Preventing Postpartum Depression: A Dyadic Approach Adjunctive to Obstetric Care

项目摘要/摘要 在美国每年近400万名活产婴儿中，约有56万人，即14% 女性会在产后的头四个月内患上抑郁症。其后果是巨大的： 妇女的生活质量下降和严重的精神痛苦。PPD预测母婴比例下降 社交-情感和认知发展方面的亲和力和不良结果。依靠标准 药物和心理干预，PPD治疗不足的部分原因是女性不愿 由于与心理健康护理相关的耻辱而寻求治疗，参加治疗的后勤障碍补充道 保健预约，以及不愿在母乳喂养时服用药物。产后抑郁的危险因素有 相对较好的描绘。即使产前抑郁症状是最可靠的 PPD的预测者、基于证据的预防性干预措施很少见。在预防性干预中，很少有 在产科护理中利用生育期或嵌入服务的独特二元取向。至 针对产后抑郁预防和治疗的巨大知识缺口，我们开发了(R21MH092665-01) 并在初步随机对照试验(RCT)中测试了一种名为Prepp(Practical)的新干预措施 有效产后育儿的资源)，在有希望的公布数据之后，我们建议进行 这种治疗的更大的随机对照试验。Prepp招募有PPD风险的孕妇，范围从怀孕晚期到6- 产后一周的体检。它由四个面对面的“辅导”课程组成，辅以产科(OB)。 产前和产后预约，以及一次电话会议。准备包括：(A)正念和自我 反思技能、(B)育儿技能和(C)心理教育。对于这个拟议的项目，我们有三个研究 旨在实现214例晚期妊娠孕妇的Prepp VS常规RCT强化治疗 (18-35岁)妊娠期、产后6周、12周和16周的PPD风险评估2倍：(1)减少 妇女在怀孕期间的痛苦(2)决定了保持改善的母亲情绪和 婴儿行为的差异(3)确定了Prepp对母亲产生积极影响的一些途径： 婴儿二人组。Prepp在其PPD的新概念和设计方面具有创新性，以克服 产后抑郁治疗。PPD的传统临床治疗方法以个体为中心，并改善他们的 症状。在Prepp中，PPD被视为母婴二联体的潜在障碍，这可能是 通过母亲的预防性心理和行为变化--从以前开始 分娩--这对她和孩子都有影响。Prepp是医疗保健创新的先锋，旨在 通过将行为健康服务与初级健康护理相结合，提高金属健康护理的接受度。这个 拟议的研究具有重要意义，因为它有望推进产后抑郁的治疗和预防，以及 在出生后的头几个月产生关于母婴行为影响的新知识。

PROJECT SUMMARY/ABSTRACT Of the nearly 4 million live births each year in the United States, approximately 560,000, or 14% of these women will develop depression within the first four months postpartum. The consequences are substantial: diminished quality of life and significant emotional suffering for women. PPD predicts diminished mother–infant bonding and poor outcomes in social–emotional and, for some, cognitive development. Relying on standard pharmacologic and psychological interventions, PPD is undertreated in part because women are reluctant to seek treatment due to the stigma associated with mental health care, logistical barriers to attending added health care appointments, and disinclination to take medications while breastfeeding. Risk factors for PPD are relatively well delineated. Even though prenatal depressive symptoms are some of the most reliable predictors, evidenced–based, preventive interventions for PPD are rare. Of the preventative interventions, few leverage the unique dyadic orientation of the childbearing period or imbed services in obstetrical care. To address the huge knowledge gap in the prevention and treatment of PPD, we developed (R21MH092665–01) and tested in a preliminary randomized control trial (RCT) a new intervention called PREPP (Practical Resources for Effective Postpartum Parenting) and, following promising published data, we propose to conduct a larger RCT of this treatment. PREPP enrolls pregnant women at risk for PPD, spans late pregnancy to the 6– week postpartum check up. It consists of four in–person `coaching' sessions adjunctive to obstetrical (OB) prenatal and postnatal appointments, and one phone session. PREPP includes (a) mindfulness and self– reflection skills, (b) parenting skills and (c) psycho–education. For this proposed project, we have three study aims to be realized in a PREPP vs Enhanced Treatment as Usual RCT of 214, 3rd trimester pregnant women (ages 18–35) at risk for PPD assessed 2x in pregnancy and at 6, 12, and 16 weeks postpartum: (1) Reduce women's distress during pregnancy (2) Determine the maintenance of improved maternal mood and differences in infant behavior (3) Identify some of the pathways by which PREPP positively affects the mother– infant dyad. PREPP is innovative in its novel conceptualization of PPD and design to overcome barriers to PPD treatment. The traditional clinical approach to PPD has as a focus the individual and improving their symptoms. In PREPP, PPD is viewed as a potential disorder of the mother–infant dyad, which can be approached through preventive psychological and behavioral changes in the mother — commencing before birth — that affect her and the child. PREPP exemplifies the vanguard of health care innovations aiming to increase metal health care uptake by integrating behavioral health services with primary health care. The proposed research is significant because it is expected to advance the treatment and prevention of PPD, and generate new knowledge about mother–infant behav-ioral influences during the first months of postnatal life.