Development of a Home-Based Family Treatment for Postpartum Depression

描述(申请人提供)：尽管10%-15%的妇女在生下孩子后会经历产后抑郁症，但大多数人没有接受任何形式的心理健康治疗。正如NIMH PA-06-376“妇女在孕期和产后期间的心理健康”所强调的那样，考虑到这种疾病对母亲和发育中的婴儿产生的严重影响，为患有产后抑郁的妇女开发更广泛的治疗方案至关重要。对于患有产后抑郁的女性，目前几乎没有得到经验支持的治疗方法，社区中最广泛使用的抑郁症治疗方法涉及精神药理学，许多产后妇女，特别是那些正在哺乳的妇女，认为这种方法是不可接受的。以家庭为基础的干预措施特别适合于治疗产后抑郁，因为产后抑郁发生在重大的家庭转型时期；此外，研究表明，家庭功能不佳和伴侣支持水平低预测了疾病的发病和病程。鉴于产后抑郁的严重后果，现有治疗方法的缺乏，以及家庭在产后抑郁中的关键作用，我们建议开发和评估一种新的以家庭为基础的治疗方案，即产后抑郁的家庭治疗(Ftp)，该疗法将针对与产后抑郁相关的特定家庭功能障碍的领域。PI已经完成了以临床为基础的最初版本的FTP的开放试点试验，发现患者可以接受它，给药可行，而且可能有效。在这项应用中，我们建议扩大干预范围，并在试点随机对照试验中对其进行评估，将其与支持性个体化治疗条件进行比较。认识到导致产后妇女，特别是哺乳妇女利用率低的许多障碍，将有选择地在家中为那些认为这更方便的患者提供治疗，而不是要求妇女前往诊所进行护理。此外，将采取战略，将治疗的普及性扩大到更广泛的患者群体。在最初的治疗改进阶段之后，我们建议进行一项试点随机对照先导试验，以评估干预的可行性、可接受性和初步疗效，并将家庭治疗与支持性心理治疗进行比较。此外，我们还将开发和评估一项治疗师培训计划。小型随机对照试验的结果将被用来为R01拨款申请提供基础，以支持全面的随机治疗结果研究。产后抑郁(PPD)与母亲及其发育中的婴儿的许多不良后果有关；然而，大多数患有PPD的妇女没有接受任何治疗。这项研究将专注于开发一种新颖的、基于家庭的PPD家庭治疗方法，并将在一项试点随机对照试验中评估这种干预措施。这种方法的目的是为产后妇女提供一种更可接受和更容易获得的治疗类型，否则她们可能不会寻求传统的、以临床为基础的精神卫生保健。

DESCRIPTION (provided by applicant): Although 10-15% of women experience postpartum depression (PPD) after giving birth to a child, the majority do not receive any form of mental health treatment. As highlighted in NIMH PA-06-376 "Women's Mental Health in Pregnancy and the Postpartum Period," developing a wider range of treatment options for women with PPD is critically important given the serious repercussions associated with the disorder for both the mother and the developing infant. Very few empirically-supported treatments exist for women with PPD, and the depression treatments most widely available in the community involve psychopharmacology, an approach viewed to be unacceptable by many postpartum women, particularly those who are breastfeeding. Family-based interventions are particularly well-suited to treat PPD, in that postpartum depression occurs during a period of significant family transition; moreover, research has shown that poor family functioning and low levels of partner support predict the onset and course of the disorder. Given the serious repercussions of PPD, the lack of existing treatments, and the critical role of the family in the disorder, we propose to develop and evaluate a novel family-based treatment, Family Treatment for Postpartum Depression (FTP) which will target specific areas of family dysfunction associated with PPD. The PI has already completed an open pilot trial of an initial, clinic-based version of FTP, finding that it was acceptable to patients, feasible to administer, and possibly efficacious. In this application, we propose to expand the intervention and evaluate it in a pilot randomized controlled trial, comparing it to a supportive individual therapy condition. In recognition of the many barriers that can contribute to low utilization rates of postpartum women, particularly those who are breastfeeding, treatment will be optionally provided in the home, for patients who find this more convenient, rather than requiring women to travel to a clinic setting for care. In addition, strategies will be taken to broaden the generalizability of the treatment to a wider range of patient groups. Following an initial period of treatment refinement, we propose to conduct a pilot randomized controlled pilot trial to evaluate the feasibility, acceptability and preliminary efficacy of the intervention, comparing the family treatment to supportive psychotherapy. In addition, we will develop and evaluate a therapist-training program. Findings from the small RCT will be used to provide the basis for an R01 grant application to support a full-scale randomized treatment outcome study. Postpartum depression (PPD) is associated with numerous adverse consequences for mothers and their developing infants; however, the majority of women with PPD do not receive any treatment. This study will focus on developing a novel, home-based family treatment for PPD and will evaluate this intervention in a pilot randomized controlled trial. This approach is intended to provide a more acceptable and accessible type of treatment for postpartum women who may otherwise not seek traditional, clinic-based mental health care.