Preventing Perinatal Anxiety: Testing an Internet-delivered Intervention

项目概要/摘要 焦虑症比任何其他精神疾病都更影响围产期妇女，但它们往往得不到治疗。 高达10.5%的母亲经历临床显著的产前焦虑，高达16%的母亲经历 产后焦虑如果不进行治疗，围产期焦虑症与以下疾病的严重不良健康后果相关： 母亲和婴儿，如早产，胎儿发育受损，出生体重低，困难， 母乳喂养，儿童焦虑，以及干扰父母与婴儿的联系。许多母亲面临经济困难， 地理障碍限制了他们获得心理健康服务的机会。心理健康的可及性是一个特殊的 关注那些生活在服务不足的美国农村地区的母亲。因此，迫切需要 可获得和有效的干预措施，以减少和预防围产期焦虑和相关疾病 症状“预防产后抑郁症”（P-POD;由斯坦曼博士开发）是一个基于互联网的， 自我指导计划，专为母亲和他们的浪漫伴侣，以减少和防止产妇 围产期焦虑及相关症状。P-POD植根于认知行为理论， 产后焦虑的风险因素包括：产前焦虑，功能失调的信念，消极的解释偏见， 低感知的合作伙伴支持。基于互联网的P-POD格式增加了获得护理的机会， 夫妇参与他们家的隐私。一项开放性试点研究的结果表明， POD是可接受的，可行的，可用的，并成功地减少产后焦虑的危险因素。我们的研究 研究小组现在准备在这些有希望的发现的基础上，对P-POD在女性中的功效进行更大规模的测试 （N = 100）在西弗吉尼亚州，一个主要的农村国家围产期焦虑的风险。本研究的目的是 进行随机对照试验，以测试P-POD与焦虑教育控制干预对危险因素的影响 产后焦虑（目标1）和母亲的焦虑症状，与伴侣的关系， 产后8周与婴儿的关系（目标2）。目标2还将包括定性访谈， 有目的的母亲子样本（暂定n = 25每种条件，基于主题饱和度），以了解 P-POD（与对照条件相比）对围产期妇女生活的影响，并了解 量化分数差异的潜在机制。假设是，与教育相比， 对照干预，1）P-POD将降低产前焦虑和产后焦虑的其他危险因素， 怀孕，和2）导致较低的母亲焦虑症状和改善家庭关系期间， 产后时期拟议的项目符合NICHD的高度优先研究领域，即改善 妇女在怀孕期间和怀孕后的健康，改善怀孕结果， 差距。

Project Summary/Abstract Anxiety disorders affect more perinatal women than any other psychiatric condition, yet they often go untreated. Up to 10.5% of mothers experience clinically significant prenatal anxiety, and up to 16% of mothers experience postpartum anxiety. Left untreated, perinatal anxiety is associated with significant adverse health outcomes for both mothers and infants, such as preterm birth, impaired fetal development, low birthweight, difficulty breastfeeding, anxiety in children, and interference with parent-infant bonding. Many mothers face economic and geographic barriers that limit their access to mental health services. Mental health accessibility is a particular concern for mothers who live in underserved, rural areas of the United States. Thus, there is a critical need for accessible and efficacious interventions to decrease and prevent perinatal anxiety and related disorder symptoms. “Preventing Postpartum Onset Distress” (P-POD; developed by Dr. Steinman) is an Internet-based, self-guided program, designed for both mothers and their romantic partners, to reduce and prevent maternal perinatal anxiety and related symptoms. P-POD is rooted in cognitive-behavioral theory and addresses key postpartum anxiety risk factors including: prenatal anxiety, dysfunctional beliefs, negative interpretation biases, and low perceived partner support. The Internet-based format of P-POD increases access to care by allowing couples to participate in the privacy of their home. Findings from an open-trial pilot study demonstrate that P- POD is acceptable, feasible, usable, and successfully reduces postpartum anxiety risk factors. Our research team is now ready to build upon these promising findings with a larger-scale test of P-POD efficacy in women (N = 100) at risk for perinatal anxiety in West Virginia, a predominantly rural state. The goal of this study is to conduct an RCT to test the effects of P-POD compared to an anxiety education control intervention on risk factors for postpartum anxiety (Aim 1) and mothers’ anxiety symptoms, relationships with their partners, and relationships with their infants at 8 weeks postpartum (Aim 2). Aim 2 will also include qualitative interviews with a purposive subsample of mothers (tentatively n = 25 per condition, based on thematic saturation), to understand the effects of P-POD (compared to the control condition) on perinatal women’s lives and to gain insight into mechanisms underlying differences in quantitative scores. The hypotheses are that compared to an educational control intervention, 1) P-POD will reduce prenatal anxiety and other risk factors for postpartum anxiety during pregnancy, and 2) result in lower maternal anxiety symptoms and improved familial relationships during the postpartum period. The proposed project is in line with NICHD’s high priority research areas of improving the health of women during and after pregnancy, improving pregnancy outcomes, and reducing perinatal health disparities.