Evaluating maternal depression among adolescent and adult women in Kenya

摘要 该F31项目旨在促进对母亲抑郁的表现和轨迹的理解 在整个孕期和产后，青春期女性(15-19岁)与成年人之间的比较，以及 制定风险评分，以确定围产期结局不良的高危妊娠。约13%的 世界各地的围产期妇女报告了心理健康问题，主要是抑郁症。青春期是一个时期 大量的发育和荷尔蒙变化增加了生理和心理社会的变化 怀孕了。青春期、孕期和产后女性患抑郁症的几率高达30% 比他们的成年和未怀孕的同龄人更多。青少年中的围产期抑郁症并没有得到严格的治疗 以大规模的纵向研究为特点的。全世界几乎所有的青少年怀孕(95%)都发生在 低收入和中等收入国家(LMIC)，但关于#年青少年中的母亲抑郁的数据很少 这些设置。最近的一项系统回顾发现，LMIC中母亲抑郁的患病率更高(16% 与高收入国家环境(高收入国家)相比，高收入国家的人口比例(怀孕、产后占20%)更低。几项关于HICs的研究已经将 抑郁和青春期到早产和低出生体重，但在理解上仍然存在严重差距 在SSA中，母亲抑郁对围产儿结局的影响，其中婴儿发病率和 死亡率是全球最高的。拟议的F31研究项目利用正在进行的 青少年和成人的随机分组试验(PRIMA研究，R01AI125498，MPI：John-Stewart/Baeten) 怀孕的肯尼亚妇女(15岁的≥)，在产后9个月内接受跟踪。我们正在放映 &gt；4000名肯尼亚妇女(中位年龄：24岁，约25%的年龄&20岁)通过产前/产后护理进行纵向护理 (ANC/PNC)治疗抑郁症状。在目标1中，我们将使用初始ANC、6周PNC和9个月的数据 PNC将纵向比较青少年和成年女性中的母亲抑郁，确定 预测因素、症状以及流行率和严重程度的变化，以便为未来的干预提供信息。在《目标2》中我们将 开发和验证经验性风险评分以预测合并抑郁的不良围产期结局 在怀孕和其他母亲因素(如青春期)方面的得分。Aim 2的结果将有助于临床 预测工具，告知谁可能需要加强监测，以避免早产等不良围产期结果 出生和低出生体重。这项大规模的研究纵向比较了青少年和 从怀孕到产后9个月的成年人将贡献一种新的临床预测工具 抑郁评分预测围产儿结局。这项研究计划将为F31候选人提供严格的 博士前培训包括1)纵向数据的量化分析，2)经验发展和内部 验证风险得分，以及3)孕产妇抑郁方面的内容领域专业知识，这是缩小 孕产妇、青少年和儿童健康。

ABSTRACT This F31 project aims to advance understanding of the manifestation and trajectory of maternal depression among adolescent women (age 15-19) compared to adults throughout pregnancy and postpartum, and to develop a risk score to identify pregnancies at high risk for adverse perinatal outcomes. Approximately 13% of peripartum women worldwide report mental health issues, predominantly depression. Adolescence is a period of substantial developmental and hormonal changes which add to physiologic and psychosocial changes in pregnancy. Frequency of depression among adolescent pregnant and postpartum women is up to 30% higher than their adult and non-pregnant counterparts. Perinatal depression among adolescents has not been rigorously characterized in a large-scale, longitudinal study. Almost all adolescent pregnancies (95%) worldwide occur in low- and middle-income countries (LMICs), yet few data exist on maternal depression among adolescents in these settings. A recent systematic review found higher prevalence of maternal depression in LMICs (16% in pregnancy, 20% in postpartum) than in high-income country settings (HICs). Several studies in HICs have linked depression and adolescence to preterm birth and low birthweight, yet critical gaps remain in understanding implications of maternal depression on perinatal outcomes within SSA where the burden of infant morbidity and mortality is highest worldwide. The proposed F31 research project leverages data collected in an ongoing randomized cluster trial (PrIMA Study, R01AI125498, MPI: John-Stewart/Baeten) among adolescent and adult pregnant Kenyan women (≥15 years old) who are followed through 9-months postpartum. We are screening >4000 Kenyan women (median age: 24 years, ~25% age <20 years) longitudinally via antenatal/postnatal care (ANC/PNC) for depressive symptoms. In Aim 1, we will use data from initial ANC, 6 weeks PNC, and 9 months PNC to longitudinally compare maternal depression among adolescent versus adult women, identifying predictors, symptoms, and changes in prevalence and severity to inform future interventions. In Aim 2 we will develop and validate an empiric risk score to predict adverse perinatal outcomes that incorporates depressive score in pregnancy and other maternal factors (e.g., adolescent age). Results from Aim 2 will contribute a clinical prediction tool to inform who may need intensified monitoring to avert adverse perinatal outcomes like preterm birth and low birthweight. This large-scale study to longitudinally compare depression among adolescents and adults from pregnancy through 9 months postpartum will contribute a novel clinical prediction tool using depression score to predict perinatal outcomes. This research plan will provide the F31 candidate rigorous predoctoral training including 1) quantitative analysis of longitudinal data, 2) experience developing and internally validating a risk score, and 3) content-area expertise in maternal depression, an area critical to closing gaps in maternal, adolescent, and child health.