Development of a Home-Based Family Treatment for Postpartum Depression

描述（由申请人提供）：虽然10-15%的女性在生完孩子后会经历产后抑郁症（PPD），但大多数人没有接受任何形式的心理健康治疗。正如NIMH PA-06-376“怀孕和产后妇女的心理健康”中所强调的那样，考虑到产后抑郁症对母亲和发育中的婴儿的严重影响，为产后抑郁症妇女提供更广泛的治疗选择是至关重要的。很少有经验支持的治疗方法适用于产后抑郁症妇女，而社区中最广泛使用的抑郁症治疗方法涉及精神药理学，这种方法被许多产后妇女，特别是那些母乳喂养的妇女视为不可接受的。以家庭为基础的干预措施特别适合治疗产后抑郁症，因为产后抑郁症发生在重要的家庭过渡时期；此外，研究表明，不良的家庭功能和低水平的伴侣支持可以预测这种疾病的发病和病程。鉴于PPD的严重影响，现有治疗方法的缺乏，以及家庭在该疾病中的关键作用，我们建议开发和评估一种新的基于家庭的治疗方法，家庭治疗产后抑郁症（FTP），它将针对与PPD相关的家庭功能障碍的特定领域。PI已经完成了一个开放的临床版本FTP的初步试点试验，发现它对患者是可接受的，可行的管理，并且可能有效。在这个应用中，我们建议扩大干预，并在一个试点随机对照试验中进行评估，将其与支持性个体治疗条件进行比较。认识到可能导致产后妇女，特别是母乳喂养妇女使用率低的许多障碍，将有选择地在家中为认为更方便的患者提供治疗，而不是要求妇女前往诊所接受治疗。此外，还将采取战略，扩大治疗的普遍性，使其适用于更广泛的患者群体。在初步的治疗细化后，我们建议进行一项随机对照先导试验，以评估干预的可行性、可接受性和初步效果，并将家庭治疗与支持性心理治疗进行比较。此外，我们将制定和评估一个治疗师培训计划。这项小型随机对照试验的结果将为R01拨款申请提供基础，以支持一项全面的随机治疗结果研究。产后抑郁症（PPD）与母亲及其发育中的婴儿的许多不良后果有关；然而，大多数患有产后抑郁症的女性没有接受任何治疗。本研究将侧重于开发一种新颖的、以家庭为基础的PPD家庭治疗方法，并将在一项随机对照试验中评估这种干预措施。这种做法的目的是为产后妇女提供一种更容易接受和更容易获得的治疗，否则她们可能不会寻求传统的、以诊所为基础的精神保健。

DESCRIPTION (provided by applicant): Although 10-15% of women experience postpartum depression (PPD) after giving birth to a child, the majority do not receive any form of mental health treatment. As highlighted in NIMH PA-06-376 "Women's Mental Health in Pregnancy and the Postpartum Period," developing a wider range of treatment options for women with PPD is critically important given the serious repercussions associated with the disorder for both the mother and the developing infant. Very few empirically-supported treatments exist for women with PPD, and the depression treatments most widely available in the community involve psychopharmacology, an approach viewed to be unacceptable by many postpartum women, particularly those who are breastfeeding. Family-based interventions are particularly well-suited to treat PPD, in that postpartum depression occurs during a period of significant family transition; moreover, research has shown that poor family functioning and low levels of partner support predict the onset and course of the disorder. Given the serious repercussions of PPD, the lack of existing treatments, and the critical role of the family in the disorder, we propose to develop and evaluate a novel family-based treatment, Family Treatment for Postpartum Depression (FTP) which will target specific areas of family dysfunction associated with PPD. The PI has already completed an open pilot trial of an initial, clinic-based version of FTP, finding that it was acceptable to patients, feasible to administer, and possibly efficacious. In this application, we propose to expand the intervention and evaluate it in a pilot randomized controlled trial, comparing it to a supportive individual therapy condition. In recognition of the many barriers that can contribute to low utilization rates of postpartum women, particularly those who are breastfeeding, treatment will be optionally provided in the home, for patients who find this more convenient, rather than requiring women to travel to a clinic setting for care. In addition, strategies will be taken to broaden the generalizability of the treatment to a wider range of patient groups. Following an initial period of treatment refinement, we propose to conduct a pilot randomized controlled pilot trial to evaluate the feasibility, acceptability and preliminary efficacy of the intervention, comparing the family treatment to supportive psychotherapy. In addition, we will develop and evaluate a therapist-training program. Findings from the small RCT will be used to provide the basis for an R01 grant application to support a full-scale randomized treatment outcome study. Postpartum depression (PPD) is associated with numerous adverse consequences for mothers and their developing infants; however, the majority of women with PPD do not receive any treatment. This study will focus on developing a novel, home-based family treatment for PPD and will evaluate this intervention in a pilot randomized controlled trial. This approach is intended to provide a more acceptable and accessible type of treatment for postpartum women who may otherwise not seek traditional, clinic-based mental health care.