Management of Maternal Depression in Primary Care

描述(由申请人提供)：母亲抑郁和儿童健康结果受损之间的关系已经确立。尽管有这些知识，许多患有抑郁症的母亲没有得到诊断和治疗。由于产科医生、儿科医生和家庭医生与年幼孩子的母亲有联系，并经常就家庭互动向母亲提供建议，影响家庭环境的幸福问题(如产妇抑郁)与她们的实践高度相关。尽管有机会和相关性，但许多医生目前并没有诊断和治疗产妇抑郁症。因此，本研究建议调查儿科医生、产科医生和家庭医学从业者目前对母亲抑郁管理的态度、信念和做法，这反过来将有助于设计未来的创新模式，解决目前当地特有的障碍，改善对母亲抑郁的整体管理。这项研究的具体目的是：1)设计一个可移植的基于网络的工具，以评估医生对管理母亲抑郁的态度、信念、知识和做法；2)在系统、实践和医生层面上检查初级保健医生有效管理母亲抑郁的障碍和促进者；3)探索不同初级保健专业(即儿科、产科和家庭医学)之间这些关系的潜在差异。这项研究将包括3个阶段，包括调查内容的制定、调查的初步测试和基于网络的调查实施。最初的调查项目池将由研究小组制定，然后由专家小组进行批评。然后，该调查将在其基于网络的实施中进行初步测试。一旦基于网络的调查经过评估，居住在弗吉尼亚州东南部汉普顿路地区的所有符合条件的医生将收到一封电子邮件和传真，其中包含定位和浏览调查的说明。从调查中收集的数据将被分析，以了解各专业对当前处理母亲抑郁的态度、信念和做法的趋势和模式。此外，新的基于网络的工具将提供对障碍(即医生、实践和系统)的强大的多层次评估，这将有助于设计敏感和有针对性的社区特定模型，以改进对产妇抑郁的识别和管理。我们预计，将在拟议的研究中开发的以评估为导向的模式将适用于美国各地的社区。总体而言，这项拟议的研究旨在为未来的教育努力提供洞察力，以增加知识库，改善沟通方式，并解决在这些特定实践环境中提高母亲抑郁发现率的系统性障碍。拟议的数据收集工作还将提供一个机会，以便能够根据当地独特的情况量身定做未来管理产妇抑郁的方法。

DESCRIPTION (provided by applicant): The relationship between maternal depression and compromised child health outcomes is well-established. Despite this knowledge, many mothers suffering from depression go undiagnosed and untreated. Because obstetricians, pediatricians, and family medicine practitioners have contact with mothers of small children and often advise mothers on family interactions, wellbeing issues (e.g. maternal depression) that affect the family environment are highly relevant to their practice. Despite opportunity and relevance, many physicians do not currently diagnose and treat maternal depression. Thus, the present study proposes to survey pediatricians, obstetricians, and family medicine practitioners on their current attitudes, beliefs and practices toward the management of maternal depression, which in turn, will help design future innovative models that address barriers unique to the present locality, improving the overall management of maternal depression. The specific aims of the study are to 1) design a transportable web-based tool to assess physician attitudes, beliefs, and knowledge toward and practices in managing maternal depression; 2) examine barriers and facilitators at the systemic, practice, and physician levels for the effective management of maternal depression among primary care physicians; and 3) explore potential variation in these relationships among different primary care specialties (i.e. pediatrics, obstetrics, and family medicine). The study will involve 3 stages including survey content development, preliminary testing of the survey, and web-based survey implementation. An initial pool of survey items will be developed by the research team and then critiqued by an expert panel. The survey will then undergo preliminary testing in its web-based implementation. Once the web-based survey has been evaluated, all eligible physicians residing in the Hampton Roads Area of Southeastern Virginia will be sent an email and fax containing instructions for locating and browsing to the survey. The data collected from the survey will be analyzed for trends and patterns among specialties on current attitudes, beliefs, and practices toward managing maternal depression. Moreover, the new web-based tool will provide a strong multi-level assessment of barriers (i.e. physician, practice, and system) that will help design sensitive and targeted community-specific models to improve identification and management of maternal depression. We anticipate that the assessment-driven model that will be developed in the proposed study will be transportable to communities across the United States. Overall, the proposed study is designed to provide insight for future educational efforts to increase the knowledge base, enhance communication style, and address systemic barriers to increase detection rates of maternal depression in these specific practice settings. The proposed data collection effort will also afford an opportunity to be able to tailor future approaches to managing maternal depression based on unique local circumstances.