Systems of Care for New Moms: Integrating Depression Treatment

描述(由申请人提供)：产后抑郁症是一个重大的公共卫生问题，特别是在获得精神卫生服务机会有限的城市贫困少数民族妇女中。通过研究，我们知道了如何治疗抑郁症。我们不知道的是，如何将有效的抑郁症治疗转化为社区非专业精神卫生环境，而不仅仅是基于办公室的初级保健。护士之家访问计划提供了一个机会，有效地增加低收入弱势母亲获得抑郁症治疗的机会。这项研究探索了抑郁症治疗(问题解决疗法)在护士之家探访中的并存情况，以及保持获得循证治疗所需的组织变革。问题解决疗法(PST)适合非专家使用和家庭使用。干预的简明扼要(4-8次会议)及其非病理性的做法应该是低收入少数群体妇女可以接受的。通过多种方法，这项研究将从妇女及其提供者那里收集信息，以确定需要哪些系统和治疗修改才能在家访计划中有效地提供可接受的抑郁症治疗，因为他们努力实施政策指令，以识别和治疗患有抑郁症的母亲。一个融合了当地和全球知识的专家小组将就干预适应的决策提供建议。一旦做出这些适应决定，一小群专家将改编一份PST手册，用于家访。然后，我们将进行一项小型的三臂随机试验，比较由家访RN提供的PST的有效性、可接受性和实用性，以及通过精神病学高级实践RN常规护理(转诊至心理健康专科护理)提供的PST。42名女性将被匹配并随机分为三种研究条件。将使用定量和定性两种方法来衡量结果。在干预后6个月和12个月，将使用贝克抑郁问卷和PHQ-9来衡量抑郁的结果。育儿压力指数将被用来衡量父母的功能。一旦转诊，处于通常护理条件下的妇女将被跟踪，以评估她们获得抑郁症治疗的障碍。这是一组母亲，他们将接受常规护士或精神病学高级实践护士的访谈，了解在家接受PST的可接受性和可行性。护理院访客将接受采访，以评估他们为母亲接生PST的可接受性和实用性。将使用效果大小和关于干预对母亲和护士的可接受性和实用性的信息来编制完整的R01量表。通过家访提供的PST有望为贫穷的城市少数族裔母亲提供有效和可接受的抑郁症治疗。值得注意的是，面对抑郁症筛查的政策要求，我们的研究有可能为家访机构提供一种可行的方式，为母亲提供有效和可接受的抑郁症治疗。7.*产后抑郁是一个重大的公共卫生问题，不仅因为母亲丧失生产力和社会功能，而且还因为对儿童的破坏性健康、心理健康和发育后果，其对家庭功能的影响，以及社会的总体代价。事实证明，即使是新妈妈的轻度抑郁也会对母子关系的建立产生影响，而对母亲进行有效的抑郁症治疗可以显著改善母亲和孩子的结局。产后期是解决妇女抑郁症的机会之窗，因为她们更有可能接触到医疗保健系统。

DESCRIPTION (provided by applicant): Maternal depression in the postpartum period is a significant public health matter, particularly among poor urban minority women with limited access to mental health services. Through research we know how to treat depression. What we do not know is how to translate effective depression treatments into community non- specialty mental health settings beyond office-based primary care. Nurse home visitation programs provide an opportunity to efficiently increase access to depression treatment for low income disadvantaged mothers. This study explores the co-location of depression treatment (Problem Solving Therapy) within nurse home visitation and the organizational changes needed to maintain access to evidence-based treatment. Problem Solving Therapy (PST) is suited to use by non-specialists and for in-home use. The brevity of the intervention (4-8 sessions) and its non-pathologizing approach should be acceptable to low income minority women. Through multiple methodologies, this study will gather information from women and their providers to determine what system and treatment modifications are needed to effectively deliver acceptable depression treatment in home visitation programs as they strive to implement policy directives to identify and treat mothers with depression. An expert panel, which blends local and global knowledge will provide advice on decisions regarding the intervention adaptation. Once these adaptation decisions are made a small group of experts will adapt a PST manual for use in home visitation. We will then carry out a small three-arm randomized trial comparing the effectiveness, acceptability, and practicality of PST provided by home visitation RNs, by a psychiatric advance practice RN usual care (referral to mental health specialty care). Forty two women will be matched and randomized into the three study conditions. Outcomes will be measured using both quantitative and qualitative methods. Depression outcomes will be measured using the Beck depression Inventory and PHQ-9 at 6 and 12 months post intervention. The Parenting Stress Index will be used to measure parental functioning. Women in the usual care condition will be tracked to assess barriers to their accessing depression treatment once referred. A sub-set of mothers and will be interviewed regarding the acceptability and practicality of receiving PST at home either from their regular nurse or a psychiatric advanced practice nurse. Nurse home visitors will be interviewed to assess the acceptability and practicality of their delivery of PST to mothers on their caseloads. Effect sizes and information on the acceptability and practicality of the intervention to both mothers and nurses will be used to prepare a full scale R01. PST delivered through home visitation holds promise for providing access to effective and acceptability depression treatment for poor urban minority mothers. Significantly, our study has the potential to provide home visitation agencies with a viable means of access to effective and acceptable depression treatment for mothers in the face of policy mandates for depression screening. 7. * Project Narrative Depression in the postpartum is a major public health problem, not only because of lost productivity and social functioning for the mother, but because of devastating health, mental health, and developmental consequences for the child, its effects on family functioning, and overall costs to society. Even mild depression in new mothers has been shown to impact on the establishment of mother-child bonding, while effective depression treatment for mothers can significantly improve outcomes for both mother and child. The postpartum period is a window of opportunity in which to address depression in women because they are more likely to come into contact with the health care system.