Developing and testing a multi-component intervention to improve Perinatal Mental Health

抑郁和焦虑是怀孕和产后期最常见的并发症， 五分之一的人在分娩尽管采取了有效的预防和治疗措施， 抑郁症和焦虑症得不到预防和治疗，特别是在边缘化社区。的 拟议的研究将与助产士，围产期的人，和临床医生共同开发和试点测试一个多， 这是一项名为“导乐环节围产期心理健康”的干预措施。导乐链接从一个 全国围产期精神病服务方案模式，以建立与社区的联系， 行为支持。这项以社区为基础的参与性研究将集中的经验和声音， 我们的目标是促进高质量的公平护理。根据NIMH战略 目标4，拟议项目的总体目标是开发和测试一种创新的服务提供模式， 减少围产期抑郁和焦虑症状。这将通过三个研究目标来实现： 1)为了通过与导乐师的迭代混合方法研究来调整和定义干预组件， 精神健康专家和边缘化社区的围产期人员; 2） 管理和完善与导乐师的干预，然后导乐师将提供心理社会干预， 3）使用试点随机分组评估导乐链接的可行性和可及性 可控可行性试验。这项研究将与高级培训和指导同时进行， 候选人。培训将针对四个具体的培训目标：1）制定围产期心理干预措施， 健康，2）社区参与研究的先进定性方法，3） 实施科学，以及4）领导和专业发展，以领导多地点研究。年底 在拟议的项目中，候选人将开发并试用一个版本的导乐链接，该版本将 包括以下产品：1）针对doula的精神病访问方案工具包，2） 导视，以实施心理社会干预，3）忠诚措施，4）干预的关键数据 可行性和可接受性，5）招募，保留和评估响应率，以及6）估计 群内相关系数和效应量。K 01指导研究科学家的目标是 发展奖是准备一个独立的研究生涯，致力于发展候选人 并测试可接受的，可行的，可扩展的，公平和有效的干预措施，以改善围产期心理 健康通过在K 01期间获得的研究、培训和指导，候选人将获得数据 和高级技能，开发R 01应用程序以进行全功能试用，并定位为 成为围产期心理健康实施科学研究的领导者。

Depression and anxiety are the most common complications of pregnancy and the postpartum period, affecting one in five birthing people. Despite effective interventions for prevention and treatment, most perinatal depression and anxiety is unprevented and untreated, especially among marginalized communities. The proposed research will work with doulas, perinatal people, and clinicians to co-develop and pilot test a multi- component intervention called “Doula Link for Perinatal Mental Health (Doula Link).” Doula Link builds from a national model of perinatal psychiatric access programs to create links to the community and direct delivery of behavioral support. This community-based participatory research will center the experiences and voices of marginalized communities with the goal of fostering high quality equitable care. In line with NIMH Strategic Goal 4, the overall goal for the proposed project is to develop and test an innovative service delivery model to reduce symptoms of perinatal depression and anxiety. This will be accomplished through three research aims: 1) To adapt and define the intervention components through iterative mixed-methods research with doulas, mental health specialists, and perinatal people who are representative of marginalized communities; 2) To administer and refine the intervention with doulas who will then offer the psychosocial intervention to their pregnant clients; 3) Assess the feasibility and accessibility of Doula Link using a pilot cluster-randomized controlled feasibility trial. This research will be conducted in tandem with advanced training and mentorship for the candidate. Training will target four specific training goals: 1) intervention development for perinatal mental health, 2) advanced qualitative methods for community-engaged research, 3) advanced methods for implementation science, and 4) leadership and professional development to lead multi-site studies. At the end of the proposed project, the candidate will have developed and piloted a version of Doula Link, which will include the following products: 1) doula-specific toolkit for Psychiatric Access Programs, 2) training manual for doulas to implement the psychosocial intervention, 3) fidelity measures, 4) critical data on intervention feasibility and acceptability, 5) recruitment, retention, and assessment response rates, and 6) estimates of intra-cluster correlation coefficient and effect size. The goal of this K01-Mentored Research Scientist Development Award is to prepare the candidate for an independent research career dedicated to developing and testing acceptable, feasible, scalable, equitable, and effective interventions to improve perinatal mental health. With the research, training, and mentorship gained during this K01, the candidate will acquire the data and advanced skills needed to develop an R01 application for a fully-powered trial and be positioned to become a leader in perinatal mental health implementation science research.