IPT for major depression following perinatal loss

最近经历过围产期丢失的妇女中严重抑郁障碍(MDD)的发生率 (包括早期和晚期胎儿死亡和早期新生儿死亡)是匹配人群中MDD发病率的3倍 社区妇女的样本。情绪困难可能在失去后持续长达4年，并可能随着 后来的怀孕。相对于活着婴儿的母亲，围产期死亡后的自杀率更高。创伤后应激障碍 这是一种常见的并存现象；围产期丧失后的创伤后应激障碍发生率是活着婴儿母亲的7倍。尽管 认识到围产期损失后的MDD是一个重要的公共卫生问题，它导致显著的 损害，而且像往常一样的治疗一直不充分，为此开发和测试的唯一治疗方法 Popular是我们团队在这项提议的试点工作中进行的随机试验的一部分。这项研究创造了 治疗围产期丢失后的任何精神障碍的第一本手册。该手册结构严谨，易于遵循， 并使用人际心理治疗(IPT)原则来处理围产期损失的情况，例如 解决在缺乏社会支持的情况下如何应对损失、悲痛和请求支持的冲突 关于如何做到这一点的规范，审查损失事件，并解决过错和角色能力问题。它 可由不了解IPT的提供商使用。我们的试点试验随机选择了50名患有MDD的女性 围产期损失为IPT组或应对抑郁(CWD)组，这是一种循证认知行为 没有重点关注围产期损失或社会支持的治疗。IPT是可行和可接受的， 显著提高(p=.001)治疗满意度得分和创伤后应激障碍恢复率(在54%的 患有创伤后应激障碍的样本；p=.009)。组间效应大小周围的可信区间 支持IPT在治疗期间减少抑郁症状以及改善特定模式 目标(社会支持、悲伤症状)、过度随访。鉴于这些有希望的发现，拟议的R01将 进行一项完全有效的随机疗效研究，比较IPT治疗围产期丢失后MDD与CWD的疗效。 274名女性的样本。这项试验将是第一个治疗精神病患者的完全有效的随机试验。 围产期丢失后的紊乱。它涉及《消除对妇女一切形式歧视公约》优先改善妇女健康的问题，在此之前、期间、 在怀孕之后。鉴于贫困增加了围产期损失的风险，非洲人的围产期损失率 美国女性是白人女性的两倍，试验地点在密歇根州弗林特和底特律 (贫困率高的少数民族占多数的城市)增加了试验的意义。结果将包括 MDD恢复时间、抑郁症状、创伤后应激障碍症状、创伤后应激障碍恢复时间、社会支持 幸福、悲伤和对后续怀孕的恐惧。结果具有很高的传播和吸收潜力： 我们已经收到并满足了160多份免费、未出版的IPT治疗手册的请求。这 这项研究将为治疗脆弱和研究不足的人群提供证据基础，这些人群的痛苦 在历史上被最小化，改善了这些妇女及其家庭的结果。

The rates of major depressive disorder (MDD) among women who have recently experienced perinatal loss (including early and late fetal death and early neonatal death) are 3 times the rates of MDD among matched samples of community women. Mood difficulties can persist up to 4 years after the loss and can worsen with subsequent pregnancies. Suicide rates after perinatal loss are higher relative to mothers of living infants. PTSD is a common co-occurrence; PTSD rates after perinatal loss are 7 times that of mothers of living infants. Despite recognition that MDD following perinatal loss is an important public health concern, that it causes significant impairment, and that treatment as usual has been inadequate, the only treatment developed and tested for this population was part of a randomized trial conducted by our team in pilot work for this proposal. That study created the first manual for treating any psychiatric disorder after perinatal loss. The manual is structured, easy-to-follow, and uses interpersonal psychotherapy (IPT) principles to address the circumstances perinatal loss, such as resolving conflicts over how to respond to the loss, grieving and requesting support in the absence of social norms about how to do so, reviewing the loss event, and resolving questions of fault and role competence. It can be used by providers who do not know IPT. Our pilot trial randomized 50 women with MDD following perinatal loss to group IPT or to group Coping with Depression (CWD), an evidence-based cognitive behavioral treatment which did not focus on perinatal loss nor social support. IPT was feasible and acceptable, with significantly higher (p = .001) treatment satisfaction scores and PTSD recovery rates (among the 54% of the sample with PTSD; p = .009) in IPT than in CWD. Confidence intervals around between-groups effect sizes favored IPT for reductions in depressive symptoms during treatment as well as for improvement in mode-specific targets (social support, grief symptoms), over follow-up. Given these promising findings, the proposed R01 will conduct a fully-powered randomized efficacy study comparing IPT for MDD following perinatal loss to CWD in a sample of 274 women. The trial will be the first fully-powered randomized trial of treatment for any psychiatric disorder following perinatal loss. It addresses NICHD priority to improve the health of women before, during, and after pregnancy. Given that poverty increases risk of perinatal loss and that rates of perinatal loss for African- American women are double those for White women, the location of the trial in Flint and Detroit, Michigan (minority-majority cities with high rates of poverty) increases the significance of the trial. Outcomes will include time to recovery from MDD, depressive symptoms, PTSD symptoms, time to recovery from PTSD, social support, well-being, grief, and fear of subsequent pregnancies. Results have high potential for dissemination and uptake: we have received and fulfilled more than 160 requests for the free, unpublished IPT treatment manual. This study will provide an evidence base for treating a vulnerable and understudied population whose distress has historically been minimized, improving outcomes for these women and their families.