Promoting Maternal Mental Health and Wellbeing in Neonatal Intensive Care Through Mindfulness

通过正念促进新生儿重症监护中的产妇心理健康和福祉

基本信息

批准号：
9389583
负责人：
Tamar Mendelson
金额：
$ 24.53万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-01 至 2020-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9389583
关键词：
Address Adoption Adult Anxiety Awareness Behavioral Caring Child Child Development Child Rearing Clinical Clinical Trials Collaborations Data Disease Emotional Emotions Family Fathers Feeling Future Goals Health Health Promotion Home environment Impairment Infant Infant Development Instruction Interpersonal Relations Intervention Maternal and Child Health Measurement Measures Medical Medical center Mental Depression Mental Health Mind-Body Intervention Mission Modality Modeling Mothers Neonatal Neonatal Intensive Care Neonatal Intensive Care Units Outcome Pain Parents Patient Self-Report Persons Phase Physiological Pilot Projects Population Prevention Prevention trial Preventive Intervention Program Evaluation Program Sustainability Provider Public Health Randomized Recording of previous events Recruitment Activity Relapse Research Research Design Research Personnel Resources Risk Safety Sample Size Self Care Site Sleep Strategic Planning Stress Surveys Symptoms Testing Trauma Well in self Work active control anxiety symptoms base behavioral outcome biological adaptation to stress comparison group coping depressive symptoms disorder prevention effective intervention efficacy trial evidence base experience flexibility heart rate variability high risk high risk infant improved indexing innovation maternal stress mindfulness mindfulness intervention negative affect perinatal mental health pressure prevent programs psychologic psychological symptom reduce symptoms scale up skills stress management stress reactivity success trauma symptom

项目摘要

Mothers of infants with medical issues requiring neonatal intensive care – an estimated 400,00-480,000 infants born per year – are at increased risk for mental health problems, which also have negative effects on parenting and child outcomes. The experience of having an infant in the neonatal intensive care unit (NICU) is often overwhelming and traumatic for parents, particularly mothers, who are more likely than fathers to be primary caretakers and are more frequent NICU visitors. NICU mothers are at high risk for depressive, anxiety, and trauma symptoms, which have been shown to persist following NICU discharge, to impair maternal-infant attachment, and to negatively impact child development. The NICU stay represents a critical window for offering evidence-based preventive interventions to mothers. However, there are few NICU-based programs to promote maternal mental health and wellbeing, their evidence base is limited, and they are generally delivered face-to-face. Our pilot research suggests face-to-face program delivery poses significant feasibility issues, including lack of acceptability for busy parents and financial and staffing challenges for NICU staff. Found to improve depression, anxiety, and trauma in adults, mindfulness has not yet been evaluated for mothers in the NICU. Mindfulness skills promote non-judgmental awareness of present-moment realities and enhance capacities for accepting painful emotions and situations. Our team developed a mindfulness-based NICU intervention delivered via video and audio modalities. Our pilot research indicates that the intervention significantly reduced maternal depressive, anxiety, and trauma symptoms and improved stress management, sleep, and coping. The proposed R34 project will enable us to further develop the intervention and prepare for a future R01 efficacy trial. In Year 1 of this project, we will develop additional mindfulness practices to address the family's transition home from the NICU, and we will develop an active control condition. In Years 2-3, we will conduct a pilot randomized study in two NICU sites to assess feasibility of our study design, program content, and measures and a preliminary evaluation of program benefits. Our pilot RCT will assess maternal psychological symptoms and heart rate variability as a measure of physiological stress reactivity, a potential mechanism for how mindfulness practices may improve stress management, which we will evaluate more fully in the future R01. Our team of experts in mindfulness interventions, perinatal mental health, neonatal health, physiologic stress response, and prevention trials has a history of productive collaboration and strong partnerships with the NICU study sites. Our proposed research is innovative in its focus on prevention in the NICU, adaptation of mindfulness strategies for a new population, use of video and audio modalities to optimize program feasibility, and inclusion of a physiological index of maternal stress. The research is significant in its focus on a critical understudied public health problem, emphasis on a potentially scalable intervention model, and promise for positively impacting an estimated 10-12% of mothers of infants born each year

患有健康问题需要新生儿重症监护的婴儿的母亲——估计有 400,00-480,000 名婴儿每年出生的人——出现心理健康问题的风险增加，这也会对养育子女产生负面影响在新生儿重症监护病房 (NICU) 中生下婴儿的经历通常很糟糕。对于父母，尤其是母亲来说，他们比父亲更有可能成为主要的孩子护理人员和经常去 NICU 的母亲患抑郁、焦虑和抑郁的风险很高。创伤症状在 NICU 出院后持续存在，会损害母婴新生儿重症监护病房（NICU）是一个关键的窗口期。为母亲提供循证预防干预措施然而，很少有基于新生儿重症监护病房 (NICU) 的计划。促进孕产妇心理健康和福祉，其基础证据有限，而且一般都已分娩我们的试点研究表明，面对面的项目交付带来了可行性重大问题，包括忙碌的父母无法接受以及新生儿重症监护病房 (NICU) 工作人员面临的财务和人员配置挑战。正念可以改善成人的抑郁、焦虑和创伤，但尚未对母亲进行评估新生儿重症监护病房（NICU）的正念技能可以促进对当下现实的非判断性认识并增强我们的团队开发了基于正念的新生儿重症监护室。我们的试点研究表明，通过视频和音频方式进行干预。显着减少母亲的抑郁、焦虑和创伤症状，并改善压力管理，拟议的 R34 项目将使我们能够进一步开发干预措施并做好准备。未来的 R01 功效试验在该项目的第一年，我们将开发额外的正念练习来解决。家庭从新生儿重症监护病房 (NICU) 过渡的家，我们将在第 2-3 年发展出积极的控制状况。将在两个 NICU 地点进行试点随机研究，以评估我们的研究设计、计划的可行性我们的试点随机对照试验将评估孕产妇的内容、措施和初步评估。心理症状和心率变异性作为生理应激反应的衡量标准，是潜在的正念练习如何改善压力管理的机制，我们将对其进行更全面的评估未来 R01 我们的正念干预、围产期心理健康、新生儿健康专家团队，生理应激反应和预防试验有着富有成效的合作历史和强大的我们提议的研究具有创新性，重点关注新生儿重症监护病房（NICU）的预防。 NICU，针对新人群调整正念策略，使用视频和音频方式进行优化该研究具有重要意义。关注一个尚未得到充分研究的关键公共卫生问题，强调潜在可扩展的干预模型，并有望对每年估计 10-12% 的婴儿母亲产生积极影响