Abstract：
BACKGROUND: The Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms are designed to help obstetric practices address perinatal depression. The PRogram in Support of Moms includes the statewide Massachusetts Child Psychiatry Access Program for Moms program, plus proactive implementation support.
OBJECTIVE: The goal of this study was to understand the impact of these programs on perinatal generalized anxiety disorder and posttraumatic stress disorder symptoms among individuals screening positive for depression.
METHODS: We conducted a secondary analysis of 2017-2022 data from a cluster randomized controlled trial of Massachusetts Child Psychiatry Access Program for Moms vs PRogram In Support of Moms. We included participants completing a generalized anxiety disorder or posttraumatic stress disorder screen at baseline (n=254) with antenatal Edinburgh Postnatal Depression Scale scores ≥10. We assessed changes in generalized anxiety disorder and posttraumatic stress disorder symptoms from pregnancy (4-25 weeks of gestational age or 32-40 weeks of gestational age), 4-12 weeks postpartum, and 11-13 months postpartum. We conducted a difference-in-difference analysis to compare symptom change from pregnancy to postpartum. We used adjusted linear mixed models with repeated measures to examine the impact of the Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms on changes in the Generalized Anxiety Disorder 7 and the Posttraumatic Stress Disorder Checklist.
RESULTS: Mean Generalized Anxiety Disorder 7 scores decreased by 3.6 (Massachusetts Child Psychiatry Access Program for Moms) and 6.3 (PRogram In Support of Moms) points from pregnancy to 4-12 weeks postpartum. Mean Posttraumatic Stress Disorder Checklist scores decreased by 6.2 and 10.0 points, respectively, at 4-12 weeks postpartum among individuals scree ning positive on the Generalized Anxiety Disorder 7 (n=83) or Posttraumatic Stress Disorder Checklist (n=58) in pregnancy. Generalized Anxiety Disorder 7 and Posttraumatic Stress Disorder Checklist scores decreased among both groups at 11-13 months postpartum. These changes were clinically meaningful. PRogram In Support of Moms conferred a statistically significant greater decrease (2.7 points) on the Generalized Anxiety Disorder 7 than the Massachusetts Child Psychiatry Access Program for Moms at 4-12 weeks postpartum. No differences were found between the Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms in Posttraumatic Stress Disorder Checklist or Generalized Anxiety Disorder 7 change at 11-13 months, although both were associated with a reduction in generalized anxiety disorder and posttraumatic stress disorder symptoms at 4-12 weeks and 11-13 months postpartum.
CONCLUSIONS: Both the Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms could help to improve symptoms for individuals experiencing co-occurring symptoms of depression, generalized anxiety disorder, or posttraumatic stress disorder. PRogram In Support of Moms may confer additional benefits in the early postpartum period, although this difference was not clinically significant.
OBJECTIVE: The goal of this study was to understand the impact of these programs on perinatal generalized anxiety disorder and posttraumatic stress disorder symptoms among individuals screening positive for depression.
METHODS: We conducted a secondary analysis of 2017-2022 data from a cluster randomized controlled trial of Massachusetts Child Psychiatry Access Program for Moms vs PRogram In Support of Moms. We included participants completing a generalized anxiety disorder or posttraumatic stress disorder screen at baseline (n=254) with antenatal Edinburgh Postnatal Depression Scale scores ≥10. We assessed changes in generalized anxiety disorder and posttraumatic stress disorder symptoms from pregnancy (4-25 weeks of gestational age or 32-40 weeks of gestational age), 4-12 weeks postpartum, and 11-13 months postpartum. We conducted a difference-in-difference analysis to compare symptom change from pregnancy to postpartum. We used adjusted linear mixed models with repeated measures to examine the impact of the Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms on changes in the Generalized Anxiety Disorder 7 and the Posttraumatic Stress Disorder Checklist.
RESULTS: Mean Generalized Anxiety Disorder 7 scores decreased by 3.6 (Massachusetts Child Psychiatry Access Program for Moms) and 6.3 (PRogram In Support of Moms) points from pregnancy to 4-12 weeks postpartum. Mean Posttraumatic Stress Disorder Checklist scores decreased by 6.2 and 10.0 points, respectively, at 4-12 weeks postpartum among individuals scree ning positive on the Generalized Anxiety Disorder 7 (n=83) or Posttraumatic Stress Disorder Checklist (n=58) in pregnancy. Generalized Anxiety Disorder 7 and Posttraumatic Stress Disorder Checklist scores decreased among both groups at 11-13 months postpartum. These changes were clinically meaningful. PRogram In Support of Moms conferred a statistically significant greater decrease (2.7 points) on the Generalized Anxiety Disorder 7 than the Massachusetts Child Psychiatry Access Program for Moms at 4-12 weeks postpartum. No differences were found between the Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms in Posttraumatic Stress Disorder Checklist or Generalized Anxiety Disorder 7 change at 11-13 months, although both were associated with a reduction in generalized anxiety disorder and posttraumatic stress disorder symptoms at 4-12 weeks and 11-13 months postpartum.
CONCLUSIONS: Both the Massachusetts Child Psychiatry Access Program for Moms and PRogram In Support of Moms could help to improve symptoms for individuals experiencing co-occurring symptoms of depression, generalized anxiety disorder, or posttraumatic stress disorder. PRogram In Support of Moms may confer additional benefits in the early postpartum period, although this difference was not clinically significant.
摘要：
背景：马萨诸塞州儿童精神病学访问计划（MCPAPforMoms）和支持妈妈的PRogram（PRISM）旨在帮助产科实践解决围产期抑郁症。PRISM包括全州MCPAPforMoms计划以及主动实施支持。
目的：本研究的目的是了解这些方案对抑郁症筛查阳性个体围产期广泛性焦虑症（GAD）和创伤后应激障碍（PTSD）症状的影响。
方法：我们对Moms与MCPAP的整群随机对照试验的2017-2022年数据进行了二次分析PRISM.我们纳入了基线时完成GAD或PTSD筛查的参与者（n=254），其产前爱丁堡产后抑郁量表（EPDS）评分≥10。我们评估了妊娠时GAD和PTSD症状的变化（4至<25周孕龄（GA）或32-40周孕龄），产后4-12周和产后11-13个月。我们进行了差异分析，以比较从怀孕到产后的症状变化。我们使用调整后的线性混合模型，并进行重复测量，以检查MCPAP对Moms和PRISM对广泛性焦虑症7（GAD-7）和PTSD清单（PCL-C）变化的影响。
结果：从怀孕到产后4-12周，平均GAD-7评分分别降低了3.6分（MCPAP）和6.3分（PRISM）。平均PCL-C评分下降6.2分和10.0分，分别,在产后4-12周，在妊娠期GAD-7（n=83）或PCL-C（n=58）筛查阳性的个体中。两组在产后11-13个月时GAD-7和PCL-C评分均下降。这些变化具有临床意义。在产后4-12周，PRISM在GAD-7上比MCPAP的下降幅度更大（2.7分）。在11-13个月的PCL-C或GAD-7变化中，Moms的MCPAP和PRISM之间没有发现差异，尽管两者都与产后4-12周和11-13个月时GAD和PTSD症状的减轻有关。
结论：MCPAP对Moms和PRISM都可以帮助改善患有抑郁症的个体的症状，GAD,或PTSD。PRISM可能会在产后早期带来额外的好处，尽管这种差异在临床上并不显著。
目的：本研究的目的是了解这些方案对抑郁症筛查阳性个体围产期广泛性焦虑症（GAD）和创伤后应激障碍（PTSD）症状的影响。
方法：我们对Moms与MCPAP的整群随机对照试验的2017-2022年数据进行了二次分析PRISM.我们纳入了基线时完成GAD或PTSD筛查的参与者（n=254），其产前爱丁堡产后抑郁量表（EPDS）评分≥10。我们评估了妊娠时GAD和PTSD症状的变化（4至<25周孕龄（GA）或32-40周孕龄），产后4-12周和产后11-13个月。我们进行了差异分析，以比较从怀孕到产后的症状变化。我们使用调整后的线性混合模型，并进行重复测量，以检查MCPAP对Moms和PRISM对广泛性焦虑症7（GAD-7）和PTSD清单（PCL-C）变化的影响。
结果：从怀孕到产后4-12周，平均GAD-7评分分别降低了3.6分（MCPAP）和6.3分（PRISM）。平均PCL-C评分下降6.2分和10.0分，分别,在产后4-12周，在妊娠期GAD-7（n=83）或PCL-C（n=58）筛查阳性的个体中。两组在产后11-13个月时GAD-7和PCL-C评分均下降。这些变化具有临床意义。在产后4-12周，PRISM在GAD-7上比MCPAP的下降幅度更大（2.7分）。在11-13个月的PCL-C或GAD-7变化中，Moms的MCPAP和PRISM之间没有发现差异，尽管两者都与产后4-12周和11-13个月时GAD和PTSD症状的减轻有关。
结论：MCPAP对Moms和PRISM都可以帮助改善患有抑郁症的个体的症状，GAD,或PTSD。PRISM可能会在产后早期带来额外的好处，尽管这种差异在临床上并不显著。
