Treatment of Maternal Depression in Home Visitation: Mother and Child Impacts

描述（由申请人提供）：家访是一项针对社会人口学高风险、首次生育的母亲及其子女的预防计划，旨在优化母亲的生命历程和儿童的轨迹。研究表明，母亲抑郁症（1）是家访中的一个重要问题，高达45%的母亲出现临床症状，而只有14%的母亲接受治疗，（2）可以显着干扰家访的效果。此外，母亲抑郁症会对母子互动和儿童功能产生负面影响，从而可能会阻碍二人组充分受益于家访。为了解决现有家访计划中产妇抑郁症的高发病率，通过R34赠款开发了家庭认知行为疗法（IH-CBT），作为对产后抑郁症的家访母亲的治疗。IH-CBT包括CBT的核心特征，这些特征经过调整以解决接受家访的母亲的独特需求和挑战。R34的研究结果表明，IH-CBT在减少抑郁症方面非常有效，66.7%的抑郁症母亲在治疗结束时不再获得MDD的诊断，而仅接受家访的母亲的诊断率为24.3%。此外，接受IH-CBT的母亲报告说，社会支持增加，其他精神症状减少，其中大部分在3个月随访时保持不变。这项研究试图用更大的样本复制IH-CBT，将治疗与更严格的对照条件（以现在为中心的治疗-PCT）进行比较，并将随访延长至18个月，以确定复发率。关于家访对抑郁母亲及其子女的长期有效性，有各种证据表明，如果得到充分证明，家访将显着增强对公共卫生的影响。因此，该研究还试图研究IH-CBT和抑郁症的恢复对父母和孩子的影响。具体而言，将招募220名参加家访的母亲，通过初步筛查和随后的MDD诊断。受试者将被随机分配至IH-CBT +家访或PCT +家访。IH-CBT和PCT将在15个疗程中实施，治疗后1个月和2个月提供两次加强疗程。将在治疗前、治疗后和治疗后6个月、12个月和18个月随访时测量抑郁、精神共病、适应功能、社会支持、养育和儿童功能。据推测，IH-CBT在（1）从抑郁症中恢复，（2）复发和复发的风险，以及（3）增加社会支持和减少整体精神病性方面上级PCT。此外，从抑郁症中康复的母亲将在养育和母子关系方面有所改善，他们的孩子将获得改善的认知，社会，情感和生物结果，相对于未康复的母亲及其后代。

DESCRIPTION (provided by applicant): Home visitation is a prevention program for sociodemographically high risk, first-time mothers and their children that is designed to optimize maternal lifecourse and child trajectories. Research indicates that maternal depression (1) is a significant problem in home visitation with up to 45% of mothers experiencing clinically elevated symptoms while only 14% receive treatment, and (2) can significantly interfere with the efficacy of home visitation. Moreover, maternal depression negatively impacts mother-child interactions and child functioning thus potentially precluding the dyad from fully benefiting from home visitation. To address the high rate of maternal depression in existing home visitation programs, In-Home Cognitive Behavior Therapy (IH-CBT) was developed through an R34 grant as a treatment for mothers in home visitation experiencing depression postpartum. IH-CBT consists of the core features of CBT that have been adapted to address the unique needs and challenges of mothers receiving home visitation. Findings from the R34 indicate that IH-CBT is highly effective at reducing depression, with 66.7% of depressed mothers no longer obtaining a diagnosis of MDD at the end of treatment in contrast to a rate of 24.3% in mothers receiving home visitation alone. In addition, mothers receiving IH-CBT reported increased social support and reduction in other psychiatric symptoms, much of which was maintained at 3 month follow-up. This study seeks to replicate IH-CBT with a larger sample, compare the treatment to a more rigorous control condition (Present-Centered Therapy-PCT), and extend follow-up to 18 months in order to determine relapse rate. There is mixed evidence regarding the long-term effectiveness of home visitation on depressed mothers and their children-critical outcomes that, if adequately demonstrated, would significantly enhance the public health implications of home visitation. Accordingly, the study also seeks to examine the impact of IH-CBT and recovery from depression on parenting and children. Specifically, 220 mothers who are enrolled in home visitation will be recruited through initial screening and subsequent diagnosis of MDD. Subjects will be randomly assigned to IH-CBT + home visitation or PCT + home visitation. Both IH-CBT and PCT will be implemented in 15 sessions with two booster sessions provided 1 and 2 months after treatment. Measures of depression, psychiatric comorbidity, adaptive functioning, social support, parenting, and child functioning will be administered at pre-treatment, post- treatment and at 6, 12 and 18 month follow-ups after post-treatment. It is hypothesized that IH-CBT will be superior to PCT in (1) recovery from depression, (2) risk of relapse and recurrence, and (3) increasing social support and reducing overall psychiatric symptomatology. In addition, mothers who recover from depression will show improvements in parenting and the mother-child relationship, and their children will achieve improved cognitive, social, emotional, and biologic outcomes, relative to non-recovered mothers and their offspring.