Digital Mindfulness Based Cognitive Therapy for Perinatal Depression

越来越多的数字心理健康技术正在开发中，以扩大获得 精神健康治疗，并以具有成本效益的方式提供。尽管这些药物的疗效试验 技术证明改善了患者的预后，特别是在与教练支持相结合的情况下 几乎没有证据表明这种数字工具可以在常规护理环境中广泛实施和维持。 围产期抑郁症是一个重大的公共卫生问题，其中数字心理的作用 卫生技术尤其相关。约30%-40%有抑郁症病史的女性 在围产期复发，大多数人对抗抑郁药(ADS)的依从性较差 最常见的预防治疗，大多数人表示倾向于非药物治疗。 然而，有效和容易获得的非药物治疗并不广泛。不足之处 围产期抑郁症的治疗具有独特的风险，包括潜在的产科和新生儿。 与围产期抑郁本身和胎儿暴露于ADS有关的并发症。因此，它是 必须测试有效和可扩展的非药物治疗的实施情况，以减少 在围产期抑郁复发的风险。 基于正念的认知疗法(MBCT)是一种很有前途的孕期预防干预方法 患有复发性抑郁症的妇女(以及一般成年人)，表现出显著的减少 抑郁复发率和残留抑郁症状。MBCT是一个由八个会议组成的面对面小组 以抑郁复发危险因素为靶点的干预措施--正念、冥想和 认知-行为策略。由于在提供面对面MBCT(健康困难)方面存在挑战 系统，以扩大干预，进入障碍的孕妇)，我们开发了移动优先 孕妇MBCT的数字改编，母亲的注意情绪平衡(MMBFM)。 我们下一阶段工作的关键是评估MMBFM作为一种有效干预的潜力 这可以在不同的患者群体中更广泛地采用、实施和维持，并 医疗保健系统。我们提出了一种大型实用混合II类有效性--实施试验 在四个MHRN中对有复发抑郁症风险的孕妇进行MMBFM和常规护理(UC)的比较 网站：科罗拉多州KP、南加州KP、HealthPartners和乔治亚州KP，以实现以下目标： 目的1：测试MMBFM在减轻抑郁症状、降低复发或复发风险方面的有效性 在现实世界的卫生系统中实施时，显著恶化和改善围产儿结局。 目的2：与UC相比，评估MMBFM的增量成本效益。 目标3：使用RE-AIM(REACH，Efficiency， 采用、实施和维护)模型。

An increasing number of digital mental health technologies are being developed to expand access to mental health treatments and deliver them in a cost-effective manner. Although efficacy trials of these technologies demonstrate improved patient outcomes, especially when combined with coaching support, there is little evidence that such digital tools can be widely implemented and sustained in routine care settings. Perinatal depression is one area of significant public health concern where the role of digital mental health technology is especially relevant. Approximately 30-40% of women with histories of depression experience relapse during the perinatal period, a majority show poor adherence to antidepressants (ADs), the most common prevention treatment, and a majority express a preference for non-pharmacologic treatments. However, effective and easily accessible non-pharmacologic treatments are not widely available. Inadequate treatment for perinatal depression poses unique risks, including potential obstetrical and neonatal complications associated with perinatal depression itself and with fetal exposure to ADs. It is therefore imperative to test the implementation of effective and scalable non-pharmacological treatments to reduce the risk of depression relapse in the perinatal period. Mindfulness Based Cognitive Therapy (MBCT) is a promising preventive intervention for pregnant women with recurrent depression (as well as for adults in general), demonstrating significant reductions in rates of depressive relapse and residual depressive symptoms. MBCT is an eight-session in-person group intervention targeting risk factors for depressive relapse through a combination of mindfulness meditation and cognitive-behavioral strategies. Because of challenges in delivering in-person MBCT (difficulty for health systems to scale up the intervention, barriers to access for pregnant women), we developed a mobile-first digital adaptation of MBCT for pregnant women, Mindful Mood Balance for Moms (MMBFM). The critical next phase of our work is to evaluate the potential of MMBFM as an effective intervention that can be more widely adopted, implemented and sustained across heterogeneous patient populations and health care systems. We propose a large pragmatic hybrid type II effectiveness--implementation trial comparing MMBFM to usual care (UC) among pregnant women at risk for recurrent depression at four MHRN sites: KP Colorado, KP Southern California, HealthPartners, and KP Georgia to address the following aims: AIM 1: Test the effectiveness of MMBFM in reducing depression symptoms, reducing risk of relapse or significant worsening, and improving perinatal outcomes when implemented in real-world health systems. AIM 2: Evaluate the incremental cost effectiveness of MMBFM compared to UC. AIM 3: Evaluate healthcare system's implementation of MMBFM using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) model.