A Systematic Review and Meta-analysis on the Effectiveness of Home Visiting Programs on Postpartum Depression

项目摘要/摘要 产后抑郁(PPD)是一种发生在分娩后的非精神病性抑郁发作。产后抑郁原因 新母亲遭受巨大痛苦和残疾，对儿童保育和发展产生不利影响。女人 来自较低社会经济地位(SES)的背景特别容易患上产后抑郁。这个 PPD对低SES母亲的负面影响因获得心理健康的机会有限而进一步加剧 由于结构性障碍和对患有心理健康问题的母亲的污名而提供的服务。 具体地说，SES低的非洲裔美国人和拉丁裔母亲寻求心理健康的可能性显著降低 比他们的非西班牙裔白人同龄人更多的服务，使低SES的非洲裔美国人和拉丁裔家庭更多 容易受到产后抑郁对健康和发展的不利影响。 在低收入母亲中解决产后抑郁的一个有希望的方法是家访。通过提供健康 在住处直接照顾母亲，家访减少了许多结构和文化障碍 防止新妈妈参与预防和治疗产后抑郁的服务。先期系统化 对PPD通过家访提供服务的有效性的审查最终发现结果喜忧参半 结论是，没有足够的证据支持家访提供服务的方法 显著改善产妇的心理健康。然而，最近的两次系统评估只包括 专门由护士或助产士接生的家访模特。另外两篇评论分别是 十多年前进行的。从那时起，早期的新研究激增。 童年家访计划。此外，迄今发表的审查报告尚未确定核心 与产后抑郁干预的有效家访模式相关的组件。核心知识 成功的要素对于家访计划来说至关重要，以更有效和高效地解决PPD问题。 因此，仍然有必要整合最新的研究，以评估家庭的整体效果 访问PPD上的模型并确定预测家访有效性的核心组件 减少产后抑郁的计划。 为了确定通过家访解决产后抑郁的整体效果，研究小组将 系统地搜索、选择和审查现有的经验性研究，评估它们的严谨性和潜在的偏见， 并对效应大小进行了定量综合。确定预测有效家访的核心要素 项目、干预效果与学习水平特征之间的关系将用元-变量分析。 回归分析。研究水平的特征--潜在的核心组成部分--包括优先考虑 家访计划的PPD干预，家访的类型，家庭的持续时间和强度 访问计划、BIPOC参加家访计划的百分比以及基线水平和风险 治疗服务接受者中的抑郁症。

PROJECT SUMMARY/ABSTRACT Postpartum depression (PPD) is a non-psychotic depressive episode occurring after childbirth. PPD causes enormous suffering and disability in new mothers, negatively impacting child care and development. Women from lower socioeconomic status (SES) backgrounds are particularly vulnerable to developing PPD. The negative impact of PPD on low-SES mothers is further compounded by limited access to mental health services due to structural barriers and stigma toward mothers experiencing mental health conditions. Specifically, low SES African American and Latina mothers are significantly less likely to seek mental health services than their non-Hispanic white peers, making low-SES African American and Latina families more vulnerable to the adverse health and developmental impacts of PPD. One promising approach to addressing PPD among low-income mothers is home visiting. By delivering health care directly to mothers in their residence, home visiting reduces many of the structural and cultural barriers preventing new mothers from engaging with services for the prevention and treatment of PPD. Prior systematic reviews on the effectiveness of service delivery via home visiting for PPD found mixed results, ultimately concluding that there was insufficient evidence to support that the home visiting approach for service delivery significantly improves maternal mental health. However, the two most recent systematic reviews only included home visiting models that were delivered exclusively by nurses or midwives. The other two reviews were conducted more than ten years ago. Since then, there has been a proliferation of new research on early childhood home visiting programs. Moreover, the reviews published to date have not identified core components associated with effective home visiting models for PPD intervention. Knowledge of core components for success is critical for home visiting programs to address PPD more effectively and efficiently. Accordingly, there remains a need to integrate the latest research to evaluate the overall effectiveness of home visiting models on PPD and to identify core components predictive of the effectiveness of home visiting programs in reducing PPD. To determine the overall effectiveness of addressing PPD via home visiting, the research team will systematically search, select, and review existing empirical studies, evaluate them for rigor and potential bias, and quantitatively synthesize the effect sizes. To identify core components predictive of effective home visiting programs, associations between intervention effect and study-level characteristics will be analyzed with meta- regression analysis. Study-level characteristics—the potential core components— include the priority given to PPD intervention by a home visiting program, types of home visitors, the duration and intensity of a home visiting program, percentage of BIPOC participants in a home visiting program, and baseline level of and risk for depression among service recipients.