The "Wings" Depressive Symptom Intervention for Latina Mothers

描述(由申请人提供)：有限的英语水平(LEP)拉美裔婴儿和幼儿的母亲面临长期的经济困难和与移民有关的压力。高达%的人出现了明显的临床抑郁症状，这些症状限制了他们为婴儿或蹒跚学步的孩子提供发展支持的能力。婴儿/幼儿接触母亲的抑郁症状与语言缺陷和持续的发育迟缓有关，而在较大的儿童中，行为障碍和社交攻击行为。许多拉美裔在美国的“新目的地”没有足够的双语心理健康服务，拉美裔LEP母亲得不到治疗。减少抑郁症状的“Wings”干预对80名拉美裔LEP母亲早期的Head Start(EHS)有显著影响。为了为更大规模的干预试验做准备，这项研究将最终确定对干预的改进，并测试选定的方法和方案的可行性、可接受性和安全性。这项干预是对人际心理治疗(IPT)的10次家庭修改，由讲英语的高级实践精神科护士与双语、受过项目培训的社区口译员配对提供。它旨在帮助母亲减少抑郁症状，应对压力，增加社会支持，更有效地为人父母。将最后敲定的干预措施包括解决人际冲突和促进家庭主义[家庭团结]的战略，支持拉丁裔[尊重]和教育[负责任的行动]价值观的额外育儿指导，增加干预后维持会议(PIM)以延长症状的减轻，并强调帮助母亲与现有的社区机构建立联系，以获得同行和团体社会支持。这项研究还将测试病例管理/控制条件和登记前心理健康评估的方案；确定招募、筛查和登记方案的可行性，以及以前研究中未使用的工具的管理。最后，这项研究将评估20名拉丁裔母亲的修订方法的可行性、可接受性和安全性，这些母亲在流行病学研究中心抑郁量表(CES-D)上得分16或更高，并且从社区机构招募了6周至36个月大的婴儿或蹒跚学步的婴儿。参与者将被随机分配到干预或病例管理/控制条件下，并在三个收集点(基线、12周和6个月)上进行测量。西文版的汉密尔顿抑郁量表(HRSD)将与其他测量(PSI；CBCL；年龄和阶段问卷-社会情绪；HSI-I、ARSMA-II、社会支持和自我效能)一起使用。这项研究将支持一项更大规模的随机试验，并最终将“翅膀”干预纳入社区诊所、早期干预计划和拉丁裔服务机构。 公共卫生相关性：婴儿和蹒跚学步的儿童的发育可能因其母亲出现抑郁症状而受到损害。该项目将确定帮助说西班牙语的拉丁裔母亲减少抑郁症状的短期家庭干预是否可行和安全，以及是否可以进行更大规模测试所需的方法。最终，通过改善这些母亲的心理健康，她们的婴儿和蹒跚学步的孩子的发展和对社会的适应能力将得到增强。

DESCRIPTION (provided by applicant): Limited English Proficiency (LEP) Latina mothers of infants and toddlers are confronted with chronic economic hardship and immigration-related stressors. As high as 64% experience clinically significant depressive symptoms, which limit their ability to offer developmental support to their infant or toddler. Infant/toddler exposure to maternal depressive symptoms has been linked to language deficits and persistent developmental lags, and in older children, conduct disorders and social aggression. Many "new destination" areas for Latinos in the US have inadequate bilingual mental health services and LEP Latina mothers cannot get treatment. The "Wings" intervention to reduce depressive symptoms had a significant impact in 80 Latina LEP mothers in Early Head Start (EHS). To prepare for a larger trial of the intervention, this study will finalize refinements to the intervention and test the feasibility, acceptability and safety of selected methods and protocols. The intervention is a 10-session, in-home modification of Interpersonal Psychotherapy (IPT) delivered by English-speaking advanced practice psychiatric nurses paired with bilingual, project-trained community interpreters. It is designed to help mothers reduce depressive symptoms, cope with stress, increase social support and parent more effectively. Refinements to the intervention that will be finalized include strategies to resolve interpersonal conflict and promote familismo [family unity], additional parenting guidance that supports Latino values of respeto [respectfulness] and educacisn [responsible actions], the addition of post- intervention maintenance sessions (PIMs) to prolong the reduction of symptoms and emphasis on helping mothers connect to existing community agencies to access peer and group social support. This study will also test protocols for a case management/control condition and a pre-enrollment mental health assessment; determine the feasibility of recruitment, screening and enrollment protocols and the administration of instruments not used in previous studies. Finally, the study will evaluate feasibility, acceptability and safety of the revised methods in 20 Latina mothers who score 16 or greater on the Center for Epidemiological Studies Depression Scale (CES-D) and who have infants or toddlers between 6 weeks and 36 months old recruited from community agencies. Participants will be randomized to the intervention or to a case management/control condition and measured over three collection points (baseline, 12 weeks and 6 months). Spanish versions of the Hamilton Rating Sale for Depression (HRSD) will be used along with other measures (PSI; CBCL; Ages and Stages Questionnaires - Social-Emotional; HSI-I, ARSMA-II, social support and self-efficacy). This study will support a larger randomized trial, and ultimately the integration of the "Wings" intervention into community clinics, early intervention programs and Latino-serving agencies. PUBLIC HEALTH RELEVANCE: The development of infants and toddlers may be harmed by exposure to depressive symptoms in their mother. This project will determine whether a short-term, in-home, intervention to help Spanish-speaking Latina mothers reduce their depressive symptoms is feasible and safe and whether the methods needed to test it on a larger scale can be carried out. Ultimately, by improving the mental health of these mothers, their infants and toddlers' development and adaptation to society will be enhanced.