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

对于早期面临逆境的婴儿，早期干预和针对特定的养育父母行为已被证明是促进健康的婴儿社会情感轨迹的有效方法。可悲的是，母亲的抑郁情绪在婴儿早期急剧上升，尤其是对低收入妇女来说，这干扰了母亲对改善婴儿社会情感结果的干预措施的参与。产后第一年的产妇抑郁症是一个巨大的、代价高昂的公共卫生问题，对婴儿养育和婴儿生命轨迹产生广泛的、有据可查的有害影响。母亲抑郁症的治疗是孤立的，与针对特定父母行为的婴儿父母干预措施是分开的，这些行为表明可以促进婴儿的能力。在减少母亲抑郁和促进培养婴儿社会情感能力的育儿行为方面，缺乏综合性干预措施。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和特定的养育父母行为的简短、可获取和综合干预措施，以改善婴儿的社会情感轨迹。在我们之前的计划性研究中，我们开发了两种独立的基于网络的远程指导干预：(a)改善婴儿结局的父母养育行为（Baby- Net R34; R01）和(b)母亲抑郁（Mom-Net R34; R01）。与对照组相比，婴儿网络项目对观察到的养育父母行为和婴儿在游戏和读书活动背景下的社会情感能力表现出中等到较大的影响。Mom-Net表现出低流失率和高水平的可行性、程序使用和满意度。与对照组相比，“妈妈网”的参与者表现出抑郁的显著减少，学前教育行为也有所改善。基于网络的远程辅导方法的一个重要优势是，它克服了阻碍低收入母亲参与社区/家访治疗项目的多重后勤障碍。虽然Mom-Net是为有学龄前儿童的抑郁母亲而存在的，但它不是为养育婴儿而设计的。此外，在婴儿网的研究中，我们发现母亲抑郁显著阻碍了项目的进展和积极的干预效果。因此，我们之前对基于网络的母亲抑郁和婴儿特定养育行为的研究，为将突出的母亲网络抑郁内容整合到婴儿网络计划中提供了强有力的经验基础，以针对促进婴儿社会情感能力和轨迹的抑郁和特定的婴儿养育行为。我们将对180名低收入抑郁症母亲和她们的婴儿进行一项双臂、意向治疗、随机对照试验，严格测试合并的“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.