The effects of expressive writing following traumatic childbirth

创伤性分娩后表达性写作的影响

• 批准号: 10592883
• 负责人: Sharon Dekel
• 金额: $ 25.2万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-02 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10592883
• 关键词: Affect; American; American College of Obstetricians and Gynecologists; Beginning of Life; Biological; Birth; Buffers; Caring; Child; Child Development; Child Health; Child Welfare; Childbirth; Clinical; Clinical Trials; Diagnosis; Disease; Early Intervention; Early treatment; Emotional; Enhancers; Event; Fostering; Foundations; Functional disorder; Funding; Future; Growth; Health Care Costs; Hospitals; Hour; Imagery; Impairment; Individual; Infant; Intervention; Maternal Health; Maternal Mortality; Measures; Mediating; Medical Care Costs; Mental Health; Mental disorders; Methodology; Mission; Morbidity - disease rate; Mother-Child Relations; Mothers; National Institute of Child Health and Human Development; Outcome; Physiological; Post-Traumatic Stress Disorders; Postpartum Depression; Postpartum Period; Postpartum Women; Pregnancy; Preventive; Preventive treatment; Productivity; Psychometrics; Psychopathology; Psychophysiology; Public Health; Quality of Care; Randomized; Randomized, Controlled Trials; Recommendation; Recovery; Reporting; Reproductive Process; Risk; Survivors; Symptoms; Testing; Therapeutic; Time; Trauma; United States National Institutes of Health; Visit; Woman; Work; Writing; acute stress; adverse maternal outcomes; behavior observation; biological adaptation to stress; child physical abuse; cost; cost effective; cost effective treatment; depressive symptoms; diagnostic tool; effective intervention; emotional distress; experience; expressive writing; improved; infant outcome; intergenerational; maternal morbidity; physical neglect; post-traumatic symptoms; preventive intervention; psychologic; remote delivery; resilience; response; tool; traumatic event; treatment effect

PROJECT SUMMARY Maternal mental illness following childbirth is associated with substantial public health burden. Postpartum psychopathology is a leading contributor of maternal morbidity and mortality and can endanger the child’s wellbeing onward from birth. This suggests intergenerational effects. While efforts exist to reduce postpartum depression, childbirth-related posttraumatic stress disorder (CB-PTSD), a condition that affects 240,000 American women each year, is underdiagnosed and undertreated. The adversity of CB-PTSD is demonstrated by 1) the close temporal relationship between the onset of CB-PTSD symptoms and the birth of the infant, 2) the child themselves becoming an unfortunate, constant reminder of the trauma (childbirth), which can distance the mother from the child during an important time for the formation of mother-infant bonding instrumental for healthy child development. Symptoms of PTSD follow a distinct triggering event and early signs appear in the period after a traumatic experience, providing a unique opportunity for an intervention of targeted individuals during a critical window when treatment could avert the PTSD symptom trajectory. This means that at-risk individuals could be approached and screened in the hospital following childbirth and receive an early intervention to buffer CB-PTSD symptoms and optimize mother and child outcomes. In this randomized controlled trial (RCT), we identify individuals who have acute stress response in the hours following delivery indicative of risk for subsequent CB-PTSD. They will be randomized to take part in a brief expressive writing (EW) about their recent childbirth or about a neutral experience over 3 consecutive days starting from Day 5 postpartum (PP). We will then follow them at repeated time points, to assess immediate (Day 8 PP) and sustained (Mo. 2) treatment effects. Their infants will be studied at Mo. 2 PP to examine the influence of the intervention on the foundation of mother-infant bonding. Maternal CB-PTSD will be quantified using psychodiagnostic, psychometric, and psychophysiologic measures and mother-infant bonding using psychometrics and a behavioral observational assessment of mother-child interaction. This study will begin to fill the critical clinical gap in interventions to support maternal mental health following traumatic childbirth and enhance opportunities for maternal resilience and psychological growth. Establishing an effective intervention, may lead to the implementation of a safe, feasible, cost-effective therapy in hospital settings that is adherent to the special needs of mothers, thereby reducing the odds of developing a potentially preventable, costly, posttraumatic disorder and fostering healthy child development. In addition, the proposed study will further the NICHD missions that “women avoid harmful effects from reproductive processes and children achieve healthy and productive lives.”

项目摘要 分娩后的孕产妇精神疾病与伯宁的实质性公共卫生有关。产后 心理病理学是孕产妇发病率和死亡率的主要贡献者，可能危害孩子的 从出生开始。这表明代际效应。虽然存在减少产后的努力 抑郁，分娩相关的创伤后应激障碍（CB-PTSD），这种疾病影响240,000 每年美国妇女被诊断不足和缺乏。证明了CB-PTSD的冒险 到1）CB-PTSD症状和婴儿的出生之间的紧密临时关系，2） 孩子自己成为不幸的，不断提醒的是创伤（分娩），这可以距离 在重要的时期，孩子的母亲从小就形成了母亲纽带的健康工具 儿童发展。 PTSD的症状遵循明显的触发事件，并在此期间出现早期迹象 经过创伤经历，为有针对性个人的干预提供了独特的机会 关键窗口当治疗可以避免PTSD符号轨迹时。这意味着高危个人 分娩后可以在医院接近和筛查，并提早干预缓冲 CB-PTSD符号并优化母亲和孩子的结果。在这个随机对照试验（RCT）中，我们 确定在交货后数小时内有急性压力反应的个人 随后的CB-PTSD。他们将被随机参加简短的表达性写作（EW） 从产后第5天（PP）开始，分娩或大约连续3天的中性经验。我们将 然后在重复的时间点上关注它们，以评估立即（第8天）并维持（MO。2）治疗 效果。他们的婴儿将在MO. 2 pp进行研究，以检查干预对基础的影响 母亲的纽带。孕产妇CB-PTSD将使用心理诊断，心理测量和 心理生理测量和使用心理计量学和行为观察的纽带 评估母子互动。这项研究将开始填补与 在创伤性分娩后支持孕产妇的心理健康，并增强了产妇韧性的机会 和心理成长。建立有效的干预措施可能会导致实施安全， 在医院环境中可行的，具有成本效益的治疗，以遵守母亲的特殊需求 减少发展潜在可预防的，昂贵的创伤后疾病并促进健康的几率 儿童发展。此外，拟议的研究将进一步进一步的NICHD任务：“妇女避免有害 生殖过程和儿童的影响实现了健康和产品的生活。”