Biobehavioral perspectives on social connectedness and the âMindful Momsâ intervention for marginalized pregnant women with depression

项目摘要/摘要 背景：近20%的美国女性出现临床上明显的抑郁症状 在怀孕期间或产后期间。尽管有治疗抑郁症状的方法，如 抗抑郁药物和心理治疗，由于担心耻辱，许多女性仍然得不到或没有得到治疗， 副作用和成本，特别是被边缘化的妇女(少数群体，社会经济地位低)。此外， 标准的抑郁症治疗不涉及社会联系，这是一个潜在的可修改因素 有抑郁症状的。专注于通过安全、非 解决边缘人群孕期社会联系问题的可获得的药物疗法 妇女是临床和研究的当务之急。初步数据：来自我们研究的初步证据 该团队展示了一条在围产期抑郁症背景下解决社交联系的有希望的途径： 我们在一项由NICHD资助的研究(R15HD086835，Kinser)中试行了“有意识的妈妈”干预措施； 周干预包括关于症状自我管理和基于小组的简短激励性讨论 有意识的体力活动(产前瑜伽)。研究结果为协议的可行性和 干预的可接受性，定性的发现引导我们假设社会联系起着如下作用 在症状管理中的关键作用。此外，我们已经确定了唯一相关的表观遗传模式 产后抑郁症；我们将评估这些DNA甲基化模式与社会相关的相似性 连通性与产后抑郁症，作为对社会连通性机制的探索。学习 设计：使用基于个人和家庭自我管理理论的概念框架，总体 这项双臂纵向随机对照试验的目的是评价该药的疗效和作用机制。 有抑郁症状的边缘化女性(n=200)的自我管理方法与积极的 控制力。第一个具体目标是按组评估对抑郁症状严重程度、焦虑和 随着时间的推移感受到的压力。第二个具体目标是理解社会联系作为一种 团体分配对抑郁症状影响的调节因子。第三个具体目标是确定 全基因组DNA甲基化模式与感知的社会联系水平相关。潜力 影响：成功完成我们的目标将为社会联系提供重要的见解 减少抑郁症状的机制在很大程度上未被研究，历史上被边缘化的人群 女人。此外，如果被证明是有效的，“有意识的妈妈”可能是一个低成本、可持续和可翻译的选择 用于干预围产期抑郁症状。

PROJECT SUMMARY/ABSTRACT Background: Nearly 20% of women in the United States experience clinically significant depressive symptoms during pregnancy or the postpartum period. Although treatments exist for depressive symptoms such as antidepressants and psychotherapy, many women remain under- or un-treated due to concerns about stigma, side effects, and costs, particularly marginalized women (minority, low socioeconomic status). Further, the standard depression treatments do not address social connectedness, which is a potentially modifiable factor involved in depressive symptoms. A focus on adequate symptom management through safe, non- pharmacologic, accessible therapies that address social connectedness during pregnancy in marginalized women is an urgent clinical and research priority. Preliminary Data: Preliminary evidence from our research team shows a promising pathway for addressing social connectedness in the context of perinatal depression: we have piloted the “Mindful Moms” intervention in a NICHD-funded study (R15HD086835, Kinser); the 12- week intervention involves a brief motivating discussion about symptom self-management plus group-based mindful physical activity (prenatal yoga) sessions. Study findings provide support of protocol feasibility and intervention acceptability, with qualitative findings leading us to hypothesize that social connectedness plays as a key role in symptom management. Also, we have identified epigenetic patterns uniquely related to postpartum depression; we will evaluate the similarity of these DNA methylation patterns related to social connectedness and postpartum depression, as an exploration of mechanisms of social connectedness. Study Design: Using a conceptual framework based upon Individual and Family Self-Management Theory, the overall goal of this two-arm longitudinal randomized controlled trial is to evaluate the effects and mechanisms of this self-management approach in marginalized women with depressive symptoms (n=200), compared to an active control. The first Specific Aim is to evaluate effects by group on depressive symptom severity, anxiety, and perceived stress over time. The second Specific Aim is to understand the role of social connectedness as a moderator of the effects of group assignment on depressive symptoms. The third Specific Aim is to identify genome-wide DNA methylation patterns associated with levels of perceived social connectedness. Potential Impact: The successful completion of our aims will provide important insights into social connectedness as a mechanism to decrease depressive symptoms in a largely understudied, historically marginalized population of women. Further, if proven efficacious, “Mindful Moms” may be a low-cost, sustainable, and translatable option for intervention in perinatal depressive symptoms.