Promoting Maternal Mental Health and Wellbeing in Neonatal Intensive Care Through Mindfulness

有健康问题的婴儿的母亲需要新生儿重症监护--估计有400，00-48万名婴儿 每年出生的孩子患心理健康问题的风险增加，这也对父母的养育产生了负面影响 和孩子的结果。在新生儿重症监护病房(NICU)生婴儿的经历通常是 父母，特别是母亲，比父亲更有可能成为初学者，这对他们来说是压倒性的和痛苦的 看护人和更频繁的NICU访客。NICU的母亲患抑郁症、焦虑症和 创伤症状，已被证明在NICU出院后持续存在，损害母婴 这会对儿童的发展产生负面影响。NICU的停留是一个关键的窗口 向母亲提供循证预防干预。然而，几乎没有基于NICU的程序可以 促进产妇的心理健康和福祉，他们的证据基础有限，他们一般都是 面对面的。我们的初步研究表明，面对面的项目交付带来了重大的可行性问题， 包括忙碌的父母缺乏接受性，以及NICU工作人员面临财务和人员方面的挑战。发现 在改善成年人的抑郁、焦虑和创伤方面，正念尚未在 新生儿重症监护室。正念技能促进对当下现实的非评判意识，并增强 接受痛苦情绪和情况的能力。我们的团队开发了一种基于正念的NICU 通过视频和音频方式进行干预。我们的初步研究表明，干预 显著减少母亲的抑郁、焦虑和创伤症状，并改善压力管理， 睡眠和应对。拟议的R34项目将使我们能够进一步发展干预措施，并为 未来的R01疗效试验。在这个项目的第一年，我们将开发更多的正念练习来解决 家人从NICU过渡回家，我们将形成主动控制条件。在2-3年中，我们 将在两个NICU地点进行一项试点随机研究，以评估我们研究设计、计划的可行性 内容、措施和方案效益的初步评价。我们的试点随机对照试验将评估产妇 心理症状和心率变异性作为衡量生理应激反应的一种潜在因素 正念练习如何改善压力管理的机制，我们将更全面地评估 在未来的R01。我们的专家团队在正念干预、围产期心理健康、新生儿健康、 生理性应激反应和预防试验具有卓有成效的合作历史和强大的 与NICU研究站点建立伙伴关系。我们建议的研究是创新的，其重点是预防 NICU，为新人群调整正念策略，使用视频和音频模式来优化 计划的可行性，并纳入了母亲压力的生理指标。这一研究具有重要的现实意义。 把重点放在一个关键的未被研究的公共卫生问题上，强调一个潜在的可扩展的干预模式， 并承诺对每年出生的婴儿的母亲产生积极影响

Mothers of infants with medical issues requiring neonatal intensive care – an estimated 400,00-480,000 infants born per year – are at increased risk for mental health problems, which also have negative effects on parenting and child outcomes. The experience of having an infant in the neonatal intensive care unit (NICU) is often overwhelming and traumatic for parents, particularly mothers, who are more likely than fathers to be primary caretakers and are more frequent NICU visitors. NICU mothers are at high risk for depressive, anxiety, and trauma symptoms, which have been shown to persist following NICU discharge, to impair maternal-infant attachment, and to negatively impact child development. The NICU stay represents a critical window for offering evidence-based preventive interventions to mothers. However, there are few NICU-based programs to promote maternal mental health and wellbeing, their evidence base is limited, and they are generally delivered face-to-face. Our pilot research suggests face-to-face program delivery poses significant feasibility issues, including lack of acceptability for busy parents and financial and staffing challenges for NICU staff. Found to improve depression, anxiety, and trauma in adults, mindfulness has not yet been evaluated for mothers in the NICU. Mindfulness skills promote non-judgmental awareness of present-moment realities and enhance capacities for accepting painful emotions and situations. Our team developed a mindfulness-based NICU intervention delivered via video and audio modalities. Our pilot research indicates that the intervention significantly reduced maternal depressive, anxiety, and trauma symptoms and improved stress management, sleep, and coping. The proposed R34 project will enable us to further develop the intervention and prepare for a future R01 efficacy trial. In Year 1 of this project, we will develop additional mindfulness practices to address the family's transition home from the NICU, and we will develop an active control condition. In Years 2-3, we will conduct a pilot randomized study in two NICU sites to assess feasibility of our study design, program content, and measures and a preliminary evaluation of program benefits. Our pilot RCT will assess maternal psychological symptoms and heart rate variability as a measure of physiological stress reactivity, a potential mechanism for how mindfulness practices may improve stress management, which we will evaluate more fully in the future R01. Our team of experts in mindfulness interventions, perinatal mental health, neonatal health, physiologic stress response, and prevention trials has a history of productive collaboration and strong partnerships with the NICU study sites. Our proposed research is innovative in its focus on prevention in the NICU, adaptation of mindfulness strategies for a new population, use of video and audio modalities to optimize program feasibility, and inclusion of a physiological index of maternal stress. The research is significant in its focus on a critical understudied public health problem, emphasis on a potentially scalable intervention model, and promise for positively impacting an estimated 10-12% of mothers of infants born each year