Promoting Maternal Mental Health and Wellbeing in Neonatal Intensive Care Through Mindfulness

通过正念促进新生儿重症监护中的产妇心理健康和福祉

• 批准号: 9389583
• 负责人: Tamar Mendelson
• 金额: $ 24.53万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9389583
• 关键词: Address; Adoption; Adult; Anxiety; Awareness; Behavioral; Caring; Child; Child Development; Child Rearing; Clinical; Clinical Trials; Collaborations; Data; Disease; Emotional; Emotions; Family; Fathers; Feeling; Future; Goals; Health; Health Promotion; Home environment; Impairment; Infant; Infant Development; Instruction; Interpersonal Relations; Intervention; Maternal and Child Health; Measurement; Measures; Medical; Medical center; Mental Depression; Mental Health; Mind-Body Intervention; Mission; Modality; Modeling; Mothers; Neonatal; Neonatal Intensive Care; Neonatal Intensive Care Units; Outcome; Pain; Parents; Patient Self-Report; Persons; Phase; Physiological; Pilot Projects; Population; Prevention; Prevention trial; Preventive Intervention; Program Evaluation; Program Sustainability; Provider; Public Health; Randomized; Recording of previous events; Recruitment Activity; Relapse; Research; Research Design; Research Personnel; Resources; Risk; Safety; Sample Size; Self Care; Site; Sleep; Strategic Planning; Stress; Surveys; Symptoms; Testing; Trauma; Well in self; Work; active control; anxiety symptoms; base; behavioral outcome; biological adaptation to stress; comparison group; coping; depressive symptoms; disorder prevention; effective intervention; efficacy trial; evidence base; experience; flexibility; heart rate variability; high risk; high risk infant; improved; indexing; innovation; maternal stress; mindfulness; mindfulness intervention; negative affect; perinatal mental health; pressure; prevent; programs; psychologic; psychological symptom; reduce symptoms; scale up; skills; stress management; stress reactivity; success; trauma symptom

Mothers of infants with medical issues requiring neonatal intensive care – an estimated 400,00-480,000 infants born per year – are at increased risk for mental health problems, which also have negative effects on parenting and child outcomes. The experience of having an infant in the neonatal intensive care unit (NICU) is often overwhelming and traumatic for parents, particularly mothers, who are more likely than fathers to be primary caretakers and are more frequent NICU visitors. NICU mothers are at high risk for depressive, anxiety, and trauma symptoms, which have been shown to persist following NICU discharge, to impair maternal-infant attachment, and to negatively impact child development. The NICU stay represents a critical window for offering evidence-based preventive interventions to mothers. However, there are few NICU-based programs to promote maternal mental health and wellbeing, their evidence base is limited, and they are generally delivered face-to-face. Our pilot research suggests face-to-face program delivery poses significant feasibility issues, including lack of acceptability for busy parents and financial and staffing challenges for NICU staff. Found to improve depression, anxiety, and trauma in adults, mindfulness has not yet been evaluated for mothers in the NICU. Mindfulness skills promote non-judgmental awareness of present-moment realities and enhance capacities for accepting painful emotions and situations. Our team developed a mindfulness-based NICU intervention delivered via video and audio modalities. Our pilot research indicates that the intervention significantly reduced maternal depressive, anxiety, and trauma symptoms and improved stress management, sleep, and coping. The proposed R34 project will enable us to further develop the intervention and prepare for a future R01 efficacy trial. In Year 1 of this project, we will develop additional mindfulness practices to address the family's transition home from the NICU, and we will develop an active control condition. In Years 2-3, we will conduct a pilot randomized study in two NICU sites to assess feasibility of our study design, program content, and measures and a preliminary evaluation of program benefits. Our pilot RCT will assess maternal psychological symptoms and heart rate variability as a measure of physiological stress reactivity, a potential mechanism for how mindfulness practices may improve stress management, which we will evaluate more fully in the future R01. Our team of experts in mindfulness interventions, perinatal mental health, neonatal health, physiologic stress response, and prevention trials has a history of productive collaboration and strong partnerships with the NICU study sites. Our proposed research is innovative in its focus on prevention in the NICU, adaptation of mindfulness strategies for a new population, use of video and audio modalities to optimize program feasibility, and inclusion of a physiological index of maternal stress. The research is significant in its focus on a critical understudied public health problem, emphasis on a potentially scalable intervention model, and promise for positively impacting an estimated 10-12% of mothers of infants born each year

有医疗问题需要新生儿重症监护的婴儿的母亲-估计有400，00 - 480，000名婴儿 - - 和孩子的结果。在新生儿重症监护室（NICU）中有婴儿的经历通常是 对父母来说，尤其是母亲，她们比父亲更有可能成为主要的受害者， 护理人员和更频繁的NICU访客。新生儿重症监护室的母亲患抑郁、焦虑和 创伤症状，已被证明在NICU出院后持续存在， 依恋，并对儿童发展产生负面影响。新生儿重症监护室是一个关键的窗口， 向母亲提供循证预防干预措施。然而，很少有基于NICU的程序， 促进孕产妇心理健康和福祉，其证据基础有限，而且通常是在分娩时进行的。 面对面我们的试点研究表明，面对面的计划交付带来了重大的可行性问题， 包括忙碌的父母缺乏可接受性以及新生儿重症监护室工作人员的财务和人员配置挑战。发现 改善抑郁症，焦虑，和创伤的成年人，正念尚未被评估为母亲在 新生儿重症监护室正念技巧促进对当下现实的非判断性意识， 接受痛苦情绪和情况的能力。我们的团队开发了一个基于正念的NICU 通过视频和音频方式提供干预。我们的初步研究表明， 显著减少了母亲的抑郁、焦虑和创伤症状，改善了压力管理， 睡眠和应对拟议的R34项目将使我们能够进一步发展干预措施，并为 未来的R 01疗效试验。在这个项目的第一年，我们将开发更多的正念练习，以解决 从新生儿重症监护室回家的过渡期，我们会积极控制病情.在第2-3年，我们 将在两个NICU中心进行一项试点随机研究，以评估我们研究设计、项目 内容、措施和方案效益的初步评价。我们的试点RCT将评估产妇 心理症状和心率变异性作为衡量生理应激反应的一个潜在指标， 正念练习如何改善压力管理的机制，我们将更全面地评估 未来的R 01我们的专家团队专注于正念干预，围产期心理健康，新生儿健康， 生理应激反应和预防试验具有富有成效的合作历史， 与NICU研究中心合作。我们提出的研究是创新的，其重点是预防在 新生儿重症监护室，适应新人群的正念策略，使用视频和音频方式来优化 方案的可行性，并列入了产妇压力的生理指标。该研究具有重要意义， 关注一个关键的未充分研究的公共卫生问题，强调一个潜在的可扩展的干预模式， 并有望对每年出生婴儿的母亲产生积极影响，