Problem Solving Education Among Parents of Premature Infants

描述(由申请人提供)：早产儿出生时健康和发育结果不佳的生物风险；低收入家庭的早产儿面临额外的社会风险，已知会加剧这些结果。无论是贫穷的母亲还是早产儿的母亲，抑郁症的发生率都很高，通常与一般功能不佳有关。早产儿的家庭也很难代表他们的孩子驾驭复杂的医疗系统，导致对循证新生儿重症监护病房(NICU)护理的坚持不够理想。2006年，医学研究所通过发布其报告《早产》认识到了这一公共卫生问题，强调需要提高NICU对早产儿的后续护理质量。这一建议的基础是，早产儿家庭中未得到解决的产妇抑郁对儿童的发展结果产生不利影响；它还导致对后续服务的坚持不够理想，这反过来又加剧了婴儿现有的不良结局风险。以理论为基础的赋权战略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改善对治疗的依从性的有效性；因此，它们代表了一系列潜在可行的干预措施，以改善NICU弱势群体的结果。我们提出了这样一种策略的随机可行性研究，即问题解决教育(PSE)，涉及50名低收入母亲，她们在一家城市医院的NICU中早产(=33周胎龄)，有抑郁症的风险。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后续数据的收集。2.获得研究参数的经验估计，这些参数将为干预模型的适当动力随机对照试验的规划提供信息。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.在基线和随访时测量的结果随时间的相关性；c.对照顾者抑郁症状和功能的干预效果大小；以及遵守卫生监督和免疫时间表、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.