Background: It is estimated that 36% of children around the world experience emotional abuse, 23% experience physical abuse and 12% experience sexual abuse. Child abuse is a risk factor for physical and mental health problems in adulthood, as well as for child abuse in the next generation, leading to a cycle of abuse and mental illness. While 85% of the world's population lives in low and middle-income countries (LMICs), just 6% of research publications on psychiatric interventions represent studies conducted in LMICs. Given resource constraints inherent to LMICs, as well as unique social and cultural factors that influence parenting practices and uptake of interventions, local contextual understanding of trauma and mental illness is key to acceptable and effective prevention and intervention. Per is a middle-income country with high rates of child abuse and adolescent pregnancy, and where depression is the leading cause of years lived with disability. The Ministry of Health has identified maternal and child health as a priority. Thus, I propose to conduct this 3-phase study in Lima, Per.
Specific aims : 1) To conduct a qualitative assessment of norms and values related to child-rearing through focus group discussions with clinical staff (N=18) and in-depth interviews with postpartum adolescents (N=10) and their family members (N=6); 2) To adapt a perinatal home visiting intervention to a unique setting, population, and format 3) To assess maternal psychiatric symptoms, child abuse risk, caregiver sensitivity, and infant emotion regulation in the intervention group (N=30) as compared to the standard care group (N=30). Candidate: I am well-positioned to accomplish these aims given my training in psychiatry and my experience conducting mixed methods research with adolescents in resource- limited settings. My overall career goal is to become an independent clinical investigator conducting global maternal and child mental health research, with a focus on intergenerational trauma. Training objectives: At the end of my 5-year training award, I will have acquired the research skills in ethnographic observational research, perinatal intervention development and assessment, and quantitative data analysis to be able to tackle the complex research questions in global mental health. The award will provide essential data to design, adapt, and expand interventions to support caregivers, prevent child abuse, and improve maternal and child mental health outcomes in resource-limited settings in the US and around the world. Training activities: I will draw on the expertise of an internationally-renowned committee of mentors (Drs. Michelle Williams, Marta Rondn, Sixto Sanchez, and Anne Becker) collaborators (Drs. Peter Cooper and Lynne Murray) and a consultant (Dr. Douglas Hayden), field-based experience in Per, formal coursework at the Harvard T.H. Chan School of Public Health, and seminars, trainings, conferences and workshop attendance.
The global prevalence of child abuse is 36%. Children who experience abuse are more likely to have physical and mental health problems as adults, and their offspring are more likely to be abused. Few studies of interventions to prevent child abuse have been conducted in low- and middle-income countries, which face unique needs and resource constraints. Implementation of a family-based perinatal intervention for pregnant adolescents in Per will provide a framework for interventions in other resource-limited settings to break the intergenerational cycle of abuse and reduce the burden of mental illness.
