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

项目总结 背景：据估计，全球36%的儿童经历过情感虐待，23% 经历过身体虐待和12%的人经历过性虐待。虐待儿童是身体和精神疾病的危险因素 成人期的精神健康问题，以及下一代的虐待儿童问题，导致 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 (LMICs)，关于精神干预的研究出版物中只有6%是在LMICs中进行的研究。 鉴于低收入和中等收入国家固有的资源限制，以及影响 父母养育实践和采取干预措施，当地对创伤和精神疾病的背景理解是 可接受和有效的预防和干预的关键。Perú是一个中等收入国家，有很高的 虐待儿童和青少年怀孕，抑郁症是与之共处多年的主要原因 残疾。卫生部已将妇幼保健确定为优先事项。因此，我建议 在佩鲁的利马进行这项分三个阶段的研究。具体目标：1)对规范和 通过与临床工作人员的焦点小组讨论(N=18)和深入讨论与育儿有关的价值观 访谈产后青少年(N=10)及其家庭成员(N=6)；2)适应围产期家庭 对独特的环境、人群和形式的访问干预3)以评估产妇的精神症状， 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)比较。应聘者：我完全有能力实现这些目标 我的精神病学培训和我在青少年中进行混合方法研究的经验- 有限的设置。我的整个职业目标是成为一名独立的临床研究员，在全球范围内进行 妇幼心理健康研究，重点关注代际创伤。培训目标：在 5年培训期满后，我将获得民族志观察方面的研究技能。 研究、围产期干预发展和评估，以及定量数据分析，以能够 解决全球心理健康中的复杂研究问题。该奖项将为设计提供必要的数据， 调整和扩大干预措施，以支持照料者，防止虐待儿童，并改善孕产妇和儿童 在美国和世界各地，在资源有限的情况下，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·威廉姆斯博士、玛尔塔 Rondón，Sixto Sanchez和Anne Becker)合作者(Peter Cooper博士和Lynne Murray博士)和 顾问(Douglas Hayden博士)，在Perú的实地经验，哈佛T.H.Chan的正式课程 公共卫生学院，以及研讨会、培训、会议和参加研讨会。

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.