Problem Solving Education Among Parents of Premature Infants

描述（由申请人提供）：早产儿出生时存在健康和发育不良的生物学风险；低收入家庭的早产儿面临已知会加剧这些后果的额外社会风险。贫困母亲和早产儿母亲患抑郁症的比例都很高，通常与一般功能低下有关。早产儿家庭也难以代表他们的孩子在复杂的医疗保健系统中导航，导致对循证新生儿后重症监护病房（NICU）护理的依从性不佳。2006年，医学研究所通过发表题为《早产》的报告认识到这一公共卫生问题，强调需要提高新生儿重症监护室对早产儿的后续护理质量。这一建议的基础是，早产儿家庭中未解决的母亲抑郁会对儿童的发育结果产生不利影响；它还导致对后续服务的依从性不够理想，这反过来又加剧了婴儿现有的不良结果风险。以理论为基础的赋权策略已经在各种环境中证明了改善抑郁症成年人的情绪和功能以及提高治疗依从性的有效性；因此，它们代表了一系列潜在可行的干预措施，以改善这一弱势新生儿重症监护室人群的预后。我们提出了一项随机可行性研究，解决问题的教育（PSE）策略，涉及50名低收入母亲，有抑郁风险，早产儿（= 33周胎龄），在一个城市医院的新生儿重症监护室。具体来说，我们的目标是：1。实地测试研究的关键后勤方面，包括受试者的招募和保留、干预措施的提供、治疗的保真度以及基线和随访数据的收集。2. 获得研究参数的经验估计，这将为干预模型的适当动力随机对照试验的计划提供信息。这些包括：a.连续结果测量的组内标准差和对照组受试者经历离散结果事件的比例；b.基线和随访结果随时间的相关性；c.干预对照顾者抑郁症状和功能的效应量；遵守健康监督和免疫计划，视力筛查和早期干预评估。

DESCRIPTION (provided by applicant): Premature infants are born at biological risk for poor health and developmental outcomes; premature infants of low-income families face additional social risks known to exacerbate these outcomes. Both impoverished mothers and mothers of premature infants have high rates of depression, often associated with poor general functioning. Families of premature infants also have difficulty navigating a complex healthcare system on their children's behalf, leading to suboptimal adherence to evidence-based, post-neonatal intensive care unit (NICU) care. In 2006, the Institute of Medicine recognized this public health problem by publishing its report, Preterm Birth, emphasizing the need to improve the quality of follow up NICU care for preterm infants. The underpinning of this proposal is that unaddressed maternal depression among families of premature infants adversely impacts children's developmental outcomes; it also contributes to suboptimal adherence to follow up services, which in turn exacerbates infants' existing risk for poor outcomes. Theory-based empowerment strategies have demonstrated effectiveness in a variety of settings for improving the mood and functioning of depressed adults, and for improving adherence to treatment; they therefore represent a family of potentially feasible interventions to improve the outcomes of this vulnerable NICU population. We propose a randomized feasibility study of one such strategy, Problem Solving Education (PSE), involving 50 low-income mothers at risk for depression, who have premature infants (= 33 weeks gestational age), in an urban hospital NICU. Specifically, we aim to: 1. Field-test key logistical aspects of the study, including recruitment and retention of subjects, intervention delivery, treatment fidelity, and the collection of baseline and follow-up data. 2. Obtain empirical estimates of study parameters that will inform the planning of an appropriately powered randomized controlled trial of the intervention model. These include: a. Within-group standard deviation of continuous outcome measures and proportion of control group subjects to experience discrete outcome events; b. Correlation over time of outcomes measured at both baseline and follow-up; and c. Effect size of the intervention on caregiver depressive symptoms and functioning; and adherence to health supervision and immunization schedules, vision screening, and early intervention evaluation.