Powers Abigail, Belton Imani, Lipschutz Rebecca, Lathan Emma, Mekawi Yara, Wallace Shimarith, Narayanan Ahana, Woods-Jaeger Briana
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Rollins School of Public Health, Atlanta, GA, USA.
Eur J Psychotraumatol. 2025 Dec;16(1):2544407. doi: 10.1080/20008066.2025.2544407. Epub 2025 Sep 2.
Toxic stress contributes to socioeconomic and racial health disparities that persist across generations. Developing and implementing prenatal interventions that reduce toxic stress and associated comorbidities is warranted. Dialectical Behavior Therapy (DBT) Skills Training group interventions have demonstrated efficacy for depression and posttraumatic stress disorder (PTSD) and are scalable in diverse settings. Implementing DBT skills group interventions for African American pregnant women with adverse childhood experiences (ACEs) and current depression or PTSD symptoms is novel and has the potential to interrupt the intergenerational cycle of toxic stress by improving maternal mental health. Yet, much remains to be understood about barriers that may impact feasibility. This mixed-method pilot randomized controlled trial (RCT) examined barriers and attitudes toward mental health treatment, feasibility, and acceptability of an adapted 8-week DBT Skills Training group for mothers-to-be (DBTMTB) compared to waitlist control (WLC) for African American pregnant women with a history of expanded ACEs and current depression or PTSD symptoms ( = 30; = 15 for DBTMTB, = 15 for WLC). The study was delivered in a prenatal clinic of an urban public hospital or virtually. Pre-treatment quantitative and qualitative measures of treatment barriers and attitudes toward mental health treatment were obtained. Feasibility was measured through treatment and study retention rates. Acceptability was measured through qualitative responses on intervention acceptability. We found a high level of barriers identified by women; stigma and time constraints were endorsed most often. Approximately half of women were receiving professional help and many reported stigma about asking others for help. Feasibility (treatment retention) was poor; only 26.7% ( = 4) of participants randomized to DBTMTB completed the intervention (≥6 sessions). Acceptability among treatment completers was high. Poor completion rates suggest challenges to feasibility and acceptability of DBTMTB in this population that must be addressed.
毒性应激导致了跨代持续存在的社会经济和种族健康差异。开展并实施能够减少毒性应激及相关合并症的产前干预措施很有必要。辩证行为疗法（DBT）技能培训小组干预已证明对抑郁症和创伤后应激障碍（PTSD）有效，且可在不同环境中推广。对有童年不良经历（ACEs）且目前患有抑郁症或PTSD症状的非裔美国孕妇实施DBT技能小组干预是一项新举措，并且有可能通过改善孕产妇心理健康来中断毒性应激的代际循环。然而，对于可能影响可行性的障碍仍有许多有待了解之处。这项混合方法的试点随机对照试验（RCT）研究了对于心理健康治疗的障碍和态度、适应性8周DBT技能培训小组（DBTMTB）对有广泛ACEs病史且目前患有抑郁症或PTSD症状的非裔美国孕妇（n = 30；DBTMTB组n = 15，等候名单对照组[WLC]组n = 15）的可行性和可接受性，对照组为等候名单。该研究在城市公立医院的产前诊所或通过虚拟方式进行。获得了治疗障碍和对心理健康治疗态度的治疗前定量和定性测量结果。通过治疗和研究保留率来衡量可行性。通过对干预可接受性的定性反应来衡量可接受性。我们发现女性指出了很高程度的障碍；耻辱感和时间限制是最常被提及的。大约一半的女性正在接受专业帮助，许多人表示向他人求助存在耻辱感。可行性（治疗保留率）很差；随机分配到DBTMTB组的参与者中只有26.7%（n = 4）完成了干预（≥6次疗程）。治疗完成者的可接受性很高。低完成率表明DBTMTB在该人群中的可行性和可接受性存在挑战，必须加以解决。
