足的妇女获得产前护理。通过关注产后恶化的重要介质， 抑郁症（育儿自我效能降低和母婴互动受损），MInD有可能 改善产妇的健康状况，从长远来看，改善儿童的健康状况。我们的项目具体目标是：目标1 在RCT中比较MInD与普通CC，以评估抑郁症结局。60名抑郁症女性， 将妊娠患者随机分配至MInD或常规CC组。我们假设随机分配至MInD组的患者 在抑郁症方面会有更好的改善（由爱丁堡产后调查测量）。 产后3个月和6个月时的抑郁量表）与常规CC相比， 根据Sheehan残疾量表和Barkin指数， 与接受常规CC的患者相比，母体功能。目的2：探讨 亲职自我效能、二元互动与忧郁的中介假设。我们假设 被随机分配到的女性的育儿自我效能感会更大，二元互动会得到改善 治疗后MInD，并将介导随机分配至 普通CC和普通CC。目的3：检查MInD与常规CC的相对利用率， 试验、评估负担和治疗与患者需求的感知匹配。我们将使用混合方法 策略使用工作联盟库存和深入的病人访谈比较MInD和普通CC。 我们假设随机分配至MInD的患者将有更高的治疗利用率， 参加至少3次产前和3次产后CM会议。我们将探讨研究问题：如何 随机分配至MInD的患者的治疗经验是否与 随机分配至常规CC组的患者？在这个项目结束时，我们的多学科和互补的团队将 准备进行一项R 01资助的更大规模的混合I型有效性实施RCT，以研究 提高国防部效率并为实施做好准备。

Project Summary Ten to 20% of women have depression in the perinatal period (pregnancy through one year postpartum), especially low income racial /ethnic minority women, yet many do not receive appropriate mental health treatment. Low parenting self-efficacy and impaired mother - infant interactions contribute to health-related burden and negative maternal and child outcomes. Yet these parenting issues are not addressed in current primary care-based perinatal depression treatments. Our team has developed, with user centered design techniques, a brief version of the evidence based Promoting First Relationships (PFR) parenting intervention: PFR-B. We now propose to test a comprehensive perinatal depression treatment - Maternal Infant and Dyadic Care (MInD) - that includes PFR-Brief in perinatal collaborative care, an evidence based intervention for perinatal depression. MInD will be responsive to the needs of women in primary care settings where most underserved women obtain prenatal care. By focusing on important mediators of worsened postpartum depression (decreased parenting self-efficacy and impaired mother-infant interaction), MInD has the potential to improve maternal outcomes, and in the long run, child outcomes. Our project specific aims are: Aim 1 To compare MInD vs. usual CC in a RCT to assess depression outcomes. Sixty women with depression in pregnancy will be randomly assigned to MInD or usual CC. We hypothesize that patients randomized to MInD will experience significantly better improvement in depression (measured by the Edinburgh Postpartum Depression Scale) at 3 months and 6 months postpartum compared to usual CC and that patients randomized to MInD will have significantly better functioning as measured by Sheehan Disability Scale and Barkin Index of Maternal Functioning compared to patients receiving usual CC. Aim 2: To explore the association between parenting self-efficacy, dyadic interaction and depression to inform a mediational hypothesis. We hypothesize that parenting self-efficacy will be greater and dyadic interaction will be improved in women randomized to MInD post treatment and will mediate differences in depression outcomes between patients randomized to MInD and usual CC. Aim 3: To examine relative utilization of MInD vs usual CC, feasibility of conducting the trial, assessment burden and perceived match of treatment to patient need. We will use a mixed methods strategy using the Working Alliance Inventory and in-depth patient interviews to compare MInD and usual CC. We hypothesize that patients randomized to MInD will have higher utilization of treatment as measured by attendance at least 3 antenatal and 3 postpartum CM sessions. We will explore the research question: How do the treatment experiences of patients randomized to MInD compare with the treatment experiences of patients randomized to usual CC? At the end of this project our multidisciplinary and complementary team will be poised to conduct an R01 funded, larger Hybrid Type I effectiveness-implementation RCT to study the effectiveness of MInD and prepare for implementation.