A Randomized Control Trial of a Culturally Relevant Maternal Wellness App to Improve Black Maternal Mental Health Outcomes

项目摘要/摘要 围产期情绪和焦虑障碍(PMADs)包括一系列发生在 怀孕和产后最多一年。大约13%的女性经历过PMADs。这一比率翻倍 对于那些围产期结局不良(APO)的人，黑人妇女有三倍于此。最近的研究指出了种族主义 作为这些健康差距的一个重要来源。文化适应以改善与中国的沟通 提供者降低少数族裔患者的抑郁率，并提高对治疗的依从性，洞察力 和联盟。歧视压力和担心经历医疗后果被认为是 增加全身炎症，这是一种已知会导致精神和身体症状的机制。炎症有 与PMADs和APO都有牵连，表明有共同的潜在病因。我们工作中的证据 提示炎症参与了PMADs的病理生理过程。拟议的试点随机对照 试验将使我们能够在有希望的初步结果的基础上再接再厉，并确定我们的文化相关移动设备 健康(MHealth)干预有效地改善了黑人孕妇的结局 将干预组与对照组进行比较。与文化相关的模块包括建立沟通 和自我宣传技能，并提供支持网络。这项研究的主要目的是提供 指导黑人妇女围产期的临床护理，目的是改善精神 健康和身体健康结果。第二个目标是检查新的炎症性信号 这一变化是为减少这一人群中PMADs的干预而产生的。就像炎症一样 PMADs的诊断，其作用的确定可能会揭示潜在的干预目标，并提供关键的 提高妇女长期健康的知识。150名黑人患者将对PMAD症状进行前瞻性评估 孕妇，其中一半将随机接受与文化相关的mHealth干预。我们 假设干预组中的女性将降低PMADs和APO的发生率， 坚持心理健康治疗，并将报告增加自我宣传技能，增加沟通 与提供者的关系，以及减少与歧视有关的压力水平。它们还将改善生物风险。 指标包括低循环C反应蛋白和差异表达的转录图谱 炎性基因，其特征是血斑中的炎性转录因子活性降低。vt.给出 黑人母亲中PMADs和APOS的高负担及其对母亲的众多后果 对于儿童结果，我们必须制定和实施有效的干预措施，并测试 可能驱动这些效应的机制。这项工作是跨学科的，建立在一个社区网络上 倡导者实施一种新的mHealth干预措施，借鉴现实世界的经验，旨在增强 自我倡导，减轻压力，防止不良后果。

Project Summary/Abstract Perinatal Mood and Anxiety Disorders (PMADs) encompass a range of mental health disorders that occur during pregnancy and up to one year postpartum. Approximately 13% of women experience PMADs. This rate doubles for those with adverse perinatal outcomes (APO) and triples in Black women. Recent research points to racism as one significant source of these health disparities. Cultural adaptations to improve communication with providers decrease rates of depression in minority patients as well as improve adherence to treatment, insight and alliance. Discrimination stress and worries about experiencing medical consequences are thought to increase systemic inflammation, a mechanism known to drive mental and physical symptoms. Inflammation has been implicated in both PMADs and APO, suggesting a shared underlying etiology. Evidence from our work suggests that inflammation contributes to the pathophysiology of PMADs. The proposed pilot randomized control trial will allow us to build on promising preliminary results and identify whether our culturally relevant mobile Health (mHealth) intervention is effective in improving outcomes among Black pregnant women randomized to the intervention compared to a control group. The culturally relevant modules include building communication and self-advocacy skills and provide a support network. The primary objective of this research is to provide guidance for clinical care of Black women during the perinatal period, with the goal to improve mental health and physical health outcomes. A secondary goal is to examine novel inflammatory signatures that change as a function of the intervention to reduce PMADs in this population. As inflammation may be diagnostic of PMADs, identification of its role may shed light of potential intervention targets and provide critical knowledge to improve women’s long-term health. PMAD symptoms will be assessed prospectively in 150 Black pregnant women, half of whom will be randomized to receive the culturally relevant mHealth intervention. We hypothesize that women in the intervention group will have reduced rates of PMADs and APOs, an increase in adherence to mental health treatment and will report increased self-advocacy skills, increased communication with providers, and reduced levels of discrimination related stress. They will also have improved biological risk indicators including lower circulating C-reactive protein and a transcription profile of differentially expressed inflammatory genes, marked by a decreased activity of inflammatory transcription factors from blood spots. Given the high burden of both PMADs and APOs among Black mothers and the numerous consequences on maternal and child outcomes, it is imperative that we develop and implement effective interventions, and test the biological mechanisms that might drive these effects. This work is interdisciplinary, building on a network of community advocates to implement a novel mHealth intervention informed by real world experiences designed to enhance self-advocacy, reduce stress and prevent adverse outcomes.