Project Grant K23HD115845

BREAKING THE CYCLE OF POSTTRAUMATIC STRESS DISORDER FOR HIGH-RISK PERINATAL POPULATIONS - PROJECT SUMMARY / ABSTRACT THE OVERALL GOAL OF THIS MENTORED CAREER AWARD IS TO ESTABLISH MY INDEPENDENT RESEARCH CAREER CENTERED ON IMPROVING PERINATAL HEALTH OUTCOMES FOR THE MOST VULNERABLE. ONE UNTESTED, PROMISING WAY TO DO SO IS TO EXAMINE HOW REDUCTION IN POST-TRAUMATIC STRESS DISORDER (PTSD) SYMPTOMS EXPERIENCED DURING PREGNANCY AND THE POSTPARTUM PERIOD MAY AFFECT SUBSEQUENT HEALTH OUTCOMES. PTSD IS AN UNDER-RECOGNIZED AND UNTREATED RISK FACTOR FOR ADVERSE PERINATAL HEALTH OUTCOMES. BLACK WOMEN, AND RURAL-DWELLING WOMEN ARE OFTEN THE MOST LIKELY TO EXPERIENCE ADVERSE PERINATAL OUTCOMES, THE HIGHEST RATES OF MATERNAL AND INFANT MORTALITY, AND INCREASED RISK FOR TRAUMA EXPOSURE AND SUBSEQUENT PTSD SYMPTOMS. ENGAGING PREGNANT AND POSTPARTUM INDIVIDUALS IN PTSD TREATMENT IS CRITICAL AS THERE ARE SERIOUS RISKS ASSOCIATED WITH UNTREATED PERINATAL PTSD THAT OFTEN EXTEND INTO THE NEXT GENERATION. ALTHOUGH EVIDENCE-BASED TREATMENTS EXIST FOR PTSD, CLINICAL RESEARCH ON TREATMENT FOR PERINATAL PTSD IS LIMITED, WITH FEW STUDIES SUFFICIENTLY ENGAGING BLACK WOMEN AND NONE TARGETING RURAL-DWELLING WOMEN. TARGETING PERINATAL PTSD IN BLACK WOMEN, AND RURAL-DWELLING WOMEN PRESENTS A UNIQUE OPPORTUNITY TO IMPROVE MATERNAL HEALTH AND ELIMINATE HEALTH DISPARITIES. TO ADDRESS THESE GAPS IN THE LITERATURE, I PROPOSE A RANDOMIZED CONTROLLED PILOT STUDY (THE NEW EMPOWERMENT AFTER EXPOSURE TO TRAUMA (NEXT) STUDY). THIS STUDY WILL EVALUATE THE ACCEPTABILITY AND FEASIBILITY OF A REVISED BRIEF (6-WEEK) VIRTUAL PTSD PROTOCOL (NARRATIVE EXPOSURE THERAPY (NET)) TARGETING BLACK WOMEN AND RURAL-DWELLING WOMEN. TRAINING ACTIVITIES UTILIZING COMMUNITY ENGAGED METHODS AND QUALITATIVE DATA COLLECTION WILL BE USED TO TAILOR THE PROTOCOL FOR MAXIMAL ACCEPTABILITY AND UPTAKE AMONG BLACK, AND RURAL-DWELLING WOMEN PRIOR TO THE PILOT TRIAL. THIS PILOT STUDY WILL EVALUATE A REVISED NET PROTOCOL AGAINST A STANDARD CARE CONTROL CONDITION. THIS WILL BE THE FIRST RIGOROUS EVALUATION OF A BRIEF PERINATAL PTSD PROTOCOL SPECIFICALLY TAILORED FOR BLACK AND RURAL-DWELLING PERINATAL INDIVIDUALS, AND RESULTS WILL BE OF HIGH INTEREST TO LOCAL AND NATIONAL STAKEHOLDERS. THE PROPOSED STUDY WILL LAY THE FOUNDATION FOR AN R01 APPLICATION FOR AN RCT DESIGNED AND POWERED TO EXAMINE IF REDUCTION IN PTSD SYMPTOMS CAN REDUCE LIKELIHOOD OF ADVERSE PERINATAL OUTCOMES IN HIGH-RISK, UNDER- REPRESENTED, VULNERABLE PERINATAL POPULATIONS. THIS PROJECT IS SPECIFICALLY DESIGNED TO ADDRESS MY TRAINING GOALS TO DEVELOP EXPERTISE IN: (1) PARTICIPANT-CENTERED METHODOLOGICAL APPROACHES TO INCREASE RECRUITMENT AND ENGAGEMENT OF MINORITIZED POPULATIONS; (2) HEALTH EQUITY CONSIDERATIONS FOR PERINATAL POPULATIONS; AND (3) CONDUCTING RIGOROUS CLINICAL TRIALS THAT IMPROVE HEALTHCARE IN ALL GROUPS OF WOMEN. TO COMPLETE THESE GOALS, I HAVE ASSEMBLED AN EXTRAORDINARY MENTORSHIP TEAM WITH EXPERTISE IN PERINATAL POPULATIONS, HEALTH EQUITY, ACADEMIC COMMUNITY PARTNERSHIPS, QUALITATIVE DATA, AND CONDUCTING CLINICAL TRIALS WITH PERINATAL WOMEN. I HAVE CREATED A HIGHLY STRUCTURED TRAINING PLAN THAT WILL BE SUPPORTED BY THE RICH TRAINING ENVIRONMENT AT THE INDIANA UNIVERSITY SCHOOL OF MEDICINE AND AFFILIATED HOSPITALS AND CLINICS.