The effects of expressive writing following traumatic childbirth

创伤性分娩后表达性写作的影响

• 批准号: 10592883
• 负责人: Sharon Dekel
• 金额: $ 25.2万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-02 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10592883
• 关键词: Affect; American; American College of Obstetricians and Gynecologists; Beginning of Life; Biological; Birth; Buffers; Caring; Child; Child Development; Child Health; Child Welfare; Childbirth; Clinical; Clinical Trials; Diagnosis; Disease; Early Intervention; Early treatment; Emotional; Enhancers; Event; Fostering; Foundations; Functional disorder; Funding; Future; Growth; Health Care Costs; Hospitals; Hour; Imagery; Impairment; Individual; Infant; Intervention; Maternal Health; Maternal Mortality; Measures; Mediating; Medical Care Costs; Mental Health; Mental disorders; Methodology; Mission; Morbidity - disease rate; Mother-Child Relations; Mothers; National Institute of Child Health and Human Development; Outcome; Physiological; Post-Traumatic Stress Disorders; Postpartum Depression; Postpartum Period; Postpartum Women; Pregnancy; Preventive; Preventive treatment; Productivity; Psychometrics; Psychopathology; Psychophysiology; Public Health; Quality of Care; Randomized; Randomized, Controlled Trials; Recommendation; Recovery; Reporting; Reproductive Process; Risk; Survivors; Symptoms; Testing; Therapeutic; Time; Trauma; United States National Institutes of Health; Visit; Woman; Work; Writing; acute stress; adverse maternal outcomes; behavior observation; biological adaptation to stress; child physical abuse; cost; cost effective; cost effective treatment; depressive symptoms; diagnostic tool; effective intervention; emotional distress; experience; expressive writing; improved; infant outcome; intergenerational; maternal morbidity; physical neglect; post-traumatic symptoms; preventive intervention; psychologic; remote delivery; resilience; response; tool; traumatic event; treatment effect

PROJECT SUMMARY Maternal mental illness following childbirth is associated with substantial public health burden. Postpartum psychopathology is a leading contributor of maternal morbidity and mortality and can endanger the child’s wellbeing onward from birth. This suggests intergenerational effects. While efforts exist to reduce postpartum depression, childbirth-related posttraumatic stress disorder (CB-PTSD), a condition that affects 240,000 American women each year, is underdiagnosed and undertreated. The adversity of CB-PTSD is demonstrated by 1) the close temporal relationship between the onset of CB-PTSD symptoms and the birth of the infant, 2) the child themselves becoming an unfortunate, constant reminder of the trauma (childbirth), which can distance the mother from the child during an important time for the formation of mother-infant bonding instrumental for healthy child development. Symptoms of PTSD follow a distinct triggering event and early signs appear in the period after a traumatic experience, providing a unique opportunity for an intervention of targeted individuals during a critical window when treatment could avert the PTSD symptom trajectory. This means that at-risk individuals could be approached and screened in the hospital following childbirth and receive an early intervention to buffer CB-PTSD symptoms and optimize mother and child outcomes. In this randomized controlled trial (RCT), we identify individuals who have acute stress response in the hours following delivery indicative of risk for subsequent CB-PTSD. They will be randomized to take part in a brief expressive writing (EW) about their recent childbirth or about a neutral experience over 3 consecutive days starting from Day 5 postpartum (PP). We will then follow them at repeated time points, to assess immediate (Day 8 PP) and sustained (Mo. 2) treatment effects. Their infants will be studied at Mo. 2 PP to examine the influence of the intervention on the foundation of mother-infant bonding. Maternal CB-PTSD will be quantified using psychodiagnostic, psychometric, and psychophysiologic measures and mother-infant bonding using psychometrics and a behavioral observational assessment of mother-child interaction. This study will begin to fill the critical clinical gap in interventions to support maternal mental health following traumatic childbirth and enhance opportunities for maternal resilience and psychological growth. Establishing an effective intervention, may lead to the implementation of a safe, feasible, cost-effective therapy in hospital settings that is adherent to the special needs of mothers, thereby reducing the odds of developing a potentially preventable, costly, posttraumatic disorder and fostering healthy child development. In addition, the proposed study will further the NICHD missions that “women avoid harmful effects from reproductive processes and children achieve healthy and productive lives.”

项目总结