OBJECTIVES: To test effects of a social media-based parenting program for mothers with postpartum depressive symptoms.

METHODS: We conducted a randomized controlled trial from December 2019 to August 2021 of a parenting program using Facebook. Women with mild-to-moderate depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS] 10-19) were randomized to the program, plus online depression treatment or depression treatment alone for 3 months. Women completed the EPDS monthly and the Parent-Child Early Relational Assessment, Parenting Stress Index-Short Form, and Parenting Sense of Competence pre- and postintervention. Differences among groups were assessed using intention-to-treat analysis.

RESULTS: Seventy-five women enrolled and 66 (88%) completed the study. Participants were predominantly Black (69%), single (57%), with incomes <$55 000 (68%). The parenting group reported a more rapid decline in depressive symptoms than the comparison group (adjusted EPDS difference, -2.9; 95% confidence interval, -4.8 to -1.0 at 1 month). There were no significant group X time interactions for the Parent-Child Early Relational Assessment, Parenting Stress Index-Short Form, or Parenting Sense of Competence scores. Forty-one percent of women sought mental health treatment for worsening symptoms or suicidality. Women in the parenting group who exhibited greater engagement or reported mental health treatment had greater parenting responsiveness.

CONCLUSIONS: A social media-based parenting program led to more rapid declines in depressive symptoms but no differences in responsive parenting, parenting stress, or parenting competence relative to a comparison group. Social media can provide parenting support for women with postpartum depressive symptoms, but greater attention to engagement and treatment access are needed to improve parenting outcomes.

Background: Effective and equitable strategies to prevent youth suicidal thoughts and behaviors (STB) are an urgent public health priority. Adolescent sleep disturbances are robustly linked to STB but are rarely addressed in preventive interventions or among Black and/or Hispanic/Latinx youth for whom STB risk is increasing disproportionately. This paper describes an application of health equity-informed implementation science models and frameworks to adapt and evaluate the evidence-based Transdiagnostic Sleep and Circadian (TSC) intervention for primary care implementation with adolescents of minoritized backgrounds with depression and STB risk.

Methods: This multiphase study protocol uses the Assessment, Decision, Adaptation, Production, Topical Experts-Integration, Training, Testing (ADAPT-ITT) model to adapt and evaluate TSC for primary care implementation with adolescents who are depressed, at risk for STB, and of primarily Black and/or Hispanic/Latinx backgrounds. We integrate the Consolidated Framework for Implementation Research (CFIR) in an initial qualitative inquiry of adolescent, caregiver, and clinician perceptions of TSC. Subsequent ADAPT-ITT phases include systematically and iteratively testing adaptations based on the qualitative inquiry, with ongoing key informant input, and then evaluating the adapted TSC for feasibility, acceptability, and efficacy in a pilot randomized trial.

Anticipated results: Based on youth depression and sleep health disparities research, we expect that TSC adaptations will be needed to enhance intervention content for adolescents with depression, STB risk, and primarily Black and/or Hispanic/Latinx backgrounds. We also anticipate adaptations will be needed to align TSC delivery methods with primary care implementation.

Conclusions: Adapting evidence-based interventions with end-users and contexts in mind can help ensure that intervention strategies and delivery methods are acceptable to, and feasible with, health disparate populations. Although TSC has shown effectiveness for adolescents with sleep disturbances, we expect that additional multiphase research is necessary to optimize TSC for primary care delivery with Black and/or Hispanic/Latinx adolescents with depression and STB risk.

<p><strong>SETTING: </strong>Diagnosing pediatric tuberculosis (TB) is difficult; to improve diagnosis gastric aspiration (GA) was performed in 121 Botswana health facilities.</p>

<p><strong>OBJECTIVE: </strong>To describe treatment initiation and outcomes in children with a positive GA result and those treated empirically.</p>

<p><strong>METHODS: </strong>Children with smear or culture-positive GA or those clinically diagnosed were referred for anti-tuberculosis treatment. Treatment initiation and outcomes were assessed from February 2008 to December 2012 using name-based matching algorithms of the GA database; treatment initiation was captured in the electronic TB registry. Analyses included descriptive statistics and regression models.</p>

<p><strong>RESULTS: </strong>GA was conducted in 1268 children. Among these, 121 (9.5%) were GA-positive; and treatment was initiated in 90 (74.3%). An additional 137 (11.9%) were treated empirically. More than a third (36.4%) had known human immunodeficiency virus status (positive or negative); this was significantly associated with TB treatment initiation (adjusted odds ratio [aOR] 1.8, 95%CI 1.3-2.5); &lt; 0.05). Among the 90 children with a positive GA result, nearly all either completed treatment (78.9%) or were on treatment (20.0%) at the time of data collection.</p>

<p><strong>CONCLUSION: </strong>We could not find documentation of treatment for more than a quarter of the children with laboratory-confirmed TB, an important gap that calls for further examination. The failure to initiate prompt treatment requires investigation and urgent action.</p>

<p><strong>OBJECTIVE: </strong>This pilot study describes the adaptation of a parenting group intervention for social media, and examines the feasibility, acceptability and initial outcomes of the adapted intervention for mothers with postpartum depression symptoms.</p>

<p><strong>BACKGROUND: </strong>Postpartum depression can negatively affect parenting and the parent-infant relationship. Mothers with postpartum depression symptoms experience barriers to access in-person parenting interventions.</p>

<p><strong>METHODS: </strong>A small, randomised controlled trial was conducted with an adapted parenting intervention delivered via social media (Facebook) or in-person for mothers who screened positive for depression in paediatric clinics. Parenting sense of competence, depression symptoms and intervention attendance and satisfaction were assessed. Twenty-four mothers (mean age 26&nbsp;years; predominantly African American with limited economic resources) participated in the study.</p>

<p><strong>RESULTS: </strong>Linear regressions showed that the social media group had significantly improved parenting competence and decreased depression severity when compared to the in-person group. Attendance in the social media group was high (83%), but extremely poor in the in-person group (3%). The mothers rated the intervention positively and the majority of the mothers participated by posting comments on the group page on social media.</p>

<p><strong>CONCLUSION: </strong>The findings suggest the feasibility and benefit of delivering a parenting intervention through social media for postpartum mothers with high levels of depression symptoms.</p>

<p><strong>OBJECTIVES: </strong>The American Academy of Pediatrics recommends postpartum depression (PPD) screening. It is unknown if pediatricians are effective in linking mothers to mental health services. The objectives of the current study are to determine: 1) mental health care utilization among women with Medicaid insurance after a positive PPD screen and 2) maternal and infant factors that predict the likelihood of mental health care utilization.</p>

<p><strong>METHODS: </strong>Retrospective cohort design of mothers attending their infants' 2-month well child visit at one of five urban primary care practices between 2011-2014. A linked dataset of the child's electronic health records, maternal Medicaid claims, and birth certificates was used. The primary outcome was mental health care utilization within six months of a positive PPD screen. Multivariate logistic regression was used to estimate maternal and infant clinical and sociodemographic factors that predict service use.</p>

<p><strong>RESULTS: </strong>3,052 mothers met study criteria, 1,986 (65.1%) completed the PPD screen, and 263 (13.2%) screened positive for PPD of whom 195 (74.1%%) were referred for services. Twenty-three women (11.8%) had at least one Medicaid claim for depression within six months of screening. In multivariate modeling, mothers with a history of depression in the prior year (OR=3.80, 1.20-12.11) were more likely to receive mental health services after a positive screen.</p>

<p><strong>CONCLUSIONS: </strong>Few mothers who screened positive for PPD received mental health services. Mothers without a recent history of depression treatment may be especially at risk for inadequate care. Additional mechanisms to improve access to mental health services following PPD screening are needed.</p>

<p>Caregiver depression impacts parenting behaviors and has deleterious effects on child behavior. Evidence-based interventions to address parenting have not been adapted for use with depressed caregivers in pediatric primary care settings. Our study examined the feasibility and explored outcomes of an evidence-based parenting program implemented in primary care and adapted for caregivers with depressive symptoms caring for toddlers. We conducted a randomized controlled trial with a wait-list control. Participants were caregivers who screened positive for depressive symptoms in pediatric settings with a toddler. Our study was implemented from July 2011 to June 2012. We adapted the Incredible Years Parents, Babies and Toddlers program with the addition of depression psychoeducation (12 weekly sessions), and assessed caregivers at baseline and immediately post-intervention. We assessed participation rates, depressive symptoms, parenting discipline practices, social support, and parenting stress. Our results revealed that 32 caregivers participating in the intervention group had significantly greater improvement in self-reported parenting discipline practices compared to the 29 wait-list control group caregivers. We found no differences between groups in depressive symptoms, social support, or parenting stress. Our study demonstrated that the average attendance was poor (mean attendance&nbsp;=&nbsp;3.7 sessions). We adapted an evidence-based parenting intervention for caregivers with depressive symptoms and toddlers in primary care; however, participation was challenging. Alternative intervention strategies are needed to reach and retain low-income caregivers with depression symptoms as they face multiple barriers to participation in groups within center-based services. Trial Registration Clinical Trials.gov identifier NCT01464619.</p>

<p>We sought to determine feasibility and acceptability of parental depression screening in urban pediatric practices. We recruited seven practices to participate. Patient Health Questionnaire-2, a validated two-item screening tool, was used to screen for depressive symptoms at 1-3 year old well visits. We conducted semi-structured interviews with clinicians to identify barriers and facilitators to screening. Of 8,621 eligible parents, 21.1% completed screening with site-specific rates ranging from 10.1% to 48.5%. Among those screened, 8.1% screened positive for depressive symptoms with site-specific rates ranging from 1.2% to 16.9%. Electronic alerts improved screening rates from 45 / month to 170 / month. Fifteen clinicians completed interviews and endorsed screening to provide help for families, build stronger ties with parents, and improve outcomes for children. However, insufficient time, need to complete activities with higher priority, lack of mental health availability, few resources for parents with limited English proficiency, and discomfort addressing depression were thought to limit screening.</p>

<p>We sought to determine feasibility and acceptability of parental depression screening in urban pediatric practices. We recruited seven practices to participate. Patient Health Questionnaire-2, a validated two-item screening tool, was used to screen for depressive symptoms at 1-3 year old well visits. We conducted semi-structured interviews with clinicians to identify barriers and facilitators to screening. Of 8,621 eligible parents, 21.1% completed screening with site-specific rates ranging from 10.1% to 48.5%. Among those screened, 8.1% screened positive for depressive symptoms with site-specific rates ranging from 1.2% to 16.9%. Electronic alerts improved screening rates from 45 / month to 170 / month. Fifteen clinicians completed interviews and endorsed screening to provide help for families, build stronger ties with parents, and improve outcomes for children. However, insufficient time, need to complete activities with higher priority, lack of mental health availability, few resources for parents with limited English proficiency, and discomfort addressing depression were thought to limit screening.</p>