Treating Maternal Depression in an Urban Community-Based Pediatric Asthma Clinic: Targeting Maternal Mood, Child Asthma Outcomes, and Health Disparities

This proposal details a 5-year plan to provide Dr. Rachel Margolis with the knowledge and skills to become an independent clinical and translational researcher focused on improving pediatric asthma outcomes. Research Plan: Socioeconomic and racial/ethnic differences persist in pediatric asthma, particularly among low-resourced, Black children in urban settings. Evidence demonstrates that psychosocial risk factors contribute to these differences. Maternal depression is one prevalent and potentially modifiable risk factor. While there is evidence that treating maternal depression may improve child health outcomes, mothers who are low-resourced face difficulties accessing depression treatment. Integrated care (i.e., the delivery of mental health care in a physical health care setting) has been associated with reduced maternal depression and improved child health in pediatric primary care. However, the feasibility, acceptability, and efficacy of embedding maternal depression treatment into a community-based asthma clinic needs to be demonstrated. Enhanced Brief Interpersonal Psychotherapy (IPT-B) is a promising depression treatment for low-resourced mothers that has proven efficacious among similar women when delivered in an obstetrics clinic setting, but it has not been studied in a pediatric asthma clinic setting. While these populations share similarities, there are substantive differences between the two settings that must be considered. Therefore, to maximize the success of Enhanced IPT-B in an asthma clinic setting, it is necessary to identify and address potential mother and provider-level barriers to integrated depression care. Stakeholder engagement with mothers and asthma clinic staff can facilitate the process of understanding and mitigating these barriers. Thus, the overall goal of this proposal is to integrate and evaluate maternal depression treatment in a community-based asthma clinic providing care to predominately low-resourced, Black children with asthma. The Specific Aims are to: 1) Engage stakeholders in determining the most effective and acceptable model for integrating Enhanced IPT-B for mothers into the community-based pediatric asthma clinic; 2) Determine the feasibility, acceptability, and preliminary efficacy of Enhanced IPT-B on decreasing maternal depressive symptoms in a community-based pediatric asthma clinic through a pilot RCT; and 3) Determine the preliminary efficacy of the intervention (vs. supplemented usual care) on improving child asthma outcomes. Training Plan: Through coursework and mentored research experiences with her multidisciplinary team of mentors/advisors, Dr. Margolis will develop advanced qualitative and mixed methods skills, learn clinical trial design with a focus on behavioral interventions for low-resourced and racial/ethnic minority families, and gain advanced implementation science skills. Dr. Margolis will emerge from her K01 training and research experience as an independent behavioral scientist.