Effects of a Prenatal Depression Preventive Intervention on Parenting and Young Children's Self-Regulation and Functioning (EPIC)

项目摘要 建议的R 01项目（EPIC）检查是否产前抑郁症预防干预-母亲 和婴儿（MB）-改善养育做法和儿童54个月的自我调节。我们建立 在现有的一项随机对照试验中，该试验招募了来自36个家庭的874名不同的低收入妇女， 访问（HV）程序。我们预计这些妇女中有598人将有资格接受EPIC（489人干预，109人 对照组），我们将额外招募260名对照参与者作为R 01的一部分，总样本量为858。 我们还将招募429名父亲。围产期抑郁症一直与不良的养育方式和不良的 儿童自我调节。这个项目建立在以前的工作，已经证明了MB的影响，改善 产妇心理健康结果，并将审查干预措施对养育子女和儿童的长期影响。 30-54个月的自我调节。干预参与者将接受为期六周的MB 除了通常的HV服务外，还以小组形式提供干预，而对照参与者将仅 提供HV服务。R 01的数据收集包括所有858名参与者的母亲自我报告， 6个月，从产后30个月开始，持续到产后54个月。一个密集的子- 在36个月、42个月和48个月时，将对460名参与者进行育儿和儿童发育研究 (230干预组230例，对照组230例。父亲自我报告调查将在30、42和54个月时进行。有 三个具体目标。首先，我们检验了MB改善父母养育和儿童自我调节技能的假设 在54个月内获得。我们将使用意向治疗以及倾向评分调整分析。 其次，我们测试了关于MB影响养育和儿童自我的母亲机制的假设， 调控我们假设，MB干预效果将介导的核心技能，目标是MB-in 特别是，增加了对思想和感情的意识，增加了情绪调节， 有抑郁症状的母亲缺乏认知行为技能， 参与促进幼儿自我调节的育儿实践。第三，我们将研究父亲的 和其他关键的社会人口学变量在调节MB对母亲养育子女的影响方面的作用， 孩子的自我调节。该项目的公共卫生意义和创新是实质性的。解决 产妇心理健康已被确定为对HV方案具有高度影响力的增强。如果像 预计，我们能够产生一个强大的科学基础，精确识别机制和结果 在我们的种族和民族多样化的样本中， 目前正在使用甲基溴的国家有可能加强其方案成果。此外，鉴于大量 HV计划可以在全国范围内采用MB，这项研究的结果可以提供强有力的数据，表明 将MB集成到其核心服务中。

PROJECT SUMMARY The proposed R01 project (EPIC) examines whether a prenatal depression prevention intervention—Mothers and Babies (MB)—improves parenting practices and child self-regulation through 54 months of age. We build on an existing cluster randomized controlled trial that enrolled 874 diverse, low-income women from 36 home visiting (HV) programs. We anticipate 598 of these women will be eligible for EPIC (489 intervention, 109 control) and we will enroll an additional 260 control participants as part of this R01, for a total sample of 858. We will also enroll 429 fathers. Perinatal depression is consistently linked to poor parenting practices and poor child self-regulation. This project builds on previous work that has demonstrated MB’s effects on improving maternal mental health outcomes and will examine the intervention’s longer-term impact on parenting and child self-regulation from 30-54 months of age. Intervention participants will have received the six-week MB intervention delivered in a group format in addition to usual HV services while control participants will have only received HV services. Data collection for the R01 includes maternal self-report with all 858 participants every six months, beginning at 30 months postpartum and continuing until 54 months postpartum. An intensive sub- study of parenting and child development will occur at 36, 42, and 48 months for a subset of 460 participants (230 intervention, 230 control). Paternal self-report surveys will occur at 30, 42, and 54 months. There are three specific aims. First, we test the hypothesis that MB improves parenting and child self-regulatory skill acquisition through 54 months of age. We will use intent-to-treat as well as propensity score adjusted analysis. Second, we test hypotheses about the maternal mechanisms by which MB influences parenting and child self- regulation. We hypothesize that MB intervention effects will be mediated by core skills targeted by MB—in particular, increased awareness of thoughts and feelings and increases in mood regulation—as these cognitive-behavioral skills are deficient in mothers with depressive symptoms and compromise mothers’ ability to engage in parenting practices that promote young children’s self-regulation. Third, we will examine fathers’ and other key sociodemographic variables’ role in moderating the impact of MB on mother’s parenting and the child’s self-regulation. The public health significance and innovation of this project is substantial. Addressing maternal mental health has been identified as a highly impactful enhancement to HV programs. If, as expected, we are able to generate a robust science base that precisely identifies mechanisms and outcomes impacted by the intervention in young children among our racially and ethnically diverse sample, HV programs currently using MB are likely to enhance their programmatic outcomes. Moreover, given the large number of HV programs that could adopt MB nationally, findings from this study can provide powerful data suggesting that MB become integrated into their core set of services.