Behavioral Change in the Mother/Infant Dyad: Preventing Postpartum Depression

描述(申请人提供)：在美国每年400多万名活产婴儿中，近800,000名或20%的母亲将在产后3个月内患上严重或轻微的抑郁症。这一数字使妊娠期糖尿病(2-5%)和早产(12.7%)的患病率相形见绌。现有的治疗产后抑郁(PPD)的临床方法使用标准的药物和心理干预来减轻妇女的症状。然而，产后抑郁没有得到足够的治疗，部分原因是女性不愿寻求治疗，因为与心理健康护理相关的耻辱，以及在母乳喂养时不愿服用精神药物。这种情况的后果是巨大的。未经治疗的产后抑郁与妇女的生活质量下降和严重的情感痛苦有关，而且，由于照顾能力的下降，儿童的认知和社会-情感发展结果不佳。尽管产后抑郁的母亲风险因素是众所周知的，但基于常用的抑郁干预措施的预防方案才刚刚开始评估。基于发育数据显示母亲和婴儿之间情感和行为影响的深刻双向影响，我们建议测试一种新的PPD干预方案，该方案挑战标准的、以个体为重点的治疗范式。我们的干预是基于PPD的概念化，即PPD是一种潜在的二联体障碍，可以通过母亲和孩子的行为变化和情感参与来接近。研究表明，婴儿的哭闹和睡眠行为与产后抑郁有关，父母的干预可以改变婴儿的行为，但这些发现从未被应用于产后抑郁。在这项R21应用中，我们的目标是收集关于一种新的PPD风险降低方案的试点和可行性数据，该方案基于PPD的二元行为方法，在该方案中，我们通过促进母体介导的婴儿行为变化来治疗高危妇女。我们将选择一名有PPD风险的孕妇样本，传授育儿技巧，以增加婴儿的夜间睡眠，并在3次围产期访问期间将哭闹/哭闹行为减少到样本的一半，然后评估6周和14周的婴儿行为，以及产后6周、10周和14周的母亲情绪。为了与NIMH发展对基本大脑行为过程的综合了解的战略目标保持一致，我们将充分利用这项干预研究的研究机会，使用最先进的脑电和胎儿监测来表征与婴儿行为和行为变化相关的早期生物标记物。我们的建议有可能对临床研究产生重大影响，并改变PPD的标准护理，因为(1)干预措施将具有很高的治疗遵从率，因为(A)礼仪会议可以被纳入通常的围产期医疗访问，(B)育儿技能作为一种非精神干预措施将吸引妇女，(C)鉴于围产期的二元重点，临床方法将具有表面有效性；(2)其目的是预防；(3)它同时促进母婴福祉；(4)它将扩大PPD的风险因素，在围产期包括神经行为标记物。 公共卫生相关性：产后抑郁症(PPD)治疗不足，这对妇女和儿童的后果是严重的。研究表明，婴儿的哭闹和睡眠行为与产后抑郁有关，父母的干预可以改变婴儿的行为，但这些发现从未被应用于产后抑郁。我们建议教授育儿技巧，增加婴儿的夜间睡眠，减少可能发生产后抑郁的女性的吵闹/哭闹行为，看看我们是否可以预防这种疾病的发生。

DESCRIPTION (provided by applicant): Of the over 4 million live births each year in the United States, nearly 800,000 - or 20% - of the mothers will develop major or minor depression within the first 3 months postpartum. This number dwarfs prevalence rates for gestational diabetes (2-5%) and preterm birth (12.7%). Existing clinical approaches to postpartum depression (PPD) use standard pharmacologic and psychological interventions to reduce women's symptoms. Nevertheless, PPD is undertreated, in part because women are reluctant to seek treatment due to stigma associated with mental health care and disinclination to take psychotropic medications when breastfeeding. The consequences of this are substantial. Untreated PPD is associated with diminished quality of life and significant emotional suffering for women, and, through compromised caregiving, poor outcomes in children's cognitive and social-emotional development. Although maternal risk factors for PPD are well known, protocols for prevention based on commonly used depression interventions are only beginning to be evaluated. Building on developmental data showing the profound bi-directionality of emotional and behavioral influences between mother and infant, we propose testing a novel PPD intervention protocol that challenges the standard, individually-focused treatment paradigm. Our intervention is based on the conceptualization of PPD as a potential disorder of the dyad, and one that can be approached through behavioral change in and affective engagement with mother and child. Studies show that infant cry/fuss and sleep behavior are associated with PPD, and that parenting interventions can change infant behavior, yet these findings have never been applied to PPD. In this R21 application, we aim to collect pilot and feasibility data on a novel PPD risk-reducing protocol based on a dyadic behavioral approach to PPD in which we treat at-risk women by promoting maternally-mediated behavioral changes in their infants. We will select a sample of pregnant women at risk for PPD, teach parenting skills to increase infant nocturnal sleep and reduce fuss/cry behavior to half of the sample during 3 perinatal visits, then evaluate infant behavior at 6 and 14 weeks, and maternal mood at 6, 10, and 14 weeks postpartum. In line with NIMH's strategic goal to develop an integrative understanding of basic brain-behavior processes, we will fully exploit the investigative opportunities of this intervention study by using state-of-the-art EEG and fetal monitoring to characterize early biomarkers associated with infant behavior and behavior change. Our proposal has the potential to have a major impact on clinical research, and to transform the standard care of PPD in that (1) the intervention will have high rates of treatment compliance because (a) the protocol sessions can be incorporated into usual perinatal medical visits, (b) parenting skills will appeal to women as a non-psychiatric intervention, (c) the clinical approach will have face validity given the dyadic focus of the perinatal period; (2) its aim is prevention; (3) it fosters both maternal and child well being; (4) it will expand the risk factors for PPD to include neurobehavioral markers in the perinate. PUBLIC HEALTH RELEVANCE: Postpartum depression (PPD) is undertreated and the consequences of this are substantial for women and children. Studies show that infant cry/fuss and sleep behavior are associated with PPD, and that parenting interventions can change infant behavior, yet these findings have never been applied to PPD. We propose teaching parenting skills to increase infant nocturnal sleep and reduce fuss/cry behavior to women likely to develop PPD to see if we can prevent the onset of this disorder.