Browsing by Subject "Child maltreatment"

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    Impact of a universal perinatal home-visiting program on reduction in race disparities in maternal and child health: Two randomised controlled trials and a field quasi-experiment.
    (Lancet regional health. Americas, 2022-11) Dodge, Kenneth A; Goodman, W Benjamin; Bai, Yu; Best, Debra L; Rehder, Peter; Hill, Sherika

    Background

    Public health interventions must become accountable for reduction of race disparities, particularly among Black, Hispanic, and Non-Hispanic White families in the United States. Family Connects (FC) is a universal perinatal home-visiting program that assesses family-specific needs, offers support, and provides connections to community resources to address identified needs. Two previously-published randomised controlled trials and a field quasi-experiment have shown positive impact on maternal mental health, infant emergency medical care utilization, and government investigations for child maltreatment; however, these reports have not tested impact on reducing race disparities in these outcomes. The current report examined three questions in these trials: 1) the extent of race disparities in maternal and infant health and well-being, absent intervention; 2) whether intervention can be implemented with high reach and fidelity among all race groups; and 3) whether assignment to intervention reduces race disparities in important outcomes.

    Methods

    Data were re-examined from: 1) a randomised controlled trial of 4777 birthing families in Durham, NC, USA; 2) a replication randomised controlled trial of 923 birthing families in Durham, NC, USA; and 3) a quasi-experiment of 988 birthing families in rural NC, USA. Families were classified as Black, Hispanic, Non-Hispanic White, or Other. Disparity reduction was tested by the interaction effect between treatment assignment and race.

    Findings

    1) In the absence of intervention, large and statistically significant differences between Black familes and Non-Hispanic White families were found in maternal anxiety, maternal depression, father non-support, child emergency medical care, and child maltreatment investigations. Few differences were found between Non-Hispanic White familes and Hispanic families.2) High rates of participation in treatment were found for each race group.3) Across studies, assignment to FC was associated with statistically significant reductions in 7 of 12 disparities, in maternal anxiety and depression, father non-support, infant emergency medical care, and child maltreatment investigations.

    Interpretation

    This study provides a method, metric, and mandate to prioritise testing of whether public health interventions reduce race disparities in family outcomes.

    Funding

    This research was supported by grant R01HD069981 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and a grant from The Duke Endowment.
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    Postpartum Depression in the Intergenerational Transmission of Child Maltreatment: Longitudinal Evidence from Global Settings
    (2017) Choi, Karmel Wong

    Childhood maltreatment is a potent and common form of early trauma that not only produces negative outcomes for individuals during their lifetime, but may also have consequences for the next generation. Mothers who have experienced childhood maltreatment are more likely to have children also exposed to maltreatment, a phenomenon known as the intergenerational transmission of maltreatment. The perinatal period, the earliest point of intersection between generations, may offer an opportunity to interrupt such transmission. This dissertation leveraged two longitudinal studies in diverse global settings to examine how childhood maltreatment influences maternal mental health during the postpartum period, in turn impacting children’s risk for maltreatment exposure and related outcomes. In Study 1, a UK-based longitudinal cohort of 1,116 mothers and their twin children (E-Risk) was used to: (1) explore maternal childhood maltreatment as a risk factor for postpartum depression; (2) test the bridging role of postpartum depression between maternal childhood maltreatment and long-term child outcomes, specifically child exposure to maltreatment, internalizing symptoms, and externalizing symptoms; and (3) examine the intergenerational effects of specific maltreatment subtypes. Structural equation modeling revealed that maternal childhood maltreatment predicted postpartum depression, which in turn predicted child maltreatment exposure between 5 and 12 years and subsequent child internalizing and externalizing symptoms at 12 years. Indirect effects through postpartum depression were significant, robust across twin zygosity and child gender, and persisted after controlling for maternal covariates – though appeared to be carried by later maternal depression when included. In particular, emotional abuse emerged as a significant predictor of this pathway above and beyond other subtypes. In Study 2, similar aims were examined in a sample of 150 South African mothers followed through pregnancy and into the first postpartum year, with more proximal outcomes including maternal-infant bonding, infant development, and infant growth. Again, maternal childhood maltreatment predicted postpartum depression through 6 months, which then predicted child outcomes at 1 year. Indirect effects through postpartum depression were significant and persisted for maternal-infant bonding and infant physical growth after controlling for maternal and child covariates and accounting for antenatal distress. In particular, emotional neglect was a significant predictor of this pathway above and beyond other subtypes. Alterations in maternal emotion processing emerged as a potential explanatory mechanism. Together, findings from this dissertation underscore how postpartum depression may play a role in perpetuating negative outcomes across generations and in different global settings. Identifying and treating postpartum depression, as well as preventing its occurrence/recurrence, may help interrupt the intergenerational transmission of maltreatment and its sequelae.