Depression Prevention for Poor Pregnant Women

描述（由申请人提供）：产后抑郁症（PPD）是一个重大的公共卫生问题，发生在10-16%的最近分娩的母亲。在美国，每年大约有400万妇女分娩，与PPD相关的发病率非常高-每年至少有40万产后妇女会抑郁。产后抑郁症对妇女的影响很大，并延伸到家庭;抑郁母亲的婴儿有可能在婴儿发育和以后的儿童适应方面受到干扰。此外，只有有限数量的研究测试了PPD治疗的疗效。显然，减少与PPD相关的有害结果的干预措施是重要的，并将特别感兴趣的卫生保健提供者和政策制定者，特别是那些有可能加强社区保健的干预措施。迄今为止，很少有研究探讨了预防性干预措施对减少高危妇女产后抑郁症的影响，这方面的研究受到方法学问题的限制。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测试。降低贫困妇女患产后抑郁症的风险是重要的，因为贫困妇女是产后抑郁症高危妇女群体，患有产后抑郁症的贫困妇女的婴儿患早期婴儿间歇性障碍的风险较高，贫困妇女比中产阶级妇女更不可能获得抑郁症治疗。我们建议在240名接受公共援助的有PPD风险的孕妇中进行随机试验。这个拟议项目的目的是比较的干预措施（产后预防计划; PPP）的疗效主要基于人际治疗，以增强护理照常控制（ECU）的条件。PPP针对那些可能在PPD发展中发挥重要作用的因素（即，不良的社会支持，角色转换和生活压力），并在妊娠的最后三个月和产后2周内施用。我们的主要假设是，在产后一年内，PPP在降低PPD风险方面比ECU条件更有效。其他假设包括PPP将比ECU条件更有效地减少抑郁症状，并利用心理健康服务，以及增强母亲的敏感性和婴儿依恋。

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.