Systems of Care for New Moms: Integrating Depression Treatment

描述（由申请人提供）：产妇产后抑郁是一个重大的公共卫生问题，特别是在获得精神卫生服务机会有限的城市贫困少数民族妇女中。通过研究，我们知道如何治疗抑郁症。我们不知道的是如何将有效的抑郁症治疗转化为社区非专业心理健康环境，而不是以办公室为基础的初级保健。护士家访计划提供了一个机会，有效地增加了低收入弱势母亲获得抑郁症治疗的机会。本研究探讨了抑郁症治疗（问题解决疗法）在护士家访中的共存位置，以及维持循证治疗所需的组织变革。问题解决疗法（PST）适合非专业人士和家庭使用。干预的简短性（4-8次）及其非病理化的方法应该是低收入少数民族妇女可以接受的。通过多种方法，本研究将收集妇女及其提供者的信息，以确定需要哪些系统和治疗修改，以便在家访项目中有效地提供可接受的抑郁症治疗，因为他们努力实施政策指令，以识别和治疗患有抑郁症的母亲。一个综合了当地和全球知识的专家小组将就适应干预措施的决定提供咨询意见。一旦做出这些调整决定，一小群专家将对PST手册进行调整，以便在家访中使用。然后，我们将进行一项小型三组随机试验，比较家访注册护士和精神科高级执业注册护士常规护理（转介到精神卫生专科护理）提供PST的有效性、可接受性和实用性。42名女性将被匹配并随机分为三种研究条件。结果将使用定量和定性方法进行测量。在干预后6个月和12个月，使用贝克抑郁量表和PHQ-9来测量抑郁结果。父母压力指数将被用来衡量父母的功能。在常规护理条件下的妇女将被跟踪，以评估她们在转诊后获得抑郁症治疗的障碍。将对一组母亲进行访谈，以了解在家接受常规护士或精神科高级执业护士的PST的可接受性和实用性。将与护理员面谈，以评估他们在工作量上向母亲提供PST的可接受性和实用性。对母亲和护士的干预的可接受性和实用性的效应大小和信息将用于准备一个完整的R01。通过家访提供的PST有望为贫穷的城市少数民族母亲提供有效和可接受的抑郁症治疗。值得注意的是，我们的研究有可能为家访机构提供一种可行的方法，为面临抑郁症筛查政策要求的母亲提供有效和可接受的抑郁症治疗。7. 产后抑郁症是一个重大的公共卫生问题，不仅因为母亲丧失生产力和社会功能，而且因为对儿童的健康、精神健康和发育造成毁灭性的后果，它对家庭功能的影响，以及对社会的总体成本。即使是新妈妈的轻微抑郁也会对母子关系的建立产生影响，而对母亲进行有效的抑郁治疗可以显著改善母亲和孩子的结果。产后时期是解决女性抑郁症的机会之窗，因为她们更有可能接触到卫生保健系统。

DESCRIPTION (provided by applicant): Maternal depression in the postpartum period is a significant public health matter, particularly among poor urban minority women with limited access to mental health services. Through research we know how to treat depression. What we do not know is how to translate effective depression treatments into community non- specialty mental health settings beyond office-based primary care. Nurse home visitation programs provide an opportunity to efficiently increase access to depression treatment for low income disadvantaged mothers. This study explores the co-location of depression treatment (Problem Solving Therapy) within nurse home visitation and the organizational changes needed to maintain access to evidence-based treatment. Problem Solving Therapy (PST) is suited to use by non-specialists and for in-home use. The brevity of the intervention (4-8 sessions) and its non-pathologizing approach should be acceptable to low income minority women. Through multiple methodologies, this study will gather information from women and their providers to determine what system and treatment modifications are needed to effectively deliver acceptable depression treatment in home visitation programs as they strive to implement policy directives to identify and treat mothers with depression. An expert panel, which blends local and global knowledge will provide advice on decisions regarding the intervention adaptation. Once these adaptation decisions are made a small group of experts will adapt a PST manual for use in home visitation. We will then carry out a small three-arm randomized trial comparing the effectiveness, acceptability, and practicality of PST provided by home visitation RNs, by a psychiatric advance practice RN usual care (referral to mental health specialty care). Forty two women will be matched and randomized into the three study conditions. Outcomes will be measured using both quantitative and qualitative methods. Depression outcomes will be measured using the Beck depression Inventory and PHQ-9 at 6 and 12 months post intervention. The Parenting Stress Index will be used to measure parental functioning. Women in the usual care condition will be tracked to assess barriers to their accessing depression treatment once referred. A sub-set of mothers and will be interviewed regarding the acceptability and practicality of receiving PST at home either from their regular nurse or a psychiatric advanced practice nurse. Nurse home visitors will be interviewed to assess the acceptability and practicality of their delivery of PST to mothers on their caseloads. Effect sizes and information on the acceptability and practicality of the intervention to both mothers and nurses will be used to prepare a full scale R01. PST delivered through home visitation holds promise for providing access to effective and acceptability depression treatment for poor urban minority mothers. Significantly, our study has the potential to provide home visitation agencies with a viable means of access to effective and acceptable depression treatment for mothers in the face of policy mandates for depression screening. 7. * Project Narrative Depression in the postpartum is a major public health problem, not only because of lost productivity and social functioning for the mother, but because of devastating health, mental health, and developmental consequences for the child, its effects on family functioning, and overall costs to society. Even mild depression in new mothers has been shown to impact on the establishment of mother-child bonding, while effective depression treatment for mothers can significantly improve outcomes for both mother and child. The postpartum period is a window of opportunity in which to address depression in women because they are more likely to come into contact with the health care system.