Preventing Maternal Depression in Head Start

描述（由申请人提供）：母亲抑郁症对低收入和少数民族妇女的影响尤为严重，并对其子女产生深远的负面影响。众所周知，在这些妇女中，获得精神保健服务的机会很少。2009年，美国医学研究所（IOM）发表了一份具有里程碑意义的报告《父母、养育和儿童中的抑郁症》，呼吁发展创新的、以社区为基础的举措，通过识别、治疗和预防父母的抑郁症来减少护理障碍。根据IOM的报告，NIMH BRAINS项目的这项申请继续了一项研究的轨迹，致力于研究一种系统方法，以识别在Head Start（一个由联邦政府资助的针对低收入家庭儿童的早期学习项目）中有抑郁症状的母亲，并提供现场干预，以预防或减轻抑郁症状；改善功能;并且，在适当情况下，主动将母亲与更明确的心理健康服务联系起来。作为申请人k23奖（K23MH074079）的一部分，我们建议对基于Head start的干预模型进行为期5年的随机对照疗效试验。该模型代表了一个基于筛查、简短干预和转诊治疗的循证结构的综合识别和干预系统。在Head Start的综合病例管理服务中，230名抑郁症风险增加的母亲将被随机分配，接受常规护理或基于Head Start的问题解决干预，以及使用动机增强原则的更明确的服务的“激活”转诊。在为期12个月的跟踪期内，我们的目标是：1)提高母亲解决问题的能力；2)降低母亲出现中度至重度抑郁症状的发生率；3)随着时间的推移减轻抑郁症状；4)增加母亲在转诊时接受初级保健或专业精神卫生服务的可能性；5)改善父母的功能，通过有效可靠的量表和评估孩子错过的“学前教育计划”上学时间来衡量。我们假设，通过我们的干预，有抑郁风险的母亲会发展出更强的解决问题的能力；而这样的技能将作为再次萧条的缓冲。因此，在研究的随访期间，受试者将经历中度至重度症状发作的发生率下降，并且随着时间的推移，症状也会减少。当转诊是必要的，干预部门的受试者将更倾向于参与精神卫生服务。我们假设，干预的母亲也会体验到功能的改善，并更多地参与孩子的“学前教育”活动，从而减少“学前教育”的缺勤天数。申请人的K23奖的结果直接导致了本文所述的研究。该疗效试验的结果将为更大规模的多地点疗效试验奠定基础。我们的最终目标是通过启智计划在全国范围内推广这一模式。

DESCRIPTION (provided by applicant): Maternal depression disproportionately affects low-income and minority women and has profound negative impacts on their children. Among these women, access to mental health services is known to be poor. In 2009, the Institute of Medicine (IOM) published a landmark report, Depression in Parents, Parenting, and Children, in which it called for the development of innovative, community-based initiatives to reduce barriers to care through identification, treatment, and prevention of depression in parents. Pursuant to the IOM's report, this application to the NIMH BRAINS program continues a trajectory of research devoted to studying a systems approach to identifying mothers with depressive symptoms in Head Start - a federally funded early learning program for children of low-income families - and providing an on-site intervention to prevent or alleviate depressive symptoms; improve functioning; and, where appropriate, proactively link mothers to more definitive mental health services. We propose a 5-year, randomized controlled efficacy trial of a Head Start-based intervention model developed as part of the applicant's K23-award (K23MH074079). The model represents an integrated identification and intervention system, based on the evidence-based construct of screening, brief intervention, and referral to treatment. Within the comprehensive case management services of Head Start, 230 mothers at increased risk for depressive disorder will be randomized to receive either usual care or a Head Start-based problem-solving intervention, plus 'activated' referral to more definitive services using principles of motivational enhancement. Measured over a 12-month follow up period, we aim to: 1) improve mothers' problem solving skills; 2) decrease the incident rate of episodes in which mothers experience moderate to severe depressive symptoms; 3) reduce depressive symptoms over time; 4) increase mothers' likelihood of engaging with primary care or specialty mental health services when referred; and 5) improve parental functioning, as measured both by valid and reliable scales and by assessing children's missed Head Start school days. We hypothesize that through our intervention, mothers at risk for depression will develop stronger problem solving skills; and that such skills will serve as a buffer again depression. Subjects, therefore, will experience a decreased incidence of moderate to severe symptomatic episodes over the study's follow-up period, as well as a reduction in symptoms over time. When referral is necessary, subjects in the intervention arm will be more apt to engage with mental health services. We hypothesize that intervention mothers will also experience an improvement in functioning, and become more involved in their children's Head Start activities, leading to fewer missed days of Head Start. Results of the applicant's K23 award led directly to the research described herein. The results of this efficacy trial, in turn, will set the stage for a larger multisite effectiveness trial. Our ultimate goal is dissemination of the model at the national level through Head Start. PUBLIC HEALTH RELEVANCE: Maternal depression disproportionately affects low-income and minority women, and has profound negative impacts on their children. This application to the NIMH BRAINS program proposes a randomized trial of a systems approach to identify mothers at risk for depression in Head Start - a federally funded early learning program for children of low-income families - and to provide an on-site intervention to prevent or alleviate depressive symptoms; improve functioning; and, where appropriate, proactively link mothers to more definitive mental health services. Through an innovative, accessible, and scalable community-based intervention model, we aim to improve mental health outcomes for both at risk mothers and their children.