Child, Family, and Population Health Nursing at the University of Washington, Seattle, Washington, USA.
Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, Washington, USA.
Infant Ment Health J. 2023 May;44(3):301-318. doi: 10.1002/imhj.22050. Epub 2023 Mar 14.
Attachment-based home visiting programs that serve new mothers experiencing psychological distress may advance health equity by helping families systemically exposed to adversity. This study examined whether one such program (Promoting First Relationships/PFR) had particularly beneficial effects on maternal and child relationship outcomes for mothers reporting the greatest psychological distress. A randomized controlled trial of the PFR program included a low-income sample of 252 Spanish- and English-speaking mother-child dyads referred prenatally for mental health concerns. The sample of mothers was 65.5% White, 17.5% Black, and 17.1% multiracial or other racial groups; 47.2% reported Hispanic ethnicity. The moderating variable of psychological distress was measured using maternal-reported screening tools for symptoms of depression, anxiety, anger, post-traumatic stress, and interpersonal sensitivity. Outcomes included observed parenting sensitivity and self-reported understanding of infants/toddlers, caregiving confidence, and child externalizing behavior. Results showed a significant treatment condition by baseline psychological distress interaction for observed parenting sensitivity such that differences in outcomes favoring the PFR condition were greatest among those with high baseline psychological distress (baseline child age 6-12 weeks). In a low-income sample of new mothers, those with the greatest need, as indicated by high psychological distress, showed greater improvements in their sensitive and responsive caregiving if they were randomized to the PFR treatment condition.
基于依恋的家庭访视项目为经历心理困扰的新妈妈提供服务，通过帮助家庭系统性地应对逆境，可能会促进健康公平。本研究考察了这样一个项目（促进第一关系/PFR）是否对报告心理困扰最严重的母亲的母婴关系结果有特别有益的影响。一项针对 PFR 项目的随机对照试验包括了 252 对西班牙语和英语双语的母婴对子，这些母亲在产前因心理健康问题而被转介。母亲样本中 65.5%为白人，17.5%为黑人，17.1%为多种族或其他种族群体；47.2%报告为西班牙裔。心理困扰的调节变量是通过母亲报告的抑郁、焦虑、愤怒、创伤后应激和人际敏感症状的筛查工具来衡量的。结果包括观察到的养育敏感性和自我报告的对婴儿/幼儿的理解、育儿信心和儿童外化行为。结果显示，观察到的养育敏感性存在显著的治疗条件与基线心理困扰的交互作用，即有利于 PFR 条件的结果差异在基线心理困扰较高的人群中最大（基线儿童年龄为 6-12 周）。在一个新妈妈的低收入样本中，那些心理困扰最大的人（如高心理困扰所表明的那样）如果被随机分配到 PFR 治疗组，他们在敏感和积极的育儿方面会有更大的改善。
