Mood, mother and infant: The psychobiology of impaired dyadic development

情绪、母亲和婴儿：二元发展受损的心理生物学

• 批准号: 8628143
• 负责人: Alison M Stuebe
• 金额: $ 60.98万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8628143
• 关键词: Address; Affect; Anxiety; Breast Feeding; Caring; Child; Childbirth; Corticotropin; Data; Development; Diagnostic; Disease; Emotional; Ensure; Functional disorder; Goals; Health; Hydrocortisone; Infant; Infant Development; Intervention; Interview; Knowledge; Lactation; Light; Link; Literature; Longitudinal Studies; Mediating; Mental Depression; Mental Health; Mission; Moods; Mothers; Neuropeptides; Neurosecretory Systems; Outcome; Oxytocin; Physiological; Physiology; Placental Hormones; Play; Postpartum Depression; Postpartum Period; Pregnancy; Public Health; Publishing; Recording of previous events; Regulation; Research; Risk; Risk Factors; Role; Salivary; Secure; Social Behavior; Stress; Testing; Visit; Withdrawal; Woman; Work; alpha-amylase; base; biobehavior; caregiving; depressive symptoms; improved; indexing; innovation; novel; prevent; psychobiology; public health relevance; response; stressor

DESCRIPTION (provided by applicant): Postpartum depression (PPD) is a common, morbid condition that affects 10-15% of mothers. Recent work implicates reductions in oxytocin, a neuropeptide that plays a central role in mothering and social behavior, in the pathophysiology of this disorder. The proposed study will use lactation as a novel physiologic challenge to determine the extent to which low oxytocin mediates associations between PPD and impaired development of the mother-infant dyad. The long-term goal of this research is to identify mother-infant dyads at risk of PPD and implement targeted interventions to address their personal neuroendocrine vulnerabilities, thereby improving the health of mother and child. The objective here is to define the role of oxytocin and dysregulated stress reactivity in the psychobiology of PPD and impaired dyadic development, indexed by maternal sensitivity, infant emotional regulation, and insecure attachment. The central hypothesis is that PPD is associated with reduced oxytocin and maternal HPA axis dysregulation, indexed by loss of expected associations between ACTH and cortisol. These changes reduce maternal sensitivity, impairing dyadic development and increasing risk for insecure attachment. This hypothesis has been formulated based on published literature and preliminary data showing diminished oxytocin and dysregulation of the HPA axis among women with PPD symptoms. The rationale for this work is that as the underlying mechanisms of PPD are identified, interventions can be developed to target at-risk dyads and diminish PPD and its sequelae for mother and infant. Guided by strong preliminary data, the central hypothesis will be tested by pursuing three specific aims: 1. Use lactation as a physiologic challenge to quantify the extent to which PPD reduces oxytocin, dysregulates stress reactivity, and diminishes maternal sensitivity; 2. Use standardized mother-infant interactions to determine the extent to which PPD and reduced maternal sensitivity impair development of infant emotional regulation and increase risk for insecure attachment; 3. Determine the extent to which diminished maternal oxytocin and reduced sensitivity mediate associations between PPD, impaired infant emotional regulation, and insecure attachment. These aims will be achieved through a longitudinal study of 200 mother-infant dyads spanning late pregnancy through 12 months postpartum, half with a history of depression and/or anxiety and half with no psychiatric history, confirmed by diagnostic interview. Mother-infant dyads will be assessed during visits to the Mother-Infant Biobehavioral Lab. The approach is innovative, because this project will use lactation as a physiologic challenge to quantify intersections among maternal oxytocin physiology, stress reactivity, care giving, emotional regulation, and attachment, thereby shedding light on both maternal mental health and infant emotional development. The proposed research is significant, because it is expected to define the role of oxytocin in PPD and impaired dyadic development. Ultimately, such knowledge has the potential to inform novel therapies to prevent PPD and reduce its sequelae for mother and child.

描述（由申请人提供）：产后抑郁症（PPD）是一种常见的病态，影响10-15%的母亲。最近的研究表明，在这种疾病的病理生理学中，催产素（一种在母性和社会行为中起核心作用的神经肽）的减少。拟议的研究将使用哺乳作为一种新的生理挑战，以确定在何种程度上低催产素介导的PPD和受损的发展之间的关联的母婴二分体。这项研究的长期目标是确定有PPD风险的母婴二人组，并实施有针对性的干预措施，以解决他们个人的神经内分泌脆弱性，从而改善母亲和儿童的健康。这里的目的是定义催产素和失调的压力反应性的精神生物学的PPD和受损的二元发展，指数由母亲的敏感性，婴儿的情绪调节，和不安全的附件的作用。中心假设是PPD与催产素减少和母体HPA轴失调有关，其指标为ACTH和皮质醇之间预期的关联丧失。这些变化降低了母亲的敏感性，损害了二元发展，增加了不安全的依恋风险。这一假设是基于已发表的文献和初步数据制定的，这些文献和数据显示，患有PPD症状的女性中催产素减少，HPA轴失调。这项工作的基本原理是，随着PPD的潜在机制被确定，可以制定干预措施，以针对有风险的二元组，减少PPD及其对母亲和婴儿的后遗症。在强有力的初步数据的指导下，中心假设将通过追求三个具体目标进行测试：1。使用哺乳作为生理挑战来量化PPD减少催产素、失调应激反应和减少母体敏感性的程度; 2.使用标准化的母婴互动来确定PPD和母亲敏感性降低对婴儿情绪调节发育的影响程度，并增加不安全依恋的风险; 3.确定母体催产素减少和敏感性降低在多大程度上介导产后抑郁症、婴儿情绪调节受损和不安全依恋之间的关联。这些目标将通过对200对母婴的纵向研究来实现，这些母婴从妊娠后期到产后12个月，其中一半有抑郁和/或焦虑病史，另一半没有精神病史，并通过诊断性访谈加以证实。将在母婴生物行为实验室访视期间评估母婴二对体。该方法是创新的，因为该项目将使用哺乳作为生理挑战，以量化产妇催产素生理学，压力反应，护理，情绪调节和依恋之间的交叉点，从而揭示产妇的心理健康和婴儿的情感发展。这项研究意义重大，因为它有望确定催产素在产后抑郁症和受损的二元发展中的作用。最终，这些知识有可能为预防PPD并减少其对母亲和儿童的后遗症提供新的治疗方法。