Preventing Maternal Depression in Head Start

描述(申请人提供)：产妇抑郁对低收入和少数族裔妇女的影响不成比例，并对其子女产生深远的负面影响。众所周知，在这些妇女中，获得心理健康服务的机会很少。2009年，医学研究所(IOM)发布了一份里程碑式的报告《父母、育儿和儿童中的抑郁》，其中呼吁开发创新的、以社区为基础的倡议，通过识别、治疗和预防父母的抑郁来减少护理障碍。根据国际移民组织的报告，NIMH Brains项目的这一应用延续了致力于研究一种系统方法的研究轨迹，该方法旨在识别Head Start中患有抑郁症状的母亲--这是一项由联邦政府资助的针对低收入家庭儿童的早期学习计划--并提供现场干预，以预防或缓解抑郁症状；改善功能；并在适当的情况下，主动将母亲与更明确的心理健康服务联系起来。我们提出了一项为期5年的随机对照疗效试验，作为申请人K23奖(K23MH074079)的一部分，开发了基于头部开始的干预模式。该模型代表了一个综合的识别和干预系统，基于循证结构的筛查、短暂干预和转诊治疗。在Head Start的综合病例管理服务中，230名患有抑郁症风险增加的母亲将被随机分配接受常规护理或基于Head Start的问题解决干预，并使用增强动机的原则将其转介到更明确的服务。在12个月的随访期内，我们的目标是：1)提高母亲解决问题的技能；2)降低母亲经历中度到重度抑郁症状的发生率；3)随着时间的推移减少抑郁症状；4)增加母亲在被转介时接受初级保健或专门心理健康服务的可能性；以及5)改善父母的功能，通过有效和可靠的量表衡量，并通过评估儿童旷课的开学日来衡量。我们假设，通过我们的干预，有抑郁风险的母亲将发展出更强的解决问题的技能；这些技能将作为再次抑郁的缓冲器。因此，在研究的后续阶段，受试者将经历中度到重度症状发作的减少，并且随着时间的推移，症状也会减少。当需要转介时，干预组的受试者会更倾向于接受心理健康服务。我们假设，干预母亲也将体验到功能的改善，并更多地参与到孩子的启蒙活动中，导致错过启蒙的天数减少。申请人的K23奖项的结果直接导致了本文所述的研究。这项疗效试验的结果反过来将为更大规模的多部位有效性试验奠定基础。我们的最终目标是通过Head Start在国家一级传播这一模式。

DESCRIPTION (provided by applicant): Maternal depression disproportionately affects low-income and minority women and has profound negative impacts on their children. Among these women, access to mental health services is known to be poor. In 2009, the Institute of Medicine (IOM) published a landmark report, Depression in Parents, Parenting, and Children, in which it called for the development of innovative, community-based initiatives to reduce barriers to care through identification, treatment, and prevention of depression in parents. Pursuant to the IOM's report, this application to the NIMH BRAINS program continues a trajectory of research devoted to studying a systems approach to identifying mothers with depressive symptoms in Head Start - a federally funded early learning program for children of low-income families - and providing an on-site intervention to prevent or alleviate depressive symptoms; improve functioning; and, where appropriate, proactively link mothers to more definitive mental health services. We propose a 5-year, randomized controlled efficacy trial of a Head Start-based intervention model developed as part of the applicant's K23-award (K23MH074079). The model represents an integrated identification and intervention system, based on the evidence-based construct of screening, brief intervention, and referral to treatment. Within the comprehensive case management services of Head Start, 230 mothers at increased risk for depressive disorder will be randomized to receive either usual care or a Head Start-based problem-solving intervention, plus 'activated' referral to more definitive services using principles of motivational enhancement. Measured over a 12-month follow up period, we aim to: 1) improve mothers' problem solving skills; 2) decrease the incident rate of episodes in which mothers experience moderate to severe depressive symptoms; 3) reduce depressive symptoms over time; 4) increase mothers' likelihood of engaging with primary care or specialty mental health services when referred; and 5) improve parental functioning, as measured both by valid and reliable scales and by assessing children's missed Head Start school days. We hypothesize that through our intervention, mothers at risk for depression will develop stronger problem solving skills; and that such skills will serve as a buffer again depression. Subjects, therefore, will experience a decreased incidence of moderate to severe symptomatic episodes over the study's follow-up period, as well as a reduction in symptoms over time. When referral is necessary, subjects in the intervention arm will be more apt to engage with mental health services. We hypothesize that intervention mothers will also experience an improvement in functioning, and become more involved in their children's Head Start activities, leading to fewer missed days of Head Start. Results of the applicant's K23 award led directly to the research described herein. The results of this efficacy trial, in turn, will set the stage for a larger multisite effectiveness trial. Our ultimate goal is dissemination of the model at the national level through Head Start.