Adapting a novel mental health prevention intervention for migrant mothers with young children in a humanitarian setting

项目摘要/摘要 这项先导研究的目标是适应和先导测试一种新的针对流动人口的心理健康预防干预措施。 在人道主义环境中有年幼子女的母亲(MMC)。全球移民正以创纪录的速度增长， 在美墨边境，带着孩子旅行的女性人数继续上升。墨西哥提华纳 位于全球最繁忙的陆地边境口岸，面临着前所未有的人道主义危机 因暴力、政治冲突、缺乏经济机会和气候变化而流离失所， 移民政策加剧了情况，这些政策迫使数十万移民在墨西哥等待 长期和不安全的条件。在这种情况下过境的移徙妇女面临着发展精神障碍的高风险 由包括暴力在内的性别社会结构因素驱动的抑郁症和焦虑症等障碍， 社会孤立、移民不确定性和获得服务的机会有限。尽管过境的移民忍受着 这种情况对心理健康预防的需求很高，很少有循证干预措施被量身定做 过境的移民妇女。此外，虽然在人道主义情况下妇女和儿童的心理健康 相互关联的、很少有心理健康干预措施解决育儿需求。我们建议改编《妈妈》 Empoderada的[妈妈力量]--一种以理论为基础、创伤知情的团体干预，以促进心理健康 以及首次使用MMC对有年幼孩子(0-5岁)的母亲进行积极的育儿。这个多- 组件干预包括一项育儿计划以及解决社会结构问题的活动 脆弱性(例如，连接资源、加强社会支持)。它已经证明了它在 减少受创伤影响的美国母亲的育儿压力和心理健康症状，最近 已被翻译成西班牙语。我们的具体目标是1)改编、预试和提炼《MamáEmpoderada》 人道主义背景下的MMC；2)对调整后的干预进行试点研究，以确定可接受性 并估计对抑郁、焦虑和育儿压力症状的影响大小；以及3)探索 基于理论的行动机制可以预测抑郁、焦虑和育儿压力等症状的变化。 并确定与不同干预反应相关的因素。我们将开展焦点小组和预赛 测试以适应和改进干预措施，并与MMC一起进行适应干预措施的试点RCT (n=100；N处理=50；N对照=50)。干预组(IG)将接受创伤知情团体和个人 关于育儿、与资源的联系(例如，食物、住所)、社会支持和复原力的会议。该控件 小组将收到书面干预材料、护理规划标准，并参与 在专家组完成研究后(即6个月后)进行干预。两个小组都将完成 基线和离职调查，以及干预后3个月和6个月的跟踪调查。在崛起中 人口流离失所和漫长而痛苦的移徙之旅，这项研究解决了一项紧迫的需求 在人道主义情况下，为运输途中的MMC提供可扩展和量身定制的心理健康预防。

PROJECT SUMMARY/ABSTRACT The goal of this pilot study is to adapt and pilot-test a novel mental health prevention intervention for migrant mothers with young children (MMC) in a humanitarian setting. Global migration is rising at record-high rates, with the number of women traveling with children continuing to rise at the U.S.-Mexico border. Tijuana, Mexico is located at the busiest land border crossing globally and faces an unprecedented humanitarian crisis resulting from displacement due to violence, political conflict, lack of economic opportunity, and climate change, exacerbated by migration policies that have forced hundreds of thousands of migrants to wait in Mexico under prolonged and unsafe conditions. Migrant women in transit in such contexts face high risk of developing mental disorders such as depression and anxiety, driven by gendered social-structural factors including violence, social isolation, migration uncertainty, and limited access to services. Although migrants in transit who endure such conditions have high need for mental health prevention, few evidence-based interventions are tailored to migrant women in transit. Moreover, while women and children’s mental health in humanitarian contexts are interconnected, few mental health interventions address parenting needs. We propose to adapt ‘Mamá Empoderada’ [Mom Power] - a theory-based, trauma-informed group intervention to promote mental health and positive parenting among mothers with young children (0-5 years) for the first time with MMC. This multi- component intervention includes a parenting program alongside activities to address social-structural vulnerabilities (e.g., connection to resources, strengthening social support). It has demonstrated efficacy on reduced parenting stress and mental health symptoms for trauma-exposed U.S. mothers and has recently been translated into Spanish. Our specific aims are to 1) Adapt, pre-test, and refine ‘Mamá Empoderada’ with MMC in a humanitarian context; 2) Conduct a pilot study of the adapted intervention to determine acceptability and estimate effect sizes on symptoms of depression, anxiety, and parenting stress; and 3) Explore which theory-based mechanisms of action predict changes in symptoms of depression, anxiety, and parenting stress, and identify factors associated with differential intervention response. We will conduct focus groups and pre- testing to adapt and refine the intervention, and conduct a pilot RCT of the adapted intervention with MMC (N=100; Ntreatment=50; Ncontrol=50). The intervention group (IG) will receive trauma-informed group and individual sessions on parenting, linkage to resources (e.g., food, shelter), social support, and resilience. The control group will receive written intervention materials, standard of care programming, and participate in the intervention following completion of the study by the IG (i.e., after 6 months). Both groups will complete baseline and exit surveys, as well as follow-up surveys at 3- and 6- months post-intervention. Amid rising population displacement and prolonged and traumatic migration journeys, this study addresses an urgent need for scalable and tailored mental health prevention for MMC in transit in humanitarian contexts.