Development of a Text Intervention for Perinatal Depression

大约七分之一的孕妇患有抑郁症，大约相同数量的人面临着这种毁灭性的压力。 分娩后的疾病围产期抑郁症的下游影响增加了其死亡人数， 早产;母婴依恋受损;对婴儿发育的不利影响;以及 减少母乳喂养的开始/持续时间。美国咨询服务工作组发现，一些主要的 抑郁发作（MDE）可以通过采用以下原则的咨询策略来避免 人际关系治疗（IPT）和认知行为治疗（CBT）。他们还观察到同伴的价值 支持，这可以减少围产期抑郁症。这些干预措施的一个可能的共同机制是 提高自我效能，这在怀孕等压力事件中至关重要， 养育然而，实际实施干预措施，以提高自我效能和减少抑郁症， 风险具有挑战性。生殖健康提供者提供抑郁症的时间和培训有限 预防方案。同样，围产期个体可能不理解参与预防的必要性。 计划或难以找到或负担行为干预的提供者。技术可以帮助 通过向围产期孕妇提供教育、支持和治疗干预措施， 个体与基于网络的应用程序（app）不同，短信干预（TMI）可以主动提供 卫生信息和信息，甚至向那些参与预防性干预措施的动机有限的人提供。 移动的手机使用率激增，超过95%的孕妇（包括超过85%的少数民族人口） 报告使用移动的电话经由短文本消息进行通信。TMI也可以筛查围产期 在一般医疗环境之外为抑郁症患者提供治疗，并提供一般的同伴支持。与最终用户 在整个过程中输入，我们将建立一个多组件的TMI（称为Text 4 Moms）， 对围产期个体的MDE风险进行分类。该系统将从IPT和CBT中提取内容;它将 发送定制的文本消息，并链接到相关的视频内容，以围产期个人的风险， 抑郁发作由同行导航员提供的按需安全聊天功能将补充 文本消息以增强支持。该系统将包括预先填充的内容，供同行剪切和粘贴 为参与者提供短信，这将支持同行并减轻他们的培训负担。该系统 利用应用程序的一些最好的组件（视频，定制，聊天）到一个共同的和用户- 友好的短信平台。开发完成后，我们将进行一项试验性随机试验， TMI增强自我效能目标和减少抑郁症状和MDE风险的能力。 我们将查询研究领域标准（RDOC）的“损失”和“威胁”结构，并将评估初步的 有效性和执行情况（评估同侪聊天的可行性、可接受性、使用情况和益处 功能）通过试点随机临床试验。

About 1 in 7 pregnant individuals experience depression, with roughly the same number facing this devastating illness after delivery. The downstream effects of perinatal depression adds to its toll with increased risk of preterm birth; impairments in maternal-child attachment; adverse effects on infant development; and decreased breastfeeding initiation/duration. The US Preventative Services Task Force finds that some major depressive episodes (MDEs) can be averted with counseling strategies that employ principles from interpersonal therapy (IPT) and cognitive behavioral therapy (CBT). They also observe the value of peer support, which can decrease perinatal depression. A possible shared mechanism for these interventions is enhancement of self-efficacy, which is critical in the setting of stressful events such as pregnancy and parenting. However, practical implementation of interventions to enhance self-efficacy and reduce depression risk is challenging. Reproductive health providers have limited time and training to deliver depression prevention programs. As well, perinatal individuals may not appreciate the need to participate in a prevention program or have difficulty finding or affording providers of behavioral interventions. Technology can assist with these challenges by providing education, support and therapeutic interventions to perinatal pregnant individuals. Unlike web-based applications (apps), text messaging interventions (TMIs) can proactively deliver health information and messages, even to those with limited motivation to engage in preventative interventions. Mobile phone use has exploded with >95% of pregnant individuals (including >85% of the minority population) reporting use of a mobile phone to communicate via short text messages. TMIs can also screen perinatal individuals for depression outside the general medical setting and provide general peer support. With end-user input throughout the process, we will build a multi-component TMI (called Text4Moms) that screens and triages perinatal individuals for risk of a MDE. This system will draw content from both IPT and CBT; it will send tailored text messages with links to relevant video content to perinatal individuals at risk for a depressive episode. An on-demand secure chat function staffed by a peer navigator will complement the text messages for enhanced support. The system will include pre-populated content for peers to cut and paste into text messages for participants, which will support peers and decrease their training burden. This system leverages some of the best components of an app (video, tailoring, chat) into a common and user- friendly text messaging platform. After development, we will conduct a pilot randomized trial to test the ability of the TMI to enhance the target of self-efficacy and decrease depressive symptoms and risk of a MDE. We will query Research Domain Criteria (RDOC) constructs of “loss” and “threat,” and will evaluate preliminary effectiveness and implementation (assessment of feasibility, acceptability, use and benefit of the peer chat feature) through a pilot randomized clinical trial.