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

对于面临早期逆境的婴儿来说，早期干预并针对特定的养育父母行为已被证明在促进婴儿健康的社会情绪轨迹方面是有效的。可悲的是，产妇抑郁在早期婴儿期急剧上升，特别是对低收入妇女来说，并干扰了产妇对干预措施的参与，这些干预措施被证明总体上对改善婴儿的社会情绪结果有效。产后第一年的产妇抑郁是一个巨大且代价高昂的公共卫生问题，对婴儿育儿和婴儿的生命轨迹产生了广泛和有据可查的有害影响。母亲抑郁的治疗是孤立的，不同于针对特定父母行为的婴儿父母干预，这些行为被证明可以促进婴儿的能力。在减少母亲抑郁和促进建立婴儿社会情绪能力的育儿行为方面，缺乏被证明有效的综合干预措施。为了满足抑郁母亲及其婴儿的生活需求，我们需要针对母亲抑郁和特定养育父母行为的简短、可获得和综合的干预措施，以改善婴儿的社会情绪轨迹。在我们之前的项目研究中，我们已经开发了两种独立的基于网络的远程指导干预措施：(A)改善婴儿结局的父母养育行为(Baby-Net R34；R01)，以及(B)母亲抑郁(妈妈-Net R34；R01)。与对照组相比，婴儿网计划在观察到的养育父母行为以及在游戏和书籍活动中对婴儿的社会情绪能力产生了中等到很大的影响。MOM-Net显示了低自然流失率和高水平的可行性、程序使用率和满意度。与对照组相比，妈妈网参与者在抑郁和改善学龄前父母行为方面表现出显著的减少。基于网络的远程辅导方法的一个显著优势是，它克服了经常阻止低收入母亲参加社区/家访治疗计划的多重后勤障碍。虽然妈妈网是为学龄前儿童的抑郁母亲而存在的，但它并不是为婴儿育儿而设计的。此外，在Baby-Net研究中，我们发现母亲抑郁显著阻碍了项目进展和积极干预效果。因此，我们先前对基于网络的母亲抑郁和婴儿期特定养育父母行为的研究，为将显著的母亲网络抑郁内容整合到婴儿网络计划中，以针对抑郁和特定的婴儿养育行为，促进婴儿的社会情绪能力和轨迹提供了强有力的实证基础。我们将通过一项双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严格测试合并后的YYS力量-您的孩子(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.