Johnson Shannon K, von Sternberg Kirk, Velasquez Mary M
The University of Texas at Austin School of Social Work, Health Behavior Research and Training Institute, Austin, Texas; The Catholic University of America, National Catholic School of Social Service, Washington, DC.
The University of Texas at Austin School of Social Work, Health Behavior Research and Training Institute, Austin, Texas.
Womens Health Issues. 2017 Jan-Feb;27(1):100-107. doi: 10.1016/j.whi.2016.09.013. Epub 2016 Nov 29.
The efficacy of a series of interventions to reduce risk of alcohol-exposed pregnancies is well-established, yet some subsets of women remain at risk. For instance, in CHOICES, a randomized clinical trial of an intervention to prevent alcohol-exposed pregnancy, nondepressed women reduced risk drinking at roughly twice the rate of women with depression (49% vs. 24%). This secondary analysis of CHOICES data examines constructs that can explicate differences between nondepressed and depressed women in the process of changing alcohol behavior.
Profile analysis was used to compare the current status on transtheoretical model constructs of change between groups of depressed (n = 41) and nondepressed (n = 171) women in CHOICES at baseline and at the 9-month follow-up (end of the study). Participants were women aged 18 to 44 years who were at risk for an alcohol-exposed pregnancy at baseline. Measures included the Timeline Followback, Brief Symptom Inventory, and the transtheoretical model measures of decisional balance, self-efficacy, and experiential and behavioral processes of change.
Differences in profiles of the transtheoretical model constructs between groups were found at baseline and 9 months (p < .001). Women with depression had a profile that has historically predicted failure to change. Profiles among depressed women were distinguished by high scores on cons for changing alcohol use and temptation to drink.
Prevention interventions should assess for depression and target interventions to improve success. Results of this study can help practitioners to better tailor interventions to the needs of individuals with depression by strategically targeting decisional balance and self-efficacy.
一系列旨在降低酒精暴露妊娠风险的干预措施的有效性已得到充分证实，但仍有部分女性群体面临风险。例如，在“选择”（CHOICES）这一预防酒精暴露妊娠干预措施的随机临床试验中，未患抑郁症的女性减少危险饮酒行为的速度约为患抑郁症女性的两倍（49% 对 24%）。对“选择”项目数据的这一二次分析考察了一些因素，这些因素可以解释未患抑郁症和患抑郁症的女性在改变饮酒行为过程中的差异。
采用轮廓分析来比较“选择”项目中患抑郁症（n = 41）和未患抑郁症（n = 171）的女性群体在基线时以及9个月随访期（研究结束时）基于跨理论模型的改变因素的当前状况。参与者为年龄在18至44岁之间、基线时存在酒精暴露妊娠风险的女性。测量指标包括时间线追溯法、简明症状量表，以及跨理论模型中关于决策平衡、自我效能感和改变的体验及行为过程的测量指标。
在基线时和9个月时均发现两组之间跨理论模型因素的轮廓存在差异（p <.001）。患抑郁症的女性具有一种历来预示着改变失败的特征。患抑郁症女性的特征表现为在改变饮酒行为的不利因素和饮酒诱惑方面得分较高。
预防干预措施应评估抑郁症情况，并针对抑郁症进行干预以提高成功率。本研究结果有助于从业者通过有策略地针对决策平衡和自我效能感，更好地根据抑郁症患者的需求调整干预措施。
