A Digital Mental Health Intervention for Pregnant People with a History of Neglect: Bridging Gaps in Mental Health Care

Childhood neglect, which constitutes 76% of confirmed child maltreatment cases, has lifelong repercussions. These include increased vulnerability to stress, mental health challenges, and difficulties in forming and maintaining relationships. Pregnancy, a profoundly sensitive developmental stage, amplifies the consequences of childhood neglect due to increased physical and emotional demands. In addition, expectant individuals with a history of neglect can have elevated mental health issues and health-related complications during this period. These challenges may result in increased risk for perpetuating the cycle of neglect from one generation to the next. Furthermore, acknowledging historical and systemic factors impacting childhood neglect among marginalized communities is essential for effective interventions, as these factors have led to distrust in healthcare systems, impeding access to care. Digital mental health interventions (DMHI) offer a potential solution, as they provide flexibility, privacy, and reduced stigma, ensuring accessibility and tailored support for individuals. Yet, no current intervention targets the prevention of the intergenerational neglect during the perinatal period via a digital format. The proposed research seeks to adapt and assess the initial efficacy of a DMHI tailored for pregnant people with a history of neglect, with the overarching goal of preventing the intergenerational transmission of neglect. I will leverage an existing DMHI, Mamma Mia, which is a effective DMHI designed to prevent perinatal depression. I will adapt, enrich, and tailor the DMHI Mamma Mia content to suit the unique needs of the target population (i.e., pregnant people with a history of neglect in childhood) (Aim 1). Aim 2 will be an open trial (N=20) to assess the DMHIs feasibility, usability, and acceptability utilizing quantitative and qualitative data. Aim 3 will be a randomized pilot study (N=100) to compare an intervention group (n=50) and a care as usual group (n=50) to evaluate the DMHI's preliminary impact on pre- to-post-intervention knowledge of the impact of early adversity, perceptions on parenting, and depression symptoms. The long-term goal is to leverage the insights gained from this research to secure larger-scale funding (R01) for a comprehensive study or further refinements to the intervention. Subsequent phases will involve larger cohorts, follow-up assessments, and the potential exploration of biological outcomes. This research addresses a critical gap in child maltreatment prevention by focusing on the often understudied, yet highly prevalent issue of neglect, offering hope for breaking the cycle of maltreatment across generations. My background in perinatal health, child development, early adversity, and evidence-based interventions set the foundation for my training goals. I will extend this knowledge to understand how neglect affects individuals during the perinatal period and the intergenerational transmission of neglect (Training goal #1), receive training in DMHIs, with a focus on development, clinical trial methodology, and applying these skills to perinatal interventions (Training goal #2), develop expertise in community engagement and culturally-sensitive research (Training goal #3), and training around professional development to develop skills in transitioning to an assistant (Training goal #4). Project Number: 1K99HD115852-01A1 | Fiscal Year: 2025 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Megan Hare | Institution: TULANE UNIVERSITY OF LOUISIANA, NEW ORLEANS, LA | Award Amount: $124,038 | Activity Code: K99 | Study Section: Health, Behavior, and Context Study Section[CHHD-M] View on NIH RePORTER: https://reporter.nih.gov/project-details/11138048