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

描述（申请人提供）：在美国每年超过400万的活产婴儿中，近80万或20%的母亲将在产后的前3个月内患上严重或轻微的抑郁症。这个数字使妊娠糖尿病（2-5%）和早产（12.7%）的患病率相形见绌。现有的产后抑郁症（PPD）的临床方法使用标准的药物和心理干预，以减少妇女的症状。然而，产后抑郁症治疗不足，部分原因是妇女不愿意寻求治疗，因为与精神卫生保健有关的耻辱和不愿意在母乳喂养时服用精神药物。其后果是巨大的。未经治疗的PPD与妇女生活质量下降和严重的情感痛苦有关，并且通过损害生育，儿童认知和社会情感发展的结果很差。虽然产妇患产后抑郁症的危险因素是众所周知的，但基于常用抑郁症干预措施的预防方案才刚刚开始评估。基于显示母亲和婴儿之间情感和行为影响的深刻双向性的发展数据，我们提出测试一种新的PPD干预方案，挑战标准的，以个人为中心的治疗范式。我们的干预是基于PPD作为一种潜在的二元障碍的概念，可以通过行为改变和母子情感参与来接近。研究表明，婴儿哭闹和睡眠行为与产后抑郁症有关，父母的干预可以改变婴儿的行为，但这些发现从未应用于产后抑郁症。在这个R21应用程序中，我们的目标是收集一种新的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，我们通过促进母亲介导的婴儿行为变化来治疗高危女性。我们将选择一个有PPD风险的孕妇样本，在3次围产期访视期间教授育儿技巧，以增加婴儿夜间睡眠并将大惊小怪/哭泣行为减少到样本的一半，然后在6周和14周评估婴儿行为，并在产后6周，10周和14周评估母亲情绪。根据NIMH的战略目标，即对基本的大脑行为过程进行综合理解，我们将充分利用这项干预研究的调查机会，通过使用最先进的EEG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志物。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）干预将具有高的治疗依从性，因为（a）协议会话可以纳入通常的围产期医疗访视，（B）育儿技能将吸引女性作为非精神病干预，（c）鉴于围产期的双重重点，临床方法将具有表面有效性;（2）其目的是预防;（3）它促进母亲和儿童的福祉;（4）它将扩大产后抑郁症的风险因素，包括围产期的神经行为标志。 公共卫生相关性：产后抑郁症（PPD）治疗不足，其后果对妇女和儿童影响很大。研究表明，婴儿哭闹和睡眠行为与产后抑郁症有关，父母的干预可以改变婴儿的行为，但这些发现从未应用于产后抑郁症。我们建议教授育儿技巧，以增加婴儿夜间睡眠，减少可能发展为PPD的女性的大惊小怪/哭泣行为，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.