Optimizing a Pediatric Intervention to Increase Maternal Depression Care-Seeking

描述（由申请人提供）：在养育幼儿的母亲中，抑郁症很常见，但治疗不足。抑郁症使母亲衰弱，对她们养育子女产生负面影响，并与孩子的精神、行为和身体健康问题有关。识别和治疗患有抑郁症的母亲既能改善母亲的健康，也能改善孩子的心理和整体健康。儿科就诊提供了一个潜在的重大干预机会。母亲们可能会比自己的医生更频繁地去看孩子的儿科医生，这些医生可以激励母亲寻求有效的、未充分利用的、正式的抑郁症治疗，通过沟通抑郁症的康复与孩子的健康之间的联系。因此，在最近的试点工作中，我们开发了一种基于儿科环境的干预措施，其中包括经过验证的母亲抑郁症筛查，以及随后的抑郁症教育和寻求护理的动机信息，这些信息强调母亲抑郁症护理对儿童的好处。初步测试表明，与接受常规护理的母亲相比，接受干预的抑郁症筛查阳性母亲有更大的意愿和尝试寻求抑郁症护理。[然后，我们专业地将干预翻译成西班牙语，作为通过在未来研究中改进来提高干预普遍性的第一步。]正如作为一揽子干预措施进行测试时经常出现的情况一样，我们缺乏经验证据来证明试点干预措施的哪些组成部分能产生最大的效果。因此，我们建议采用快速周期干预改进方法。我们将：(1)使用定性数据完善试点测试干预的组成部分[和西班牙语翻译]；(2)使用析因实验评估这些建议的改进对抑郁症筛查阳性母亲寻求抑郁症护理的影响。由此产生的干预将通过只包括那些经实验发现最有效的精制成分来暂时优化。这种临时优化的干预措施将更有可能显示出可重复的有效性，从而可能加快实施的速度。[最终优化的干预措施将通过成为未来基于儿科的产妇抑郁症筛查和有效的基于社区的产妇心理保健计划之间的综合系统的重要环节来改善产妇抑郁症护理。]我的长期职业目标是通过为儿科医生制定干预措施，指导父母为自己和孩子提供有效的[综合的]心理和行为保健，从而成为改善代际心理健康，特别是为处境不利的患者改善心理健康的全国领导者。我的中期职业目标是开发以儿科为基础的干预措施，以改善有效但未充分利用的产妇抑郁症治疗方法的获取和吸收。我的短期职业目标是获得孕产妇抑郁症（影响不同人群）和求医干预优化策略方面的专业知识，并通过(1)更好地了解母亲对以儿科为基础的孕产妇抑郁症干预措施的偏好，(2)产生临时优化的以儿科为基础的干预措施，以增加孕产妇抑郁症求医。这些目标将通过以下方面的进一步培训和指导来实现：(1)定性研究的设计、实施和分析；(2)设计和分析自适应和因子随机对照试验数据，用于优化多组分干预措施；(3)[以社区为基础，文化上适当的]产妇心理保健服务[和研究]；(4)作为儿科医生研究人员的机构和国家职业发展。拟议的研究将在加州大学戴维斯分校（UCD）进行。UCD支持这项工作的研究和培训环境包括：儿科及其相关的多个儿科诊所；国立卫生研究院临床与转化科学中心；[减少健康差距中心；医疗保健政策与研究中心；研究生水平的定性研究、拨款写作、健康信息学和临床研究人员的职业发展课程；数据库管理和统计规划与分析的基础设施；负责任的研究行为的培训计划；并强调有经验的研究人员指导初级教师，包括跨部门和儿科部门。UCD在合作研究和培训方面有着悠久的历史，这与本次职业发展奖的目标直接相关。

DESCRIPTION (provided by applicant): Depression in mothers parenting young children is common and undertreated. Depression is debilitating for mothers, negatively affects their parenting, and is associated with mental, behavioral, and physical health problems in their children. Identifying and treating mothers with depression improves both the mothers' well-being and their children's mental and overall health. Pediatric visits offer a potential significant opportunity to intervene. Mothers may see their child's pediatric provider more often than their own, and these providers could motivate mothers to seek effective, underutilized, formal depression care, by communicating how recovery from depression is linked to child well-being. Therefore, in recent pilot work, we developed a pediatric setting-based intervention that includes a validated maternal depression screen, and subsequent depression education and care-seeking motivational messages that emphasize the benefits of maternal depression care for children. Initial testing demonstrated that depression screen-positive mothers receiving the intervention had greater intention and attempts to seek depression care compared to mothers receiving usual care. [We then professionally translated the intervention into Spanish as a first step in increasing the generalizability of the intervention through refinement in future studies.] As is often the case with interventions tested as a package, we lack empirical evidence on which components of the pilot intervention deliver the greatest effects. Therefore, we propose to adopt a rapid-cycle intervention improvement approach. We will: (1) refine the components of the pilot-tested intervention [and a Spanish-language translation] using qualitative data and (2) assess the effects of those proposed refinements on depression screen-positive mothers' depression care- seeking, using factorial experiments. The resulting intervention will be provisionally optimized by including only those refined components found to be most experimentally efficacious. This provisionally optimized intervention will have a higher probabilit of demonstrating reproducible effectiveness, potentially speeding the way to implementation. [The ultimate optimized intervention will improve maternal depression care by being an essential link in future integrated systems between pediatric-based maternal depression screening and effective community-based programs for maternal mental health care.] My long-term career goal is to become a national leader in improving intergenerational mental health, particularly for patients in disadvantaged settings, by developing interventions for pediatric providers to guide parents to effective, [integrated] mental and behavioral health care for themselves and their children. My medium-term career goal is to develop pediatric-based interventions for improving access to and uptake of effective but underused maternal depression therapies. My short-term career goals are to acquire expertise in maternal depression [affecting diverse populations] and in care-seeking intervention optimization strategies, and to advance the field by (1) better understanding mothers' preferences for pediatric-based maternal depression interventions and (2) producing a provisionally optimized pediatric-based intervention to increase maternal depression care-seeking. These goals will be achieved through further training and mentoring in (1) qualitative research design, implementation, and analysis; (2) design and analysis of data from adaptive and factorial randomized-controlled trials used in the optimization of interventions with multiple components; (3) [community-based, culturally appropriate] maternal mental health services [and research]; and (4) institutional and national career progression as a pediatrician-researcher. The proposed research will be conducted at the University of California, Davis (UCD). The research and training environment at UCD supporting the proposed work includes: the Department of Pediatrics and its associated multiple pediatric clinic sites; the NIH Clinical and Translational Science Center; [the Center for Reducing Health Disparities;] the Center for Healthcare Policy and Research; graduate level courses in qualitative research, grant writing, health informatics, and career development as a clinician-researcher; infrastructure for database management and statistical planning and analysis; a training program in the responsible conduct of research; and an emphasis on experienced researchers mentoring junior faculty, both interdepartmentally and within the Department of Pediatrics. UCD has a long history of collaborative research and training directly relevant to the aims of this Career Development Award.