Improving Preterm Outcomes by Safeguarding Maternal Mental Health

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DESCRIPTION (provided by applicant): Preterm infants are born at biological risk for poor health and developmental outcomes; maternal depression is disproportionately common among this population, and is known to exacerbate these outcomes. In its 2006 report, Preterm Birth, the Institute of Medicine stated the public health importance of optimizing the developmental outcomes of preterm infants, and specifically called for novel postnatal intervention strategies to accomplish this goal. This R01 application is based on the premise that preventing maternal depression and optimizing maternal functioning will ultimately improve the developmental outcomes of preterm infants. It follows the successful completion of an R03-funded pilot trial of Problem Solving Education (PSE) among mothers of preterm infants in two neonatal intensive care units (NICUs). PSE is a cognitive behavioral strategy that aims to impart recipients with skills to reduce the impact of stress on personal functioning, and thereby prevent depression. We now propose a randomized trial of a tailored intervention - NICU-PSE - which augments the core pilot model with brief motivational strategies to maximize intervention adherence, and devotes three of six intervention sessions to specific challenges faced by families of preterm infants, identified in the pilot: caregiver burden, navigating complex infant follow-up services, and social reintegration of the family following prolonged infant hospitalization. We will conduct an RCT of 325 low-income mothers with preterm infants in three NICUs - Boston Medical Center, Tufts Medical Center, and University of Massachusetts Medical Center. Over 12-months of follow-up, we will assess the effects of NICU-PSE on a series of outcomes measures for mothers of preterm infants, and a series of measures that represent specific risk mechanisms by which maternal depression is theorized to impact young children. Specifically, we aim to decrease the incidence of major depressive episode and improve depressive symptom trajectories; and improve general and parental functioning. We also aim to improve adherence to evidence-based quality indicators for NICU follow-up care; improve mothers' perceptions of mastery, and decrease their perceptions of caregiver burden and social isolation; and improve mothers' sensitivity to infant cues. Through our intervention, we hypothesize that mothers of preterm infants will develop stronger problem solving skills and perceive less stress. This will lead to a decreased burden of depressive symptomatology. Intervention mothers will also experience improved functioning, manifested in better adherence to NICU follow- up care, and decreased perceptions of caregiver burden and social isolation. NICU-PSE is a replicable intervention, designed to be delivered within two to four months of preterm delivery by bachelor level practitioners without extensive training. Our ultimate goal is to disseminate a safe and effective intervention applicable to all low-income families with preterm infants.