2/2-Preventing Perinatal Depression (PRE-D): Developing Tools and Interventions

描述（由申请人提供）：通过两个相关的申请，该R34将支持：a)位于学术医疗中心的心理治疗专家（Jarrett）和围产期专家（Brandon）之间的合作/伙伴关系，以及私营部门的网络教育专家（Shanahan）；(b)为计划怀孕或怀孕后56天内有患重度抑郁症风险的妇女制定一项创新的、先发制人的预防战略；c)评价干预措施的安全性、耐受性、可接受性和可行性。我们建议启动一项研究计划，该计划有可能改变基于证据的选择，获取和吸收MDD妇女在怀孕计划和围产期可用的实践，当她们处于抑郁复发和复发的高风险时。早期的创新和发展努力是必要的，以提供概念证明，作为未来在这一人群中进行正式测试的先决条件，这一人群在临床试验中的代表性往往不足。风险定义为当前重度抑郁症缓解和至少一次既往明确的重度抑郁症发作。我们将开发一种网络辅助干预，预防性认知疗法（P-CT），以防止或减少从受孕计划到分娩和产后的复发/复发。我们还将建立一个临床医生辅助互联网监测（C-AIM）系统来监测抑郁症状。本R34和相关的新兴研究计划解决了NIMH的优先事项：1。制定新的和更好的干预措施，将精神疾病患者的不同需求和情况纳入其中。计划怀孕的脆弱妇女选择有限，以减少她们的风险；本研究旨在通过开发P-CT来解决高危妇女的需求，从而增加她们的循证选择。NIMH呼吁进行研究，以解决PA09-174中所述的围产期心理健康问题的现有干预措施和治疗发展。2. 绘制精神疾病轨迹图，以确定何时、何地以及如何进行干预。我们将绘制围产期重度抑郁症的发展轨迹，并就何时、何地以及如何干预提供初步假设。临床辅助互联网监测旨在促进早期发现重度抑郁症，从而增加在停药或避免抗抑郁药物期间和之后的“观察等待”的安全性。3. 加强nimh支持的研究对公共卫生的影响。将围产期心理健康研究成果从学术环境转化为现实世界的实践是一项公共卫生优先事项。在高危人群中使用临床医生辅助的症状互联网监测和基于网络的预防性心理治疗有可能增加护理的可得性，并有可能推广到初级保健机构。我们预测，如果将P-CT和C-AIM纳入开发，并取决于成功的有效性测试，则P-CT和C-AIM都可以纳入初级保健社区诊所。

DESCRIPTION (provided by applicant): Through two linked applications, this R34 would support: a) collaboration/partnership between a psychotherapy expert (Jarrett) and a perinatal specialist (Brandon) located in an academic medical center, and an expert in web-based education (Shanahan) in the private sector; b) development of an innovative, preemptive, preventive strategy for women at risk for major depressive disorder (MDD) who are planning to conceive or who are within the first 56 days of pregnancy; and c) evaluation of the safety, tolerability, acceptability, and feasibility of the intervention. We propose to initiate a program of research that has the potential to transform the evidence-based choices, access, and uptake of practices available to women with MDD during pregnancy planning and the perinatal period, when they are at high risk for depressive relapse and recurrence. Early innovative, developmental efforts are necessary to provide a proof-of-concept as a prerequisite to future, formal tests in this population, which is often underrepresented in clinical trials. Risk is defined by current remission of MDD and at least one previous episode of definite MDD. We will develop a web-assisted intervention, Preventive Cognitive Therapy (P-CT), to prevent or reduce relapse/recurrence from conception planning through delivery and postpartum. We will also create a Clinician-Assisted Internet Monitoring (C-AIM) system for monitoring depressive symptoms. This R34 and the associated emerging research program address the NIMH priorities to: 1. Develop new and better interventions that incorporate the diverse needs and circumstances of people with mental illnesses. Vulnerable women planning to conceive have limited choices in order to reduce their risk; this research seeks to increase their evidence-based choices by developing P-CT to address the needs of at-risk women. The NIMH has called for studies to address the expansion of existing interventions and treatment development for perinatal mental health problems as described in PA09-174. 2. Chart mental illness trajectories to determine when, where, and how to intervene. We will chart the trajectory of MDD during the perinatal period and provide initial hypotheses on when, where, and how to intervene. Clinician-Assisted Internet Monitoring is designed to promote early detection of MDD, thereby increasing the safety of "watchful waiting" during and after antidepressant medication withdrawal or avoidance. 3. Strengthen the public health impact of NIMH-supported research. Moving perinatal mental health research findings from the academic setting into real-world practice is a public health priority. Using clinician-assisted Internet monitoring of symptoms and web-based preventive psychotherapy in at-risk groups has the potential to increase the availability of care, as well as the potential for dissemination into primary care settings. We predict that both P-CT and C-AIM can be integrated within primary care community clinics, if these constituencies are included in development and contingent upon successful tests of effectiveness. PUBLIC HEALTH RELEVANCE: This two-site collaborative R34 application addresses significant public health issues for women with a history of at least one episode of major depressive disorder (currently in remission) who wish to remain free of antidepressant medications during preparation for conception, pregnancy, and lactation. The risks of maternal depression for the mother and infant during and after pregnancy are well-documented, yet women have few empirically based options to avoid depression at this critical time. The investigators aim to: 1) create a Clinician-Assisted Internet Monitoring system to help women and health care providers evaluate depressive symptoms longitudinally, and 2) develop a non-pharmacological intervention (based on cognitive therapy) delivered by a clinician in a web-based platform to prevent depressive relapse and recurrence. Development of these tools is an important step in responding to a significant public health need in an under-researched, at-risk population. This research will aid in filling the gap in current scientific knowledge concerning the prevention and treatment of perinatal depression.