The effects of expressive writing following traumatic childbirth

创伤性分娩后表达性写作的影响

基本信息

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
项目类别：
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

项目摘要

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.”

项目概要产后精神疾病与巨大的产后健康负担有关。精神病理学是孕产妇发病率和死亡率的主要原因，并可能危及儿童的健康这表明了代际影响，尽管人们正在努力减少产后的影响。抑郁症、与分娩相关的创伤后应激障碍 (CB-PTSD)，这种疾病影响着 240,000 人每年，美国女性的 CB-PTSD 都没有得到充分的诊断和治疗。 1) CB-PTSD 症状的出现与婴儿出生之间的密切时间关系，2) 孩子本身就成为不幸的、不断提醒人们创伤（分娩）的人，这可能会疏远他们母亲与孩子之间是形成母婴感情的重要时期，对健康有帮助创伤后应激障碍 (PTSD) 的症状伴随着明显的触发事件，并且在此期间出现早期迹象。在经历创伤性经历后，为目标个人提供独特的干预机会治疗可以避免 PTSD 症状轨迹的关键窗口期，这意味着高危人群。可以在分娩后在医院进行接触和筛查，并接受早期干预以缓冲在这项随机对照试验 (RCT) 中，我们研究了 CB-PTSD 症状并优化母婴结局。识别在分娩后数小时内出现急性应激反应的个体风险指标随后，他们将被随机参加关于他们最近的简短表达性写作（EW）。分娩或从产后第 5 天开始连续 3 天的中性经历 (PP)。然后在重复的时间点进行跟踪，以评估立即（第 8 天 PP）和持续（第 2 天）治疗他们的婴儿将在 Mo. 2 PP 进行研究，以检查干预措施对基金会的影响。母婴关系的建立将通过心理诊断、心理测量和评估来量化。使用心理测量学和行为观察进行心理生理测量和母婴联系这项研究将开始填补干预措施中的关键临床空白。支持创伤性分娩后产妇的心理健康并增强产妇恢复能力的机会建立有效的干预措施，可能会导致实施安全、在符合母亲特殊需求的医院环境中提供可行的、具有成本效益的治疗，从而减少患上可预防的、代价高昂的创伤后疾病的可能性，并培养健康的此外，拟议的研究将进一步推进 NICHD 的使命，即“女性避免有害的事物”。生殖过程和儿童实现健康和富有成效的生活的影响。”