Intervening during the Prenatal Period with Women Exposed to Intimate Partner Violence to Improve Maternal Functioning and Infant Adjustment

项目总结 亲密伴侣暴力(IPV)的发生率高得令人震惊，在以下期间接触IPV的风险最高 怀孕了。在这一关键时刻，IPV与产后抑郁症、创伤后应激、 母婴关系中断，婴儿结局不佳。也有新的证据表明 这表明新冠肺炎大流行正在加剧IPV的流行。与其他正在进行的 大流行相关的压力源，有IPV病史的妇女，特别是围产期妇女，可能是 特别容易受到新冠肺炎负面影响的影响。因此，迫切需要 调查大流行对暴露于IPV的妇女及其青年的影响的纵向研究 孩子们。鉴于大流行的情况在不同人和时间之间有很大的波动， 能够捕捉动态变化的纵向方法可能会提供对风险的有价值的见解 以及这些家庭的韧性。这项紧急的竞争性修订旨在解决这些紧迫的问题， 利用NICHD正在进行的一项理论驱动的干预研究的现有优势 怀孕、接触IPV的妇女的方案，怀孕母亲赋权方案(PMEP；MPIS Miller-Graff&Howell，R01HD098092)。家长提案的具体目标是：(1)评估疗效 PMEP对围产期妇女的心理健康、复原力和IPV受害情况的影响，(2) 评价PMEP促进婴儿发育的效果和(3)测试治疗过程模型 妇女和婴儿的变化在两个站点的背景下。父项目包括4次评估 评分(产前2分，产后3个月，产后1年)。目前(n=67)目标为N=230的妇女 已加入母项目，该项目已完全适应远程保健的提供和评估， 使我们能够在整个大流行期间保持出色的参与者留存率。该项目是为 竞争性修订将增加对大流行相关应激源的每月评估，并收集30天的 在最终评估后立即写关于压力、情绪和母子关系质量的每日日记 WAVE(即产后一年)，以解决三个独特和及时的目标：(1)评估 对流行病相关应激源的干预，(2)检查社会和工具的调节作用 支持，以及(3)分析母亲日常情绪、感受到的压力和母子之间的动态关联 关系质量。将使用多层次和结构方程模型进行分析。这个项目是 创新--不仅在大流行的背景下--而且在更广泛的IPV研究领域也是如此 多时间尺度、多方法设计。此外，这些具体目标解决了与 新冠肺炎对儿童和家庭的社会和行为影响，为 以受疫情影响最大的个人的需求为依据的公共卫生应对措施。

PROJECT SUMMARY Intimate partner violence (IPV) occurs at alarmingly high rates, with the highest risk of IPV exposure during pregnancy. IPV during this critical juncture is associated with postpartum depression, posttraumatic stress, disruption to the mother-infant relationship, and poor infant outcomes. There is also emerging evidence suggesting that the COVID-19 pandemic is exacerbating the prevalence of IPV. Paired with other, on-going pandemic-related stressors, women with a history of IPV, especially those in the perinatal period, may be particularly vulnerable to the negative ramifications of COVID-19. A critical need therefore exists for longitudinal research investigating the effects of the pandemic on IPV-exposed women and their young children. Given that the conditions of the pandemic fluctuate significantly across persons and time, intensive longitudinal methods that are able to capture dynamic change are likely to provide valuable insights into risk and resilience in these families. This urgent competitive revision seeks to address these pressing questions, leveraging the existing strengths of an ongoing NICHD-funded study of a theoretically-driven intervention program with pregnant, IPV-exposed women, the Pregnant Moms’ Empowerment Program (PMEP; MPIs Miller-Graff & Howell, R01HD098092). The specific aims of the parent proposal are to (1) evaluate the efficacy of the PMEP for women’s mental health, resilience and IPV victimization across the perinatal period, (2) evaluate the efficacy of the PMEP in promoting infant development and (3) test process models for treatment change for women and infants in the context of a two-site. The parent project includes assessments at 4 time points (2 prenatal, 3 months postpartum, 1 year postpartum). Currently (n=67) women of a targeted N=230 have enrolled in the parent project, and the project has fully adapted to telehealth delivery and assessments, allowing us to maintain excellent participant retention throughout the pandemic. The project proposed for the competitive revision will add monthly assessments of pandemic-related stressors and the collection of a 30-day daily diary on stress, mood, and mother-child relational quality immediately following the final assessment wave (i.e., 1 year postpartum), to address three unique and timely aims: (1) evaluating the indirect effects of intervention on pandemic-related stressors, (2) examining the moderating effect of social and instrumental supports, and (3) analyzing dynamic associations in daily maternal mood, perceived stress, and mother-child relational quality. Analyses will be conducted using multilevel and structural equation modeling. This project is innovative – not just in the context of the pandemic – but also in the field of IPV research more generally for its multi-time scale, multi-method design. Further, the specific aims address pressing questions relative to the social and behavioral impacts of COVID-19 on children and families, providing valuable information for the public health response that is informed by the needs of individuals most significantly affected by the pandemic.