Evaluating perinatal mood and anxiety disorder in Kenyan: a mixed methods approach

评估肯尼亚围产期情绪和焦虑症：混合方法

基本信息

批准号：
10462206
负责人：
Anna M Larsen
金额：
$ 7.13万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10462206
关键词：
Affect Africa South of the Sahara African Age Anxiety Anxiety Disorders Area Behavior Characteristics Child Child Health Clinic Cohort Studies Data Development Developmental Delay Disorders Disease Management Disease remission Economics Education Emotional Enrollment Epidemiology Equation Event Future Generalized Anxiety Disorder Health Infant Infant Behavior Influentials Interruption Intervention Interview Link Longevity Maternal Age Maternal and Child Health Measures Mental Depression Mental Health Mental Health Services Methods Mood Disorders Mothers Outcome Participant Pathological anxiety Pathway interactions Patient Preferences Patients Perinatal Play Population Positioning Attribute Postpartum Period Postpartum Women Pregnancy Pregnant Women Qualitative Methods Reading Reporting Research Research Personnel Research Project Grants Risk Risk Estimate Site Social support Socioeconomic Status Specific qualifier value Stress Surveys Time UNICEF Visit Woman anxiety symptoms center for epidemiological studies depression scale cohort critical period depressive symptoms dyadic interaction early childhood evidence base experience health of the mother high risk improved infant outcome intimate partner violence modifiable behavior novel parity patient oriented perceived stress perinatal outcomes perinatal period peripartum depression post-doctoral training preference prospective psychologic response social social skills therapy design therapy development uptake

项目摘要

ABSTRACT This F32 project aims to advance understanding of perinatal mood and anxiety disorders (PMAD), their consequences to infant social-emotional development, modifiable behaviors to alleviate PMAD, and preferences for evidence-based PMAD management approaches. Approximately 20% of women worldwide report PMAD during pregnancy or within the first year postpartum—predominantly depression, anxiety, and high stress. Maternal PMAD increases risk of adverse infant outcomes. Risk of social-emotional developmental (SED) delays is 60% higher among infants born to women experiencing PMAD compared to infants unexposed to PMAD. Infant SED impacts mental health, social competence, and economic attainment throughout the lifespan. Little is known about particularly influential timing of PMAD within the perinatal period which could optimize intervention timing for maximal benefit to mother-infant dyads. Maternal engagement with infants through interactive behaviors like playing, talking, and singing may mitigate mechanisms connecting PMAD and infant SED delays. Low quality dyadic interactions are more likely with maternal PMAD and associated with suboptimal SED. Interventions that increase mother-infant engagement quality improve infant SED, yet improvement to maternal mental health is unclear. Gaps remain in understanding preferences for PMAD interventions among pregnant and postpartum women in the sub-Saharan African region where PMAD disproportionately affects women and maternal child health (MCH) clinics are widely attended, offering a high-impact access point for maternal mental health services. The proposed F32 research project leverages data from an ongoing cohort study (PrIMA-X, R01HD100201, PI: Pintye) among 1300 Kenyan mother-infant pairs followed from pregnancy through 36-months postpartum with longitudinal assessment of maternal perinatal mood and anxiety disorder, mother-infant engagement, and infant-child social-emotional development. In Aim 1, we will use dyadic data collected monthly in pregnancy and 6-monthly through 36 months postpartum to prospectively assess impact and timing of PMAD on SED delays among Kenyan mother-infant pairs. In Aim 2, we will determine the relationship between mother-infant engagement and PMAD remission timing longitudinally through 36 months postpartum, potentially highlighting an effective avenue for intervention. In Aim 3, we will evaluate acceptability and preferences for PMAD management approaches among perinatal Kenyan women to inform patient-driven intervention design using qualitative methods guided by the Theoretical Framework of Acceptability. This large- scale mixed method study will contribute novel data toward informing a future PMAD intervention. The research plan will provide the F32 candidate rigorous postdoctoral training including: 1) advanced epidemiologic and time- to-event methods using longitudinal data with repeated measures, 2) experience with qualitative methods to inform a patient-centered intervention, 3) content-area expertise in maternal-infant mental health—an area critical to closing MCH gaps.

抽象的该 F32 项目旨在增进对围产期情绪和焦虑障碍 (PMAD) 及其影响的了解对婴儿社交情感发展的影响、缓解 PMAD 的可改变行为以及偏好全球大约 20% 的女性报告 PMAD 的循证管理方法。怀孕期间或产后第一年内——主要是抑郁、焦虑和高压。母亲 PMAD 会增加婴儿不良结局的风险。与未接触过 PMAD 的婴儿相比，患有 PMAD 的女性所生的婴儿的患病率要高 60%。婴儿 SED 会影响一生的心理健康、社交能力和经济成就。众所周知，PMAD 在围产期的时机特别有影响力，可以优化通过母亲与婴儿的接触，为母婴二人带来最大利益的干预时机。玩耍、说话和唱歌等互动行为可能会减轻 PMAD 和婴儿之间的联系机制 SED 延迟更可能与母体 PMAD 相关，并与次优相关。提高母婴参与质量的 SED 干预措施可改善婴儿 SED，但也可改善婴儿的 SED。对于孕产妇心理健康状况的了解仍存在差距。撒哈拉以南非洲地区的孕妇和产后妇女，PMAD 对这些地区的影响尤为严重妇女和妇幼保健 (MCH) 诊所得到广泛普及，为妇女和妇幼健康 (MCH) 诊所提供了一个具有高影响力的接入点拟议的 F32 研究项目利用了正在进行的队列数据。研究（PriIMA-X，R01HD100201，PI：Pintye）对 1300 对肯尼亚母婴进行妊娠跟踪调查产后 36 个月对母亲围产期情绪和焦虑障碍进行纵向评估，在目标 1 中，我们将使用二元数据。怀孕期间每月收集一次，产后 6 个月至 36 个月收集一次，以前瞻性评估影响在目标 2 中，我们将确定肯尼亚母婴对 SED 延迟的 PMAD 时间。 36 个月内母婴参与度与 PMAD 缓解之间的纵向关系产后，可能会强调有效的干预途径，在目标 3 中，我们将评估可接受性。肯尼亚围产期妇女对 PMAD 管理方法的偏好和偏好，以告知患者驱动在可接受性理论框架的指导下使用定性方法进行干预设计。规模混合方法研究将为未来的 PMAD 干预提供新的数据。计划将为F32候选人提供严格的博士后培训，包括：1）高级流行病学和时间- 使用重复测量的纵向数据的事件方法，2) 使用定性方法的经验告知以患者为中心的干预措施，3）母婴心理健康领域的内容专业知识——一个领域对于缩小妇幼保健差距至关重要。