Web-Based Cognitive Behavioral Intervention for Women with Postpartum Depression

描述(由申请人提供)：背景：产后时期提供了独特的重要的公共卫生挑战和机会。这是许多女性感到压力很大的时候，在原本是积极的人生阶段，会出现意想不到的抑郁症状。产后抑郁症(PPD)困扰着许多女性。如果不加以治疗，它会对产妇的心理健康和婴儿的发育造成严重后果。该领域的大部分研究都集中在以临床为基础的PPD治疗方案上。但最近的证据表明，这种治疗方法的接受度很低，这与女性担心耻辱、针对她们需求的治疗计划有限、计划成本和/或应对新生儿使其无法抽出时间安排外出旅行这一事实有关。这项拟议的研究具有创新性：1)它测试了一种新的基于网络的方法，它整合了现有的数据和治疗方法；b)它有可能通过提供一种可行的(有效的、可用的)治疗方案来增加对PPD治疗的接受。建议的干预建立在成功使用认知行为干预(CBT)治疗多种类型抑郁症的既定记录的基础上，并扩展了基于网络的健康行为干预的快速增长的证据基础。最后，拟议的研究汇集了一个非常强大的国际团队(美国和澳大利亚)，他们为项目的成功做出了至关重要的贡献。目的：我们建议遵循适当的形成步骤来开发针对患有产后抑郁的妇女的互动式、基于网络的治疗计划，然后进行可行性测试，评估其相对于对照网站的有效性。方法：在拟议的研究中，100名患有产后抑郁的妇女(每种情况50名妇女)将被随机分配到两种基于网络的条件之一。尖端的增强型干预条件提供针对PPD的在线CBT干预，包括互动内容、个性化抑郁症治疗的引导性行为策略、使用过推荐策略的女性的在线视频、网络论坛(同行和“询问专家”)以及定期电话指导。基本控制条件将提供妇女可以通过典型的谷歌搜索获得的有关产后抑郁的信息(例如，关于产后抑郁的相对详细信息，包括关于其来源和治疗的基于研究的信息)。措施：我们建议衡量：a)在6周的后测和3个月的随访中，每个网络计划对PPD症状的改善效果；b)参与者使用该计划的程度；以及c)患有PPD的女性对该计划的接受程度。好处：这项拟议的研究解决了NIMH确定的一个关键主题：即基于互联网的心理教育干预对健康相关问题的影响。我们认为，这对NIMH关于妇女孕期和产后心理健康的倡议至关重要。我们提议的研究有可能开发一种可行的工具，可以接触到大量产后妇女，并有助于缓解她们当前和长期的痛苦。 公共卫生相关性：产后抑郁症(PPD)困扰着许多妇女，如果不加以治疗，将对产妇心理健康和婴儿发育造成严重后果。最近的证据表明，以临床为基础的PPD治疗的接受度极低，这与妇女担心耻辱、针对其需求的治疗计划有限、计划成本和/或应对新生儿使其无法抽出时间安排外出旅行这一事实有关。这项拟议的研究将为另一种方法-基于网络的认知行为PPD治疗-提供可行性测试，旨在减少在6周后测和3个月随访中测量的抑郁症状。

DESCRIPTION (provided by applicant): Background: The postpartum period offers uniquely important public health challenges and opportunities. It is a time that many women find stressful, and unexpected depressive symptoms occur in what would otherwise be a positive time of life. Postpartum depression (PPD) afflicts many women. If left untreated, it has serious consequences for maternal mental health and infant development. Most research in this area has focused on clinic-based PPD treatment programs. But recent evidence for significantly poor uptake of this treatment is related to women's concerns about stigma, limited availability of treatment programs targeted to their needs, program costs, and/or the fact that coping with a newborn makes it impossible to find the time to schedule trips outside of the home. The proposed research is innovative: 1) it tests a new Web-based approach that integrates existing data and treatments; and b) it has the potential to increase uptake of PPD treatment by offering a viable (effective, available) treatment option accessible to a large number of women. The proposed intervention builds on an established record of successfully using a cognitive behavioral intervention (CBT) to treat many types of depression and it extends the rapidly-growing evidence base for Web-based health behavior interventions. Finally, the proposed research brings together a very strong International team (US and Australia) that contributes critically important components to make the project a success. Objectives: We propose to follow appropriate formative steps to develop an interactive, Web-based treatment program targeted to women suffering with PPD and then to perform a feasibility test evaluating its efficacy relative to a control website. Methods: In the proposed study, 100 women with PPD will be randomized (50 women per condition) to one of two Web-based conditions. The cutting-edge Enhanced Intervention Condition offering an online CBT intervention targeted to PPD includes engaging content with interactivity, guided behavioral strategies for a personalized depression treatment, online videos of women who have used the recommended strategies, Web forums (peer and "Ask an Expert"), and periodic phone coaching. The Basic Control Condition will present information about PPD that women could obtain through a typical Google search (e.g., relatively detailed information about PPD including what research-based information says about its sources and treatment). Measures: We propose to measure: a) each Web programs' ameliorating effects on PPD symptoms at a 6-week posttest and a 3-month follow-up; b) how much participants use the program; and c) how well the program is received by women with PPD. Benefits: This proposed research addresses a key theme identified by the NIMH: namely, the impact of Internet-based psycho-educational interventions on health-related problems. And we believe it is vital to NIMH's initiatives on women's mental health in pregnancy and the postpartum. Our proposed research has the potential of developing a viable tool that can reach a large number of postpartum women and can help relieve their immediate and long-term suffering. PUBLIC HEALTH RELEVANCE: Postpartum depression (PPD) afflicts many women and, if left untreated, it has serious consequences for maternal mental health and infant development. Recent evidence shows that significantly poor uptake of clinic-based PPD treatment is related to women's concerns about stigma, limited availability of treatment programs targeted to their needs, program costs, and/or the fact that coping with a newborn makes it impossible to find the time to schedule trips outside of the home. The proposed research will provide a feasibility test of an alternative approach - a Web-based cognitive behavioral PPD treatment - designed to reduce depressive symptoms measured at a 6-week posttest and a 3-month follow-up.