Literacy and Utilization of Maternal Depression Care

描述（由申请人提供）：10- 20%的妇女在分娩6个月内发生非精神病性重性抑郁症（MOD），早产后发生率更高。减少参与MOD护理的患者因素是提供有效抑郁症治疗的主要障碍。识字率低的成年人出现抑郁症状的风险更高，对各种保健服务的利用也更少，在孕产妇保健差异风险最大的人群中，20- 37%的妇女识字率低（<六年级）。卫生素养结构，即获取卫生决策所需信息的能力，已被提出作为低识字率与低卫生保健服务使用率之间关联的中介。评估低识字率在产后识别的MOD护理利用中的作用，可能允许干预措施减少对这一弱势群体的治疗障碍。本申请概述了一项混合方法研究（R03），其中定性方法将添加到正在进行的随机对照试验中，以治疗重复早产的危险因素（n=1420）。早期早产（<34周EGA）后被诊断为DSM-IV MOD的参与者将提供免费治疗（心理治疗，抗抑郁药物或两者结合）的选择。本研究对低文化水平的女性抑郁症患者（< 6年级，n=117）进行调查的主要目的是：1)确定具有高抑郁症状的女性接受或拒绝抑郁症转诊治疗的相关因素（ses - d 22）；2)确定在患有DSM-IV MOD的女性中接受或拒绝积极治疗抑郁症的相关因素；3)确定患有DSM-IV MOD的女性继续或停止抑郁症治疗的相关因素。拟议的研究将利用在父母研究中收集的大量定量数据，这些数据将与半结构化访谈（n=60）和临床访谈（n=40）的定性分析相关联。定性方法将大大增强定量评估，提供澄清结果不一致的机会。这是一个发现健康素养和抑郁症治疗利用之间联系的新因素的机会。这项研究提供了一个独特的、具有成本效益的机会，可以研究阻碍低文化水平妇女抑郁症治疗的患者因素，并为未来的干预提供信息。

DESCRIPTION (provided by applicant): Nonpsychotic major depression (MOD) occurs in 10-20 percent of women within 6 months of delivery with higher rates seen following preterm birth. Patient factors which reduce participation in care for MOD are major barriers to the delivery of effective depression treatments. Adults with low literacy have higher risk of depressive symptomatology and less utilization of a variety of health care services 20-37 percent of women in populations most at risk for maternal health disparities have low literacy (< 6th grade). The health literacy construct, the capacity to access information needed for health decisions, has been proposed as a mediator of the association between low literacy and low health care service use. Assessing the role of low literacy in the utilization of care for MOD identified postpartum may allow interventions that would reduce barriers to treatment for this vulnerable population. This application outlines a mixed methods study (R03) in which qualitative methods will be added to an ongoing randomized controlled trial to treat risk factors for repeat preterm birth (n=1420). Participants who are diagnosed with DSM-IV MOD following an early preterm birth (<34 weeks EGA) will be offered a choice of free treatments (psychotherapy, antidepressant medication, or a combination of the two). The primary aims of this investigation of women with depression and low literacy (< 6th grade, n=117) are to: 1) Identify factors associated with accepting versus declining referral for depression care among women with high depressive symptomatology (CES-D 22); 2) Identify factors associated with accepting versus declining any of the active treatments for depression offered among women with DSM-IV MOD; and 3) ldentify factors associated with depression treatment continuation versus discontinuation among women with DSM-IV MOD. The proposed study will take advantage of extensive quantitative data collected in the parent study which will be linked to qualitative analyses of transcripts from semi-structured interviews (n=60) and clinical interviews (n=40) The qualitative methods will greatly enhance the quantitative assessments, provide an opportunity to clarify inconsistencies in results, and an opportunity to uncover novel factors linking health literacy and depression treatment utilization. This study represents a unique and cost effective opportunity to study patient factors which are obstacles to depression treatment in women with low literacy and inform future interventions.