Computer-Based Intervention for Victimized Perinatal Women with Mental Illness

描述（由申请人提供）：亲密伴侣暴力（IPV）是围产期妇女中的一个重大社会和公共卫生问题。研究表明，从21%到33%的围产期妇女报告IPV，有大量的发病率与IPV有关。此外，IPV将妇女置于几种精神疾病的高风险之中，这将围产期从一个已经具有挑战性的过程转变为一个潜在的压倒性过程。此外，IPV和未经治疗的精神疾病在围产期对妇女及其发育中的胎儿/婴儿造成不利的身体和情绪后果的双重风险。该领域的专家主张在IPV高危妇女中进行更多的IPV筛查和干预。鉴于寻求心理健康治疗的妇女中IPV的比例很高，与其他医疗机构（例如初级保健）相比，心理健康诊所是更有效的重点病例发现和干预场所。此外，IPV的存在增加了脱离治疗的可能性，这可能会损害患有IPV的妇女有效利用为自己和子女建立安全所需的重要住所和社区资源的能力。及时的干预可能会降低未来IPV的风险，提高治疗利用率，并减少心理健康症状。尽管患有IPV和精神健康疾病的妇女的高风险概况，但在精神卫生机构内患有IPV的女性精神健康患者的筛查和干预率较低。该R21奖的目标是开发和评估一种创新的、高覆盖率的、易于实施的、低成本的计算机提供的干预措施，即ROSE计划（为安全环境伸出援手），该计划将解决在早期识别和干预寻求心理健康治疗的近期IPV围产期妇女方面的已知障碍。R21提出了两个不同的阶段来评估ROSE计划与围产期妇女最近IPV。在发展阶段，研究小组将发展干预措施，以满足我们的目标群体的需要，开发软件，为计算机提供的干预措施，包括在焦点小组获得的信息，并进行了一个开放的试验，有8名参与者。在初步研究阶段，我们将进行一项两组随机对照研究，样本为50名围产期寻求治疗的近期IPV妇女，这将为在未来的大型临床试验中检查ROSE计划的疗效提供必要的基础。如果发现拟议的干预措施在我们脆弱的taret人群中有效，我们预计它可能会对其他生育，寻求心理健康治疗的受害妇女的成本效益，高影响力和广泛禁用干预产生重大影响。

DESCRIPTION (provided by applicant): Intimate partner violence (IPV) is a significant social and public health problem among perinatal women. Research suggests that from 21 percent to 33 percent of perinatal women report IPV and there is an enormous amount of morbidity associated with IPV. Moreover, IPV places a woman at high risk for several psychiatric disorders, which transforms the perinatal period from an already challenging process into a potentially overwhelming one. Further, IPV and untreated mental illness during the perinatal period pose a dual risk of adverse physical and emotional outcomes for women and their developing fetus/infant. Experts in the field advocate for more IPV screening and intervention to take place among women who are at high-risk for IPV. Given the high rates of IPV among women who seek mental health treatment, mental health clinics compared to other medical settings (e.g. primary care) are more effective sites for focused case finding and intervention. Further, the presence of IPV increases the likelihood of disengagement from treatment, which could compromise the ability of women with IPV to effectively use important shelter and community resources necessary for establishing safety for themselves and their children. A timely intervention might reduce the risk of future IPV, improve treatment utilization, and reduce mental health symptoms. Despite the high-risk profile of women with IPV and mental health illness, there are low screening and intervention rates of female mental health patients with IPV within mental health settings. The objective of this R21 Award is to develop and assess an innovative, high- reach, easily implementable, low-cost computer-delivered intervention, the ROSE Program (Reach out for a Safe Environment) that will address known barriers in early identification and intervention with perinatal women with recent IPV who seek mental health treatment. The R21 proposes two distinct phases to assess the ROSE Program with perinatal women with recent IPV. During the Development Phase, the research team will develop the intervention to meet the needs of our target group, develop the software for the computer- delivered intervention incorporating information gained in focus groups, and conduct an open trial with 8 participants. During the Pilot Study Phase, we will conduct a two-group, randomized controlled study with a sample of 50 perinatal treatment-seeking women with recent IPV, which will provide the necessary groundwork to examine the efficacy of the ROSE Program in a future, large clinical trial. If the proposed intervention is found to be efficacious in our vulnerable taret population, we anticipate that it could have significant implications for a cost-effective, high-reaching and widely disenable intervention for other childbearing, victimized women seeking mental health treatment.