Depression Clinical Trial
— RISEOfficial title:
Resources, Inspiration, Support and Empowerment (R.I.S.E.) for Black Pregnant Women
Perinatal Mood and Anxiety Disorders (PMADs) encompass a range of mental health disorders that occur during pregnancy and up to one year postpartum. Approximately 13% of women experience PMADs. This rate doubles for those with adverse perinatal outcomes (APO) and triples in Black women. Recent research points to racism as one significant source of these health disparities. Cultural adaptations to improve communication with providers decrease rates of depression in minority patients as well as improve adherence to treatment, insight and alliance. Discrimination stress and worries about experiencing medical consequences are thought to increase systemic inflammation, a mechanism known to drive mental and physical symptoms. Inflammation has been implicated in both PMADs and APO, suggesting a shared underlying etiology. Evidence from our work suggests that inflammation contributes to the pathophysiology of PMADs. The proposed pilot randomized control trial will allow the investigators to build on promising preliminary results and identify whether our culturally relevant mobile Health (mHealth) intervention is effective in improving outcomes among Black pregnant women randomized to the intervention compared to a control group. The culturally relevant modules include building communication and self-advocacy skills and provide a support network. The primary objective of this research is to provide guidance for clinical care of Black women during the perinatal period, with the goal to improve mental health and physical health outcomes. A secondary goal is to examine novel inflammatory signatures that change as a function of the intervention to reduce PMADs in this population. As inflammation may be diagnostic of PMADs, identification of its role may shed light of potential intervention targets and provide critical knowledge to improve women's long-term health. PMAD symptoms will be assessed prospectively in 150 Black pregnant women, half of whom will be randomized to receive the culturally relevant mHealth intervention. The investigators hypothesize that women in the intervention group will have reduced rates of PMADs and APOs, an increase in adherence to mental health treatment and will report increased self-advocacy skills, increased communication with providers, and reduced levels of discrimination related stress. Participants will also have improved biological risk indicators including lower circulating C-reactive protein and a transcription profile of differentially expressed inflammatory genes, marked by a decreased activity of inflammatory transcription factors from blood spots. Given the high burden of both PMADs and APOs among Black mothers and the numerous consequences on maternal and child outcomes, it is imperative that investigators develop and implement effective interventions, and test the biological mechanisms that might drive these effects. This work is interdisciplinary, building on a network of community advocates to implement a novel mHealth intervention informed by real world experiences designed to enhance self-advocacy, reduce stress and prevent adverse outcomes
Status | Recruiting |
Enrollment | 150 |
Est. completion date | June 1, 2026 |
Est. primary completion date | June 1, 2025 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | Female |
Age group | 18 Years to 65 Years |
Eligibility | Inclusion Criteria: 1. Provision of signed and dated informed consent form 2. Stated willingness to comply with all study procedures and availability for the duration of the study 3. Pregnant Black individuals, at least 18 years of age 4. English speaking 5. Access to a tablet, smartphone, or computer capable of running the apps Exclusion Criteria: 1. Psychosis 2. Perinatal loss 3. Individuals outside of the US |
Country | Name | City | State |
---|---|---|---|
United States | Cedars Sinai | Los Angeles | California |
Lead Sponsor | Collaborator |
---|---|
Cedars-Sinai Medical Center | Candlelit Therapy, Maternal Mental Health NOW, National Institutes of Health (NIH), University of California, Los Angeles |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Inflammation | Lower circulating inflammation (hs-CRP), and a transcription profile of differentially expressed inflammatory genes, marked by a decreased activity of inflammatory transcription factors NF?B, CREB and JUN. | 6 months - 1 year | |
Primary | Depression symptoms | Reduced symptoms of depression assessed by the Edinburgh Postnatal Depression Scale (EPDS) | 6 months - 1 year | |
Primary | Anxiety symptoms | Reduced symptoms of anxiety assessed by the Overall Anxiety Severity and Impairment Scale (OASIS) | 6 months - 1 year | |
Primary | PTSD Symptoms | Reduced symptoms of post-traumatic stress symptoms assessed by the Impact of EVents Scale (IES) | 6 months - 1 year | |
Secondary | Communication | Increased communication with providers assessed by the Communication Assessment Tool (CAT) | 6 months - 1 year | |
Secondary | Self-Advocacy | Improved self-advocacy skills assessed by the Patient Self-Advocacy Scale (PSAS) | 6 months - 1 year | |
Secondary | Discrimination stress | Reduced levels of discrimination stress assessed by the Discrimination in Medical Settings (DMS) Scale. | 6 months - 1 year |
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