Evaluating perinatal mood and anxiety disorder in Kenyan: a mixed methods approach

摘要 这个F32项目旨在促进对围产期情绪和焦虑症(PMAD)的了解，他们的 对婴儿社交-情绪发育的影响，缓解PMAD的可修改行为，以及偏好 关于循证的PMAD管理方法。全球约20%的女性报告PMAD 在怀孕期间或产后第一年内--主要是抑郁、焦虑和高压力。 母亲的PMAD增加了婴儿不良结局的风险。社会情绪发育(SED)延迟的风险 与未接触PMAD的婴儿相比，患有PMAD的母亲所生婴儿的发病率高出60%。 婴儿SED会在一生中影响心理健康、社交能力和经济成就。一点儿 已知围产期PMAD的时机特别有影响，这可能会优化 为母婴双方带来最大利益的干预时机。母亲通过以下方式与婴儿接触 互动行为，如玩耍、交谈和唱歌，可能会缓解PMAD和婴儿之间的联系 SED延迟。低质量的二元交互作用更有可能与母体PMAD相关，并与次优相关 塞德。提高母婴接触质量的干预措施改善了婴儿的SED，但改善了 产妇的心理健康状况尚不清楚。在对PMAD干预措施偏好的理解方面仍然存在差距 撒哈拉以南非洲地区的孕妇和产后妇女，PMAD对该地区的影响不成比例 妇女和妇幼保健(MCH)诊所得到广泛关注，为 孕产妇心理健康服务。拟议的F32研究项目利用了来自正在进行的队列的数据 1300对肯尼亚母婴妊娠后的研究(PRIMA-X，R01HD100201，PI：Pintye) 通过产后36个月对母亲围产期情绪和焦虑症的纵向评估， 母婴参与、婴幼儿社交情绪发展。在目标1中，我们将使用并元数据 怀孕期间每月收集一次，产后6个月至36个月收集一次，前瞻性评估影响 以及关于肯尼亚母婴配对中SED延迟的PMAD的时间。在目标2中，我们将确定 36个月母婴参与度与PMAD缓解时间的纵向关系 产后，潜在地突出了一种有效的干预途径。在目标3中，我们将评估可接受性 以及肯尼亚围产期妇女对PMAD管理方法的偏好，以告知患者驱动 干预设计以可接受性理论框架为指导，采用定性研究方法。这么大的- 量表混合方法研究将有助于为未来的PMAD干预提供新的数据。这项研究 计划将为F32候选人提供严格的博士后培训，包括：1)高级流行病学和时间- 使用纵向数据和重复测量的事件方法，2)使用定性方法的经验 告知以患者为中心的干预措施，3)母婴心理健康内容领域的专业知识--一个领域 对缩小妇幼保健差距至关重要。

ABSTRACT This F32 project aims to advance understanding of perinatal mood and anxiety disorders (PMAD), their consequences to infant social-emotional development, modifiable behaviors to alleviate PMAD, and preferences for evidence-based PMAD management approaches. Approximately 20% of women worldwide report PMAD during pregnancy or within the first year postpartum—predominantly depression, anxiety, and high stress. Maternal PMAD increases risk of adverse infant outcomes. Risk of social-emotional developmental (SED) delays is 60% higher among infants born to women experiencing PMAD compared to infants unexposed to PMAD. Infant SED impacts mental health, social competence, and economic attainment throughout the lifespan. Little is known about particularly influential timing of PMAD within the perinatal period which could optimize intervention timing for maximal benefit to mother-infant dyads. Maternal engagement with infants through interactive behaviors like playing, talking, and singing may mitigate mechanisms connecting PMAD and infant SED delays. Low quality dyadic interactions are more likely with maternal PMAD and associated with suboptimal SED. Interventions that increase mother-infant engagement quality improve infant SED, yet improvement to maternal mental health is unclear. Gaps remain in understanding preferences for PMAD interventions among pregnant and postpartum women in the sub-Saharan African region where PMAD disproportionately affects women and maternal child health (MCH) clinics are widely attended, offering a high-impact access point for maternal mental health services. The proposed F32 research project leverages data from an ongoing cohort study (PrIMA-X, R01HD100201, PI: Pintye) among 1300 Kenyan mother-infant pairs followed from pregnancy through 36-months postpartum with longitudinal assessment of maternal perinatal mood and anxiety disorder, mother-infant engagement, and infant-child social-emotional development. In Aim 1, we will use dyadic data collected monthly in pregnancy and 6-monthly through 36 months postpartum to prospectively assess impact and timing of PMAD on SED delays among Kenyan mother-infant pairs. In Aim 2, we will determine the relationship between mother-infant engagement and PMAD remission timing longitudinally through 36 months postpartum, potentially highlighting an effective avenue for intervention. In Aim 3, we will evaluate acceptability and preferences for PMAD management approaches among perinatal Kenyan women to inform patient-driven intervention design using qualitative methods guided by the Theoretical Framework of Acceptability. This large- scale mixed method study will contribute novel data toward informing a future PMAD intervention. The research plan will provide the F32 candidate rigorous postdoctoral training including: 1) advanced epidemiologic and time- to-event methods using longitudinal data with repeated measures, 2) experience with qualitative methods to inform a patient-centered intervention, 3) content-area expertise in maternal-infant mental health—an area critical to closing MCH gaps.