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

摘要 这个F32项目旨在促进对围产期情绪和焦虑障碍（PMAD）的理解， 对婴儿社会情感发展的影响，减轻PMAD的可修改行为，以及偏好 循证PMAD管理方法。全球约20%的女性报告PMAD 在怀孕期间或产后一年内，主要是抑郁、焦虑和高度压力。 母亲PMAD增加了不良婴儿结局的风险。社交情绪发育迟缓（SED） 与未暴露于PMAD的婴儿相比，经历PMAD的妇女所生的婴儿高出60%。 婴儿SED影响整个生命周期的心理健康，社会能力和经济成就。小 已知在围产期内PMAD的特别有影响力的时间， 干预时机，以最大限度地造福于母婴二人组。母亲与婴儿的接触， 像玩耍、说话和唱歌这样的互动行为可能会减轻PMAD和婴儿之间的联系机制。 SED延迟。低质量的二元相互作用更可能与母体PMAD有关，并与次优相关。 SED。提高母婴接触质量的干预措施改善了婴儿的SED，但改善 产妇的心理健康状况尚不清楚。在理解PMAD干预措施的偏好方面仍然存在差距， 撒哈拉以南非洲地区的孕妇和产后妇女， 妇女和妇幼保健诊所的就诊人数很多，为妇女和儿童提供了一个高影响力的接入点， 产妇心理健康服务。拟议的F32研究项目利用了正在进行的队列数据 研究（PrIMA-X，R 01 HD 100201，PI：Pintye）在1300对肯尼亚母婴中进行， 通过产后36个月对产妇围产期情绪和焦虑障碍的纵向评估， 母婴互动，以及婴儿与儿童的社会情感发展。在目标1中，我们将使用二元数据 在妊娠期间每月收集一次，产后6个月至36个月收集一次，以前瞻性评估影响 PMAD对肯尼亚母婴对SED延迟的影响。在目标2中，我们将确定 36个月内母婴参与与PMAD缓解时间的纵向关系 产后，潜在地突出了干预的有效途径。在目标3中，我们将评估可接受性 以及围产期肯尼亚妇女对PMAD管理方法的偏好， 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。这么大的- 大规模混合方法研究将为未来的PMAD干预提供新的数据。研究 计划将为F32候选人提供严格的博士后培训，包括：1）先进的流行病学和时间- 采用重复测量的纵向数据的事件方法，2）定性方法的经验， 告知以患者为中心干预，3）母婴心理健康的内容领域专业知识-一个领域 对缩小妇幼保健差距至关重要。

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.