Efficacy of an Exercise Intervention for the Prevention of PostPartum Depression

申请者描述(申请人提供)：本申请是对PA-06-377“妇女在孕期和产后期间的心理健康”的回应。最近的估计表明，大约10%-15%的分娩妇女在产后期间经历过抑郁症(Dietz等人，2007年；Gaven等人，2005年)。研究表明，心理干预对治疗产后抑郁症是有效的(Dennis&Hodnett，2007)。然而，鉴于许多妇女不寻求治疗(Dennis&Chung-Lee，2006年)，而且那些寻求治疗的妇女可能已经经历了与抑郁有关的负面后果，包括停止母乳喂养和母子纽带不良(Dennis&McQueen，2007年；Murray等人，1999年)，因此也必须注重预防产后抑郁症。不幸的是，研究表明，在有产后抑郁症风险的妇女中，心理干预在预防产后抑郁症方面并不有效(有关综述，请参阅Dennis&Creedy，2004)。因此，有必要测试新的和创新的干预措施来预防产后抑郁症。运动干预已被证明对成人抑郁症的治疗有效，因此，这种干预措施在预防产后抑郁症方面可能是有效的。这项初步研究的目的是考察招募和留住产后抑郁高危人群进行随机试验的可行性，以检验运动干预对产后抑郁的预防作用。我们还将研究运动干预在预防产后抑郁症方面的初步效果。具体地说，120名久坐的健康孕妇将从各种妇产科诊所、精神科诊所和广告中招募，她们至少有一次抑郁发作的病史和/或有抑郁的母亲家族史。一旦潜在参与者获得医疗保健提供者的同意进行锻炼(约阴道分娩后两周和剖腹产后四周)，参与者将被随机分配到运动干预或健康与健康接触控制条件下。锻炼条件将包括以电话为基础的咨询会议，旨在激励产后妇女进行体育活动。这种基于理论的干预将基于先前研究中证明有效的干预措施。接触控制条件将包括与健康教育工作者就与健康和健康相关的问题(例如，减压、睡眠、营养)进行预定的电话会议。这项研究的具体目的将是：1)确定招募和留住孕妇和产后妇女进行运动干预试验的可行性；2)确定基于家庭的行为运动干预对产后妇女抑郁的影响(通过DSM-IV轴I障碍结构化临床访谈；SCID-I和PHQ-9来衡量)。将使用7天体力活动回忆访谈(Blair等人，1985年；Sallis等人，1985年)和加速计(即对体力活动的客观评估)来评估坚持体力活动的情况。与公共卫生相关：最近的估计表明，大约10%-15%的分娩妇女在产后期间经历了抑郁症。本研究旨在探讨运动干预预防产后抑郁症的可行性和有效性。如果有效，我们的干预可以在“现实世界环境”中传播，以努力预防产后抑郁症。

DESCRIPTION (provided by applicant): This application is in response to PA-06-377 "Women's Mental Health in Pregnancy and the Postpartum Period." Recent estimates indicate that approximately 10-15 percent of women giving birth experience depression during the postpartum period (Dietz et al., 2007; Gaven et al., 2005). Research indicates that psychological interventions are efficacious for treating postpartum depression (Dennis & Hodnett, 2007). However, it is important to also focus on the prevention of postpartum depression given many women do not seek treatment (Dennis & Chung- Lee, 2006) and those who do seek treatment may have already experienced negative consequences related to depression including cessation of breastfeeding and poor maternal-child bonding (Dennis & McQueen, 2007; Murray et al., 1999). Unfortunately, research indicates that psychological interventions are not efficacious in the prevention of postpartum depression among women at risk for postpartum depression (for a review see Dennis & Creedy, 2004). Consequently, there is a need to test new and innovative interventions for the prevention of postpartum depression. Exercise interventions have been shown to be effective for the treatment of depression among adults and therefore, this intervention may be efficacious in the prevention of postpartum depression. The purpose of the present pilot study is to examine the feasibility of recruiting and retaining participants at risk for postpartum depression for a randomized trial examining an exercise intervention for the prevention of postpartum depression. We will also examine the preliminary efficacy of the exercise intervention on the prevention of postpartum depression. Specifically, 120 sedentary, healthy pregnant women who have a history of at least one depressive episode and/or have a maternal family history of depression will be recruited from various ObGyn clinics, psychiatry clinics, and via advertisements. Once the potential participants receive healthcare provider consent to exercise (approx. two weeks following a vaginal delivery and four weeks following a c-section), participants will be randomly assigned to either an exercise intervention or a health and wellness contact control condition. The exercise condition will consist of telephone-based counseling sessions designed to motivate postpartum women to become physically active. This theory-based intervention will be based on interventions shown to be effective in previous studies. The contact control condition will consist of scheduled telephone sessions with a health educator on issues related to health and wellness (e.g., stress reduction, sleep, nutrition). The specific aims of the study will be 1) to determine the feasibility of recruiting and retaining pregnant and postpartum women for an exercise inter-vention trial and 2) to determine the effect of a home-based behavioral exercise intervention on depression (as measured by the Structured Clinical Interview for DSM-IV Axis I Disorders; SCID-I and the PHQ-9) among postpartum women. Physical activity adherence will be assessed using the 7-Day Physical Activity Recall Interview (Blair et al., 1985; Sallis et al., 1985) and accelerometers (i.e., an objective assessment of physical activity). PUBLIC HEALTH RELEVANCE: Recent estimates indicate that approximately 10-15 percent of women giving birth experience depression during the postpartum period. The purpose of this study is to examine the feasibility and efficacy of an exercise intervention for the prevention of postpartum depression. If efficacious, our intervention could be disseminated in "real world settings" in an effort to prevent postpartum depression.