Adaptation and assessment of a family intervention designed to improve maternal and child mental health in resource-limited settings

项目摘要 背景：据估计，全世界36%的儿童经历过情感虐待，23% 遭受身体虐待，12%遭受性虐待。虐待儿童是一个危险因素， 成年后的心理健康问题，以及下一代的虐待儿童，导致一个循环， 虐待和精神疾病。虽然世界上85%的人口生活在低收入和中等收入国家， 在低收入国家中，只有6%的精神病干预研究出版物代表了在低收入国家中进行的研究。 鉴于中低收入国家固有的资源限制，以及影响这些国家的独特社会和文化因素， 父母的做法和采取干预措施，当地的背景理解的创伤和精神疾病是 是可接受和有效预防和干预的关键。秘鲁是一个中等收入国家， 虐待儿童和青少年怀孕，抑郁症是多年生活的主要原因， 残疾。卫生部已将妇幼保健确定为优先事项。因此，我建议 在秘鲁的利马进行这一3阶段研究。具体目标：（1）对规范进行定性评估， 通过与临床工作人员（N=18）的焦点小组讨论和深入研究， 对产后青少年（N=10）及其家属（N=6）进行访谈; 2）调整围产期之家 对独特环境、人群和形式的访问干预3）评估产妇精神症状， 干预组（N=30）的儿童虐待风险、照顾者敏感性和婴儿情绪调节， 与标准护理组（N=30）相比。候选人：我有能力完成这些目标， 我在精神病学方面的训练和我对青少年进行混合方法研究的经验， 有限的设置。我的总体职业目标是成为一名独立的临床研究者， 孕产妇和儿童心理健康研究，重点是代际创伤。培训目标：在 在我5年的培训结束时，我将获得民族志观察方面的研究技能。 研究、围产期干预开发和评估以及定量数据分析， 解决全球心理健康领域复杂的研究问题。该奖项将为设计提供必要的数据， 调整和扩大干预措施，以支持照顾者，防止虐待儿童，并改善孕产妇和儿童 在美国和世界各地资源有限的环境中的心理健康结果。培训活动：我会 利用国际知名导师委员会的专业知识（米歇尔威廉姆斯、玛尔塔 Rondón，Sixto Sanchez和Anne Becker）合作者（Peter库珀和Lynne Murray博士）和 顾问（道格拉斯海登博士），在秘鲁的实地经验，在哈佛T.H.的正式课程。陈 公共卫生学院，并参加研讨会、培训、会议和讲习班。

PROJECT SUMMARY Background: It is estimated that 36% of children around the world experience emotional abuse, 23% experience physical abuse and 12% experience sexual abuse. Child abuse is a risk factor for physical and mental health problems in adulthood, as well as for child abuse in the next generation, leading to a cycle of abuse and mental illness. While 85% of the world's population lives in low and middle-income countries (LMICs), just 6% of research publications on psychiatric interventions represent studies conducted in LMICs. Given resource constraints inherent to LMICs, as well as unique social and cultural factors that influence parenting practices and uptake of interventions, local contextual understanding of trauma and mental illness is key to acceptable and effective prevention and intervention. Perú is a middle-income country with high rates of child abuse and adolescent pregnancy, and where depression is the leading cause of years lived with disability. The Ministry of Health has identified maternal and child health as a priority. Thus, I propose to conduct this 3-phase study in Lima, Perú. Specific aims: 1) To conduct a qualitative assessment of norms and values related to child-rearing through focus group discussions with clinical staff (N=18) and in-depth interviews with postpartum adolescents (N=10) and their family members (N=6); 2) To adapt a perinatal home visiting intervention to a unique setting, population, and format 3) To assess maternal psychiatric symptoms, child abuse risk, caregiver sensitivity, and infant emotion regulation in the intervention group (N=30) as compared to the standard care group (N=30). Candidate: I am well-positioned to accomplish these aims given my training in psychiatry and my experience conducting mixed methods research with adolescents in resource- limited settings. My overall career goal is to become an independent clinical investigator conducting global maternal and child mental health research, with a focus on intergenerational trauma. Training objectives: At the end of my 5-year training award, I will have acquired the research skills in ethnographic observational research, perinatal intervention development and assessment, and quantitative data analysis to be able to tackle the complex research questions in global mental health. The award will provide essential data to design, adapt, and expand interventions to support caregivers, prevent child abuse, and improve maternal and child mental health outcomes in resource-limited settings in the US and around the world. Training activities: I will draw on the expertise of an internationally-renowned committee of mentors (Drs. Michelle Williams, Marta Rondón, Sixto Sanchez, and Anne Becker) collaborators (Drs. Peter Cooper and Lynne Murray) and a consultant (Dr. Douglas Hayden), field-based experience in Perú, formal coursework at the Harvard T.H. Chan School of Public Health, and seminars, trainings, conferences and workshop attendance.