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: 9759786
• 负责人: Tamar Mendelson
• 金额: $ 24.56万
• 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 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9759786
• 关键词: Address; Adoption; Adult; Anxiety; Awareness; Behavioral; Caring; Child; Child Development; Child Rearing; Child Welfare; 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; 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; recruit; 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

患有健康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 每年出生的人——出现心理健康问题的风险增加，这也会对养育子女产生负面影响 和儿童的成果。在新生儿重症监护病房 (NICU) 生下婴儿的经历通常是 对于父母，尤其是母亲来说，他们比父亲更有可能成为主要的孩子 护理人员，并且是新生儿重症监护病房 (NICU) 的常客。 NICU 母亲患抑郁、焦虑和抑郁的风险很高 创伤症状在 NICU 出院后持续存在，会损害母婴 依恋，并对儿童的发展产生负面影响。 NICU 住院是一个关键窗口期 为母亲提供循证预防干预措施。然而，基于 NICU 的项目很少 促进孕产妇心理健康和福祉，其证据基础有限，并且通常已交付 面对面。我们的试点研究表明，面对面的项目交付带来了重大的可行性问题， 包括忙碌的父母无法接受以及新生儿重症监护室工作人员面临财务和人员配置挑战。发现 正念可以改善成人的抑郁、焦虑和创伤，但尚未对母亲进行评估 新生儿重症监护室。正念技能可以促进对当下现实的非评判性认识，并增强 接受痛苦的情绪和情况的能力。我们的团队开发了基于正念的新生儿重症监护室 通过视频和音频方式进行干预。我们的试点研究表明，干预 显着减少产妇抑郁、焦虑和创伤症状并改善压力管理， 睡眠和应对。拟议的 R34 项目将使我们能够进一步开发干预措施并为 未来的 R01 功效试验。在该项目的第一年，我们将开发额外的正念练习来解决 家庭从新生儿重症监护室过渡的家，我们将制定积极的控制条件。在第 2-3 年，我们 将在两个 NICU 地点进行试点随机研究，以评估我们的研究设计、计划的可行性 内容、措施以及计划效益的初步评估。我们的试点随机对照试验将评估母亲 心理症状和心率变异性作为生理应激反应的衡量标准，是潜在的 正念练习如何改善压力管理的机制，我们将对其进行更全面的评估 未来的R01。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有着富有成效的合作历史和强大的 与 NICU 研究中心建立伙伴关系。我们提出的研究具有创新性，重点关注预防 NICU，针对新人群调整正念策略，使用视频和音频方式进行优化 计划的可行性，并纳入孕产妇压力的生理指数。该研究的意义重大在于 重点关注尚未得到充分研究的关键公共卫生问题，强调潜在可扩展的干预模型， 并承诺每年对大约 10-12% 的婴儿母亲产生积极影响