Intervention for Poor Pregnant Women with Partner Abuse

伴侣虐待（PA）每年影响大约324，000名孕妇。经历过PA的孕妇有很高的风险发生不良的产后结果，包括杀人，医疗保健的高利用率以及身体和心理困难。PA的心理健康结果，即创伤后应激障碍（PTSD）和抑郁症，将产后期从一个已经具有挑战性的过程转变为一个潜在的压倒性过程，这可能会威胁到母亲，婴儿和其他孩子的福祉。此外，这些情感上的困难可能会损害妇女获得必要支持和资源的能力，以增加自己和子女的安全。不幸的是，几乎没有干预措施，旨在减少PA对围产期妇女的心理健康的影响已经开发或系统测试。一个更被忽视的领域是为经济上处于不利地位的妇女制定这种干预措施。低收入妇女特别容易受到PA和与PA有关的精神健康后遗症的影响。此外，低收入妇女面临着工具性障碍，限制了她们获得心理健康治疗的机会，尽管存在精神障碍，但很少有人获得心理健康治疗。 总体而言，这项治疗开发补助金的目的是：（i）为PA孕妇制定干预措施，（ii）进行随机对照研究，以评估拟议干预措施的初步疗效，并在过去一年内报告PA的100名接受公共援助的孕妇样本中，与常规护理相比。主要结果将是产后抑郁症或创伤后应激障碍的存在，以及在访问旨在建立安全的资源的有效程度。拟议的干预措施，即ROSE计划，“争取安全环境”，是一项针对这些因素（即，不良的社会支持、角色转换和生活压力），这可能导致与PA相关的产后心理健康困难（即，PTSD和抑郁症）。这项试点研究将为更大规模的临床试验奠定基础，以评估这种新干预措施的有效性。

DESCRIPTION (provided by applicant): Partner abuse (PA) affects approximately 324,000 pregnant women annually. Pregnant women who experience PA are at high risk for adverse postpartum outcomes that include homicide, high utilization of medical care as well as physical and psychological difficulties. The mental health outcomes of PA, that is posttraumatic stress disorder (PTSD) and depression, transform the postpartum period from an already challenging process into a potentially overwhelming one, which may threaten the well-being of the mother, infant, and her other children. Furthermore, these emotional difficulties may compromise a woman's ability to access the necessary support and resources to increase safety for herself and her children. Unfortunately, virtually no interventions that aim to decrease the impact of PA on the mental health of perinatal women have been developed or systematically tested. An area of even greater neglect is the development of such an intervention for financially disadvantaged women. Low-income women are especially vulnerable to PA and to the mental health sequelae related to PA. Further, low-income women face instrumental barriers that limit their access to mental health treatment and few are offered mental health treatment, despite the presence of a psychiatric disorder. Overall, the aims of this treatment development grant are to: (i) develop an intervention for pregnant women with PA and (ii) conduct a randomized controlled study to evaluate the initial efficacy of the proposed intervention compared to an enhanced care-as-usual condition in a sample of 100 pregnant women on public assistance who report PA within the last year. The primary outcomes will be the presence of postpartum depression or PTSD as well as degree of effectiveness in accessing resources designed to establish safety. The proposed intervention, the ROSE Program, "Reach Out for a Safe Environment," is an interpersonally oriented intervention that targets those factors (i.e., poor social support, role transitions, and life stressors) that may contribute to postpartum mental health difficulties associated with PA (i.e., PTSD and depression). This pilot study will lay the groundwork for a larger clinical trial evaluating the efficacy of this new intervention.