Intervening during the Prenatal Period with Women Exposed to Intimate Partner Violence to Improve Maternal Functioning and Infant Adjustment

项目摘要 亲密伴侣暴力（IPV）的发生率高得惊人， 怀孕在这个关键时刻，IPV与产后抑郁症、创伤后应激有关， 母婴关系的破坏，以及婴儿的不良后果。也有新的证据表明 表明COVID-19大流行正在加剧IPV的流行。与其他正在进行的 与流行病相关的压力源，有IPV病史的妇女，特别是围产期的妇女， 尤其容易受到COVID-19的负面影响。因此，迫切需要 调查大流行对接触IPV的妇女及其子女影响的纵向研究 孩子鉴于大流行病的情况在不同的人和时间之间波动很大， 能够捕捉动态变化的纵向方法可能提供对风险的有价值的洞察 和恢复力的能力。这一紧迫的竞争性修订旨在解决这些紧迫的问题， 利用NICHD资助的一项正在进行的理论驱动干预研究的现有优势 一项针对怀孕、暴露于IPV的妇女的计划，即怀孕母亲赋权计划（PMEP; MPI Miller-Graff和豪厄尔，R 01 HD 098092）。母提案的具体目标是：（1）评估效力 PMEP对妇女的心理健康，复原力和整个围产期IPV受害的影响，（2） 评估PMEP促进婴儿发育的功效;（3）测试治疗过程模型 改变妇女和婴儿在一个两个网站的背景下。父项目包括4次评估 分（产前2分，产后3个月，产后1年）。目前（n=67）目标N=230的女性 已加入母项目，该项目已完全适应远程保健的提供和评估， 使我们能够在疫情期间保持出色的参与者保留率。拟议的项目 竞争性修订将增加对流行病相关压力因素的每月评估，并收集30天的 在最后评估后立即进行关于压力、情绪和母子关系质量的每日日记 波（即，产后1年），以解决三个独特和及时的目标：（1）评估的间接影响， 干预流行病相关的压力源，（2）检查社会和工具的调节作用 支持，和（3）分析动态协会在日常母亲的情绪，感知压力，和母子 关系质量将使用多水平和结构方程模型进行分析。这个项目是 创新-不仅在大流行的背景下-而且在IPV研究领域更普遍， 多时间尺度、多方法设计。此外，具体目标还解决了与 2019冠状病毒病对儿童和家庭的社会和行为影响，提供有价值的信息， 根据受大流行病影响最严重的个人的需要作出的公共卫生反应。

PROJECT SUMMARY Intimate partner violence (IPV) occurs at alarmingly high rates, with the highest risk of IPV exposure during pregnancy. IPV during this critical juncture is associated with postpartum depression, posttraumatic stress, disruption to the mother-infant relationship, and poor infant outcomes. There is also emerging evidence suggesting that the COVID-19 pandemic is exacerbating the prevalence of IPV. Paired with other, on-going pandemic-related stressors, women with a history of IPV, especially those in the perinatal period, may be particularly vulnerable to the negative ramifications of COVID-19. A critical need therefore exists for longitudinal research investigating the effects of the pandemic on IPV-exposed women and their young children. Given that the conditions of the pandemic fluctuate significantly across persons and time, intensive longitudinal methods that are able to capture dynamic change are likely to provide valuable insights into risk and resilience in these families. This urgent competitive revision seeks to address these pressing questions, leveraging the existing strengths of an ongoing NICHD-funded study of a theoretically-driven intervention program with pregnant, IPV-exposed women, the Pregnant Moms’ Empowerment Program (PMEP; MPIs Miller-Graff & Howell, R01HD098092). The specific aims of the parent proposal are to (1) evaluate the efficacy of the PMEP for women’s mental health, resilience and IPV victimization across the perinatal period, (2) evaluate the efficacy of the PMEP in promoting infant development and (3) test process models for treatment change for women and infants in the context of a two-site. The parent project includes assessments at 4 time points (2 prenatal, 3 months postpartum, 1 year postpartum). Currently (n=67) women of a targeted N=230 have enrolled in the parent project, and the project has fully adapted to telehealth delivery and assessments, allowing us to maintain excellent participant retention throughout the pandemic. The project proposed for the competitive revision will add monthly assessments of pandemic-related stressors and the collection of a 30-day daily diary on stress, mood, and mother-child relational quality immediately following the final assessment wave (i.e., 1 year postpartum), to address three unique and timely aims: (1) evaluating the indirect effects of intervention on pandemic-related stressors, (2) examining the moderating effect of social and instrumental supports, and (3) analyzing dynamic associations in daily maternal mood, perceived stress, and mother-child relational quality. Analyses will be conducted using multilevel and structural equation modeling. This project is innovative – not just in the context of the pandemic – but also in the field of IPV research more generally for its multi-time scale, multi-method design. Further, the specific aims address pressing questions relative to the social and behavioral impacts of COVID-19 on children and families, providing valuable information for the public health response that is informed by the needs of individuals most significantly affected by the pandemic.