Reducing Maternal Depression and Promoting Infant Social-Emotional Health and Development.

对于面临早期逆境的婴儿，早期干预和针对特定的养育父母的行为已被证明是有效的，以促进健康的婴儿社会情感轨迹。可悲的是，母亲抑郁症在婴儿早期飙升，特别是对低收入妇女，并干扰母亲参与干预措施，这些干预措施通常在改善婴儿社会情感结果方面有效。产后第一年的产妇抑郁症是一个巨大的和昂贵的公共卫生问题，对婴儿养育和婴儿生命历程轨迹产生广泛和有据可查的有害影响。母亲抑郁症的治疗是孤立的，与婴儿父母的干预措施分开，这些干预措施针对特定的父母行为，以促进婴儿的能力。目前缺乏综合干预措施，在减少产妇抑郁和促进婴儿养育行为，建立婴儿的社会情感能力的有效性。为了解决抑郁母亲及其婴儿的生命历程需求，我们需要针对母亲抑郁症和特定养育父母行为的简短，可访问和综合干预措施，以改善婴儿的社会情感轨迹。在我们之前的计划研究中，我们已经开发了两种独立的基于网络的远程辅导干预措施：（a）改善婴儿结局的父母养育行为（Baby-Net R34; R 01），以及（B）母亲抑郁症（Mom-Net R34; R 01）。与对照组相比，婴儿网计划对观察到的养育父母行为和婴儿在游戏和书本活动中的社会情感能力表现出中等至大的影响。Mom-Net表现出低损耗和高水平的可行性，程序使用和满意度。与对照组相比，Mom-Net参与者表现出抑郁症的显着减少，并改善了学龄前父母的行为。基于网络的远程辅导方法的一个重大优势是，它克服了往往阻止低收入母亲参加社区/家访治疗方案的多种后勤障碍。虽然Mom-Net是为学龄前儿童的抑郁母亲而存在的，但它并不是为养育婴儿而设计的。此外，在婴儿网的研究中，我们发现，母亲的抑郁症显着阻碍程序的进展和积极的干预效果。因此，我们先前对基于网络的母亲抑郁症和婴儿期特定养育养育行为的研究，提供了一个强有力的经验基础，将突出的母亲网抑郁症内容整合到婴儿网计划中，以针对抑郁症和特定的婴儿养育行为，促进婴儿的社会情感能力和轨迹。我们将通过一项2臂、意向治疗、随机对照试验，对180名患有抑郁症的低收入母亲及其婴儿进行严格测试合并后的“你的力量-你的孩子”（YSYB）干预效果。

For infants facing early adversity, intervening early and targeting specific nurturing parent behaviors has proven to be effective in promoting healthy infant social-emotional trajectories. Sadly, maternal depression skyrockets during early infancy, especially for low-income women and interferes with maternal engagement in interventions shown to be effective generally in improving infant social-emotional outcomes. Maternal depression in the first year postpartum constitutes an enormous and costly public health concern with extensive and well-documented detrimental effects on infant parenting and infant life course trajectories. Maternal depression treatments operate in silos, separate from infant parent interventions that target specific parent behaviors shown to promote infant competencies. There is an absence of integrated interventions with demonstrated effectiveness in reducing both maternal depression and promoting infant parenting behavior that builds infant social-emotional competencies. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific nurturing parent behaviors shown to improve infant social-emotional trajectories. In our prior programmatic research, we have developed two separate web- based, remote coaching interventions for: (a) parent nurturing behaviors that improve infant outcomes (Baby- Net R34; R01), and (b) maternal depression (Mom-Net R34; R01). Compared to controls, the Baby- Net program demonstrated medium to large effects on observed nurturing parent behavior and on infant social- emotional competencies in the context of play and in the context of book activities. Mom-Net demonstrated low attrition and high levels of feasibility, program use, and satisfaction. Compared to controls, Mom-Net participants demonstrated significant reductions in depression and improved preschool parenting behavior. A substantial advantage of the web-based, remote coaching approach is that it overcomes multiple logistical barriers that often prevent low-income mothers from participating in community/home-visiting treatment programs. While Mom-Net exists for depressed mothers of preschoolers, it is not designed for infant parenting. Moreover, in Baby-Net studies, we found that maternal depression significantly impeded program progress and positive intervention effects. Thus, our prior research on web-based maternal depression and specific nurturing parenting behavior in infancy, provides a strong empirical basis to integrate salient Mom-Net depression content into the Baby-Net program to target depression and specific infant parenting behaviors that promote infant social-emotional competencies and trajectories. We will rigorously test the merged Your Strength-Your Baby (YSYB) intervention effects with 180 low-income mothers with depression and their infants via a 2-arm, intent-to-treat, randomized controlled trial.