Prenatal Pandemic Stress and Intimate Partner Violence Intervention, Preliminary Results
Intimate partner violence (IPV) in pregnancy represents a significant threat to intergenerational health. IPV involves emotional, physical, and/or sexual abuse committed by a romantic partner. IPV in pregnancy is associated with poor prenatal health, including psychopathology, substance use and sleep problems. Prenatal IPV may lead to infant dysregulation and disruption to the mother-infant relationship. Notably, IPV may be exacerbated by stressors related to the COVID-19 pandemic. Thus, it is crucial to develop and rigorously evaluate effective interventions that attend to the specific experiences of violence-exposed, pregnant women.
Laura Miller-Graff, PhD, Associate Professor of Psychology and Peace Studies at the University of Notre Dame, and Kathryn Howell, PhD, Associate Professor in the Department of Psychology at the University of Memphis, used an MRI grant to support additional data collection related to an ongoing NICHD-funded study evaluating the effectiveness of such an intervention. The study is ongoing, but Drs. Miller-Graff and Howell are reporting some very exciting preliminary results.
The Pregnant Moms’ Empowerment Program (PMEP) is a brief group intervention for IPV-exposed pregnant women. The PMEP’s theory of change underscores social support and maternal empowerment as key processes of treatment change. By integrating assessments of pandemic-related stressors, the current study provides valuable evidence for the effectiveness of PMEP in addressing accompanying stressors associated with COVID-19.
In response to the unique stressors of the COVID pandemic, the aims of the project were to begin initial data collection to (1) evaluate the indirect effects of intervention participation on pandemic-related stressors, (2) examine the moderating effect of social and instrumental supports, and (3) analyze dynamic associations in daily maternal mood, perceived stress, and mother-child relational quality.
They hypothesized that (1) women receiving the PMEP intervention would have less IPV re-victimization at post-treatment than women in the active control group, and that this, in turn, would be associated with lower levels of monthly pandemic-related stressors following the intervention. They also hypothesized that (2) IPV re-victimization would be associated with higher levels of monthly pandemic-related life stressors and that the relation between IPV and pandemic stressors would be buffered by monthly social and instrumental support as well as participating in the PMEP intervention, and (3) there would be a negative impact of daily maternal stress and mood on mother-child relational quality. They additionally hypothesize that this effect would be weaker for women who participated in the PMEP.
To date, Drs. Miller-Graff and Howell have recruited 165 pregnant women into the NICHD-funded parent study. Women were of 10-30 weeks gestational age and had experienced IPV within the last year. Women were randomly assigned to the PMEP or active control group condition.
The PMEP is a theory-based, manualized intervention designed to integrate psychoeducation, interactive learning (e.g., demonstrations, observations and role playing), and group-based discussion. Each session is designed to target both social support and empowerment. Sessions include: Becoming a Group & Safety Planning, Identifying and Understanding Sources of Stress, Cognitive and Behavioral Strategies to Build Resilience and Resolve Conflict, Perinatal Health and Infant Care, Positive Parenting. The contact-equivalent active control group receives non-directive group services. Since the start of the pandemic in 2020, the groups have run in a virtual format. MRI grant support was used to pilot a supplemental data collection of an intensive, 30-day daily diary on daily pandemic-related stress, mood, and mother-child relational quality. Assessments were conducted at pre-test, post-test, 3-month post-partum and 1-year post-partum. There are few longitudinal studies such as this in the literature, making this study particularly important. In 2021, the researchers were successful in gaining additional funding support from NICHD to allow for the continued collection of this, and other pandemic-related data for the remainder of the study duration.
Preliminary findings have thus far indicated that the Pregnant Moms’ Empowerment Program (PMEP), as compared to the contact-equivalent active control group, is effective in reducing women’s IPV revictimization up to one-year postpartum. Further, women in the PMEP, as compared to women in the control group, reported fewer pandemic-related stressors. Examination of the dynamic relationship between maternal daily stress, mood, and aspects of the mother-child relationship showed that associations were in the expected direction, with evidence to indicate the negative effects of day 1 stressors on day 2 mood, which in turn was associated with more day 3 maternal rejection/anger toward infants. Further, preliminary evidence suggested that participating in the PMEP intervention may play a role in disrupting the association between daily stressor exposure and negative maternal mood.