Siegel Molly R, Simione Meg, James Kaitlyn E, Perkins Meghan E, Luo Man, Swift Hannah, Kim Joon, Jasset Olyvia J, Shook Lydia L, Taveras Elsie M, Edlow Andrea G
Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (Drs Siegel, James, Shook, and Edlow).
Division of General Academic Pediatrics, Department of Pediatrics, Mass General Hospital for Children, Boston, MA (Dr Simione, Mses Perkins and Luo, and Dr Taveras).
Am J Obstet Gynecol MFM. 2024 Feb;6(2):101264. doi: 10.1016/j.ajogmf.2023.101264. Epub 2023 Dec 21.
BACKGROUND: Targeted programs aimed at improving maternal mental health, particularly among those exposed to social determinants of health, are increasingly critical since the onset of the COVID-19 pandemic, yet the impact of such programs is poorly understood. OBJECTIVE: This study aimed to evaluate the impact of a novel, language-concordant community-based program on perinatal mental health. STUDY DESIGN: We conducted a prospective cohort study of peripartum individuals referred to a new community-based intervention known as Helping Us Grow Stronger (HUGS/Abrazos). Participants received up to 4 remote sessions with a cognitive behavioral therapy trained social worker, up to 3 resource navigation sessions with a community health worker, and direct relief with a grocery gift card and care package. Before and after the program, participants completed validated survey instruments to assess mental health and social determinants of health. RESULTS: A total of 178 participants were assessed after program completion, including 133 who were assessed before and after the program. The cohort was composed of 62.9% Hispanic or Latinx participants with a mean age of 29.8 year (standard error of mean, 0.46). There were high rates of food insecurity (111/178; 62.4%), experiences of discrimination (119/178; 66.9%), and SARS-CoV-2 infection (105/178; 59.0%). The program was associated with statistically significant improvements in the Edinburgh Postnatal Depression scores (baseline [mean±standard error of mean], 8.44±0.55 vs 6.77±0.51 after program completion; P=.0001) and Perceived Stress Scale scores (baseline, 15.2±0.74 vs 14.0±0.71; P=.035). Participants exposed to stressors including food insecurity and experiences of discrimination had higher baseline depression, stress, and anxiety scores. Those with experiences of discrimination, food insecurity, and SARS-CoV-2 infection during pregnancy were more likely to have improvements in mental health scores postintervention. CONCLUSION: In this diverse urban cohort, a novel community-based intervention was associated with improvements in depressive symptoms, perceived stress, and anxiety, particularly among those with social determinants of health.
背景：自新冠疫情爆发以来，旨在改善孕产妇心理健康的针对性项目变得愈发关键，尤其是对于那些受到健康的社会决定因素影响的人群，但此类项目的影响尚不清楚。 目的：本研究旨在评估一项新颖的、语言匹配的社区项目对围产期心理健康的影响。 研究设计：我们对被转介至一个名为“帮助我们更强大（拥抱）”（HUGS/Abrazos）的新型社区干预项目的围产期个体进行了前瞻性队列研究。参与者接受了最多4次由接受过认知行为疗法培训的社会工作者进行的远程辅导、最多3次由社区卫生工作者进行的资源导航辅导，以及一张食品杂货礼品卡和一个护理包的直接救助。在项目前后，参与者完成了经过验证的调查问卷，以评估心理健康和健康的社会决定因素情况。 结果：项目结束后，共评估了178名参与者，其中133名在项目前后均接受了评估。该队列由62.9%的西班牙裔或拉丁裔参与者组成，平均年龄为29.8岁（平均标准误差为0.46）。粮食不安全率（111/178；62.4%）、歧视经历（119/178；66.9%）和新冠病毒感染率（105/178；59.0%）都很高。该项目与爱丁堡产后抑郁量表得分（基线[平均±平均标准误差]，8.44±0.55 vs项目结束后6.77±0.51；P = 0.0001）和感知压力量表得分（基线，15.2±0.74 vs 14.0±0.71；P = 0.035）在统计学上的显著改善相关。暴露于包括粮食不安全和歧视经历等压力源的参与者基线抑郁、压力和焦虑得分更高。孕期有歧视经历、粮食不安全和新冠病毒感染的参与者在干预后心理健康得分更有可能得到改善。 结论：在这个多元化的城市队列中，一项新颖的社区干预项目与抑郁症状、感知压力和焦虑的改善相关，尤其是在那些受到健康的社会决定因素影响的人群中。
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