Dyadic Intervention for Women at Risk for Postpartum Depression and their Infants

描述（由申请人提供）：本申请是对PA-09-175妇女怀孕和产后心理健康的回应。本探索性/发展性（R21）项目的目标是进一步开发、试点测试和完善一种新型的双焦点母婴干预方法，以预防/减少产妇产后抑郁症（PPD），改善母婴关系和儿童发展结果。大约10-15%的妇女在婴儿出生后会经历产后抑郁症，这对母亲的健康、母婴关系以及随后的儿童发育都有严重的负面影响。目前大多数产后抑郁症治疗只关注母亲的结果，忽视了母婴关系，因此不能改善母子关系或儿童的结果。目前还没有研究整体性地解决母亲抑郁和母婴关系障碍的双重问题。拟议的项目创新性地解决了这一关键的研究缺口，通过理论和临床基础的早期双元干预，同时针对PPD和相关的母婴关系障碍，包括：(a)以洞察为导向和支持性关系为基础的母婴心理治疗成分，利用婴儿作为治疗的一个组成部分；(b)以婴儿发育为基础的面向婴儿的成分，旨在增强母亲敏感的反应能力，促进积极的母婴互动。我们的具体目标是：(1)在对5对母婴进行可行性测试后，制定干预方案并进行适当的完善；(2)在干预后、产后6个月和产后1年随访中评估干预对预防或减少产后抑郁和提高母婴互动质量的主要结局的效果；(3)在干预后和随访时间点探讨干预对母亲焦虑、父母压力、母亲自尊、母亲对婴儿依恋、儿童依恋安全、儿童认知发展等次要结局的影响。在根据专家咨询和初步可行性测试的结果开发和完善干预措施后，我们将使用60名因产后1周抑郁评分升高而被确定有PPD风险的妇女及其婴儿样本来测试其有效性。二人组将被随机分配到干预组或对照组。以家庭为基础的干预将包括由经过专门培训的护士在产后头3个月内提供的8次母婴护理。对照组将接受短暂的教育干预，随后是常规护理，并通过电话监测产妇抑郁症，其时间表与干预访问相当。将在基线、干预后和两个随访点测量产妇和母婴结局。婴儿结果将在1岁时进行评估。重复测量方差分析将用于确定干预效果。如果成功，这项研究的结果将为未来R01建议的发展提供信息，以进行更大规模的干预随机试验。

DESCRIPTION (provided by applicant): This application is in response to PA-09-175 Women's Mental Health in Pregnancy and the Postpartum Period. The goal of this exploratory/development (R21) project is to further develop, pilot test, and refine a novel dual-focused mother-infant intervention to prevent/decrease maternal postpartum depression (PPD) and improve aspects of mother-infant relationships and child development outcomes. Approximately 10-15% of women experience PPD after the birth of a baby, with serious negative consequences for maternal well-being, the mother-infant relationship, and subsequent child development. Most current PPD treatments focus exclusively on maternal outcomes, neglect the mother-infant relationship, and thus do not result in improvements in relationship or child outcomes. No study has yet addressed the dual problems of maternal depression and mother-infant relationship dysfunction in an integrated way. The proposed project innovatively addresses this critical research gap by targeting PPD and the associated mother-infant relationship dysfunction concurrently in a theoretically and clinically based early dyadic intervention that consists of: (a) an insight- oriented and supportive relationship-based mother-infant psychotherapeutic component utilizing the infant as an integral part of the therapy, and (b) a developmentally-based infant-oriented component designed to enhance maternal sensitive responsiveness and promote positive mother-infant interactions. Our specific aims are to: (1) Develop the intervention protocol and refine it as appropriate after testing its feasibility with 5 mother-infant dyads; (2) Assess the efficacy of the intervention on the primary outcomes of prevention or reduction of PPD and enhancing the quality of mother-infant interaction at post-intervention, 6 months, and 1 year postpartum follow-ups; and (3) Explore the effects of the intervention on secondary outcomes of maternal anxiety, parenting stress, maternal self-esteem, maternal attachment to the infant, child attachment security, and child cognitive development at post-intervention and follow-up time points. After developing the intervention and refining it based on expert consultation and findings from the initial feasibility testing, we will test its efficacy using a sample of 60 women determined to be at-risk for PPD due to elevated depression scores at 1 week postpartum and their infants. Dyads will be randomly assigned to the intervention or control group. The home-based intervention will consist of 8 mother-infant sessions delivered by specially trained nurses over the first 3 months postpartum. Control group will receive a short educational intervention followed by usual care plus maternal depression monitoring by phone on a schedule comparable to the intervention visits. Maternal and mother-infant outcomes will be measured at baseline, post-intervention, and at two follow- up points. Infant outcomes will be assessed at 1 year of age. Repeated measures analysis of variance will be used to determine intervention effects. If successful, findings from this study will inform the development of a future R01 proposal to conduct a larger randomized trial of the intervention. PUBLIC HEALTH RELEVANCE: Postpartum depression (PPD) is a major public health concern that affects approx 10-15% of mothers with serious negative consequences for not only the mothers, but also the mother-infant relationship and child development. The goal of the proposed project is to develop and assess the feasibility and efficacy of a novel dual-focused mother-infant intervention by specially trained nurses to prevent/decrease maternal postpartum depression and associated mother-infant relationship dysfunction. If shown to be effective, this intervention would provide a new early-stage treatment option for PPD that would hold great benefit for mothers and infants and could be easily adapted for widespread public use for at-risk mother-infant dyads.