Treating Maternal Depression in an Urban Community-Based Pediatric Asthma Clinic: Targeting Maternal Mood, Child Asthma Outcomes, and Health Disparities

项目总结/摘要：本提案详细说明了一项5年计划，旨在为Rachel Margolis博士提供 知识和技能，成为一个独立的临床和翻译研究人员，专注于促进 通过改善儿童哮喘结局实现健康公平。研究计划：突出社会经济和种族/民族 在儿童哮喘方面，特别是在城市环境中资源不足的黑人儿童中，差异仍然存在。 有证据表明，结构性和心理社会风险因素促成了这些差异。产妇 抑郁症是一种普遍存在且可能改变的风险因素。虽然有证据表明， 抑郁症可能会改善儿童健康状况，来自资源不足社区的母亲面临着显著的 以社区为基础的抑郁症治疗的障碍。综合护理（即，提供精神卫生保健 在身体健康护理环境中的其他正在进行的医疗护理的背景下）提供了令人兴奋的和不足的- 探索的选择。它与减少母亲抑郁症和改善儿童健康有关， 初级保健.然而，嵌入式母亲抑郁症治疗的可行性，可接受性和有效性 以社区为基础的儿童哮喘护理需要证明。增强的Brief人际关系 心理疗法（IPT-B）是一种很有前途的抑郁症治疗资源不足的母亲，已被证明 在其他环境中的类似女性中有效，但尚未在正在进行的儿童哮喘中进行研究 在乎为了最大限度地提高增强型IPT-B在哮喘临床环境中的成功率，有必要识别并 解决潜在的母亲和提供者层面的障碍，以综合抑郁症护理。利益攸关方参与 与母亲和哮喘诊所的工作人员可以促进理解和减轻这些障碍的过程。 因此，本提案的总体目标是利用利益相关者的投入来整合和评估孕产妇抑郁症 在一个以社区为基础的哮喘诊所治疗，为主要资源不足的黑人儿童提供护理 哮喘具体目标是：1）让利益相关者参与确定最有效和可接受的 将针对母亲的增强型IPT-B整合到基于社区的儿科哮喘护理中的模型; 2）确定 增强型IPT-B降低母亲抑郁的可行性、可接受性和初步疗效 通过试点随机对照试验，在特定的社区儿童哮喘诊所中评估哮喘症状;以及3）确定 干预措施对改善儿童哮喘护理和健康结果的初步效果。培训计划： 通过教学课程和指导研究经验，她的多学科团队， 导师/顾问，马戈利斯博士将发展先进的定性和混合方法的技能，学习临床试验 设计重点是对资源不足和种族/少数民族家庭的行为干预， 先进的实施科学技能。马戈利斯博士将从她的K 01培训和研究经验中脱颖而出 作为一个独立的行为科学家致力于提高健康公平。

PROJECT SUMMARY/ABSTRACT: This proposal details a 5-year plan to provide Dr. Rachel Margolis with the knowledge and skills to become an independent clinical and translational researcher focused on promoting health equity by improving pediatric asthma outcomes. Research Plan: Striking socioeconomic and racial/ethnic disparities persist in pediatric asthma, particularly among under-resourced, Black children in urban settings. Evidence demonstrates that structural and psychosocial risk factors contribute to these disparities. Maternal depression is one prevalent and potentially modifiable risk factor. While there is evidence that treating maternal depression may improve child health outcomes, mothers from under-resourced communities face significant barriers to community-based treatment of depression. Integrated care (i.e., the delivery of mental health care within the context of other ongoing medical care in a physical health care setting) offers an exciting and under- explored option. It has been associated with reduced maternal depression and improved child health in pediatric primary care. However, the feasibility, acceptability, and efficacy of embedding maternal depression treatment into community-based pediatric asthma care needs to be demonstrated. Enhanced Brief Interpersonal Psychotherapy (IPT-B) is a promising depression treatment for under-resourced mothers that has proven efficacious among similar women in other settings, but it has not been studied within ongoing pediatric asthma care. To maximize the success of Enhanced IPT-B in an asthma clinic setting, it is necessary to identify and address potential mother and provider-level barriers to integrated depression care. Stakeholder engagement with mothers and asthma clinic staff can facilitate the process of understanding and mitigating these barriers. Thus, the overall goal of this proposal is to use stakeholder input to integrate and evaluate maternal depression treatment in a community-based asthma clinic providing care to predominately under-resourced, Black children with asthma. The Specific Aims are to: 1) Engage stakeholders in determining the most effective and acceptable model for integrating Enhanced IPT-B for mothers into community-based pediatric asthma care; 2) Determine the feasibility, acceptability, and preliminary efficacy of Enhanced IPT-B on decreasing maternal depressive symptoms in a specific community-based pediatric asthma clinic through a pilot RCT; and 3) Determine the preliminary efficacy of the intervention on improving child asthma care and health outcomes. Training Plan: Through didactic coursework and mentored research experiences with her multidisciplinary team of mentors/advisors, Dr. Margolis will develop advanced qualitative and mixed methods skills, learn clinical trial design with a focus on behavioral interventions for under-resourced and racial/ethnic minority families, and gain advanced implementation science skills. Dr. Margolis will emerge from her K01 training and research experience as an independent behavioral scientist committed to enhancing health equity.