Depression Prevention for Poor Pregnant Women

描述（由申请人提供）：产后抑郁症（PPD）是一个重要的公共卫生问题，发生在10-16%的新分娩母亲中。在美国，每年大约有400万名妇女分娩，与产后抑郁症相关的发病率非常高——每年至少有40万名产后妇女患有抑郁症。产后抑郁症对妇女造成了巨大的影响，并延伸到家庭；抑郁症母亲的婴儿在婴儿发育和以后的儿童适应方面有障碍的风险。此外，只有有限数量的研究测试了治疗PPD的疗效。显然，减少与产后抑郁症相关的有害结果的干预措施是非常重要的，并且将是卫生保健提供者和政策制定者特别感兴趣的，特别是那些有可能加强社区护理的干预措施。迄今为止，很少有研究检查了预防干预对减少高危妇女产后抑郁症的影响，并且该领域的研究受到方法问题的限制。一个更被忽视的领域是对经济上处于不利地位的妇女进行这种干预的试验。降低贫困妇女患产后抑郁症的风险具有重要意义，因为贫困妇女是产后抑郁症高危妇女群体的代表，患有产后抑郁症的贫困妇女的婴儿出现早期婴儿互动障碍的风险较高，而且贫困妇女获得抑郁症治疗的可能性低于中产阶级妇女。我们建议在240名有产后抑郁症风险的孕妇中进行一项随机试验。本项目的目的是比较一种主要基于人际治疗的干预措施（产后预防计划，PPP）与一种增强的照护控制（ECU）状况的效果。PPP的目标是那些可能在PPD的发展中起重要作用的因素（即，缺乏社会支持，角色转换和生活压力源），并在怀孕的最后三个月和产后两周内进行。我们的主要假设是，在产后一年的过程中，PPP将比ECU更有效地降低PPD的风险。其他假说包括PPP在减少抑郁症状、利用心理健康服务以及增强母亲敏感性和婴儿依恋方面比ECU条件更有效。

DESCRIPTION (provided by applicant): Postpartum depression (PPD) is a significant public health problem occurring in 10-16% of recently delivered mothers. With approximately 4,000,000 women giving birth annually in the United States, there is an enormous amount of morbidity associated with PPD - at least 400,000 postpartum women will be depressed each year. PPD exacts a substantial toll on women which extends to the family as well; infants of depressed mothers are at risk for disturbances in infant development and later child adjustment. Further, only a limited number of studies have tested the efficacy of treatments for PPD. Clearly, interventions that reduce the deleterious outcomes associated with PPD are of importance and will be of special interest to health care providers and policy makers, especially those interventions that have the potential to enhance community care. To date, there are few studies that have examined the effects of a preventive intervention to reduce PPD in high-risk women and research in this area has been limited by methodological problems. An area of even greater neglect is the testing of such an intervention for financially disadvantaged women. To reduce the risk of PPD in poor women is consequential as poor women represent a group of women at high-risk for PPD, the infants of poor women with PPD have an elevated risk for early infant interactional disturbances, and poor women are less likely to access treatment for depression than middle-class women. We propose to conduct a randomized trial in 240 pregnant women on public assistance at risk for PPD. The aim of this proposed project is to compare the efficacy of an intervention (the Postpartum Prevention Program; PPP) based primarily on interpersonal therapy to an enhanced care-as-usual control (ECU) condition. The PPP targets those factors that may play a significant role in the development of PPD (i.e., poor social support, role transitions, and life stressors) and is administered during the last trimester of pregnancy and within 2-weeks postpartum. Our main hypothesis is that the PPP will be significantly more efficacious than the ECU condition in reducing the risk of PPD over the course of one-year postpartum. Other hypotheses include that the PPP will be more efficacious than the ECU condition in reducing depressive symptoms, and utilization of mental health services as well as enhance maternal sensitivity and infant attachment.