1/2 - Online Collaborative Learning Intervention to Prevent Perinatal Depression

产后抑郁症（PPMD）是常见的，发生在大约7%的妇女在前三个 分娩后几个月。PPMD可能对女性产生深远的影响，降低生活质量，增加 情绪困扰和降低自主能力，并可增加婴儿出现障碍的风险 发展越来越多的研究表明，心理治疗可以有效地减少 PPMD的发病率。此外，绝大多数妇女更喜欢心理治疗，而不是药物治疗， 怀孕或哺乳。然而，存在着许多障碍，使妇女无法获得面对面的咨询服务。 服务 互联网在向围产期妇女提供预防服务方面具有巨大潜力。虽然这种 干预措施尚未在这一人群中进行调查，两大类互联网干预措施已被 评估。个人互联网干预（IIIs），为患者提供基于网络的自我干预， 管理技能培训计划，已被证明是有效地减少抑郁症的一般 特别是在通过电子邮件或电话辅导提供一些人力支持的情况下。互联网 支助小组似乎是妇女在围产期经常使用的。然而，随机 对照试验发现它们对减轻抑郁症无效。关于利用问责制的理论， 提高坚持和在线协作学习的应用，以提高技能的获取建议， III和ISG的仔细整合可以在改善依从性和结局方面产生协同效应， 在线治疗，以防止抑郁症。因此，使用联网的对等体来增强依从性和结果， 而不是治疗师或教练，将使这种干预高度可扩展。 我们已经设计、构建并试行了一个在线干预的原型，我们称之为“分享“， 在功能上整合了III和ISG目标技能，以管理情绪和预防抑郁症。共同目标 通过联网的对等体的设置和支持性监控被设计为增加对该计划的遵守。共享 学习工具旨在通过小组学习过程加强学习。基于在以下方面取得的可喜成果， 作为一个试点，我们提出了一个随机对照试验来评估共享。怀孕20-28周的妇女将 随机接受Share或III，作为最低治疗对照。分享有潜力 为预防抑郁症提供一种新颖的范式，一种易于使用、高度可扩展且成本低廉的范式 有效

Postpartum major depression (PPMD) is common, occurring in approximately 7% of women in the first three months after childbirth. PPMD can have a profound impact for the woman, decreasing quality of life, increasing emotional distress and reducing caregiving capacity, and can increase the risk of disturbances in infant development. A growing number of studies have shown that psychological treatments are effective at reducing the incidence of PPMD. In addition, women overwhelmingly prefer psychological treatment to medication while pregnant or breast feeding. However, numerous barriers exist that prevent women from accessing face-to-face services. The Internet offers great potential in extending preventive services to women in the perinatal period. While such interventions have not been investigated in this population, two broad classes of internet interventions have been evaluated. Individual Internet Interventions (IIIs), which provide patients with access to web-based self- management skills training programs, have been shown to be effective in reducing depression in general populations, particularly when accompanied by some human support via email or telephone coaching. Internet Support Groups (ISGs) appear to be commonly used by women in the perinatal period. However, randomized controlled trials have found them ineffective at reducing depression. Theories on the use of accountability to improve adherence and the application of online collaborative learning to enhance skill acquisition suggest that a careful integration of III and ISG could have a synergistic effect in improving both adherence and outcomes in online treatments to prevent depression. Thus, use of networked peers to enhance adherence and outcomes, instead of therapists or coaches, would make this intervention highly scalable. We have designed, constructed, and piloted a prototype of an online intervention, which we call "Share"that functionally integrates an III and an ISG targeting skills to manage mood and prevent depression. Shared goal setting and supportive monitoring by networked peers is designed to increase adherence to the program. Shared learning tools are designed to enhance learning through group learning processes. Based on promising results in a pilot, we are proposing an RCT to evaluate Share. Women in weeks 20-28 of their pregnancy will be randomized to receive either Share or an III that will serve as a minimal treatment control. Share has the potential to provide a novel paradigm for the prevention of depression, one that is accessible, highly scalable and cost- effective.