Dialectical behavior therapy skills training for African American pregnant women with ACEs: a pilot study of feasibility, acceptability, and mental health barriers and attitudes

Abstract

Background: Toxic stress contributes to socioeconomic and racial health disparities that persist across generations. Developing and implementing prenatal interventions that reduce toxic stress and associated comorbidities is warranted. Dialectical Behavior Therapy (DBT) Skills Training group interventions have demonstrated efficacy for depression and posttraumatic stress disorder (PTSD) and are scalable in diverse settings. Implementing DBT skills group interventions for African American pregnant women with adverse childhood experiences (ACEs) and current depression or PTSD symptoms is novel and has the potential to interrupt the intergenerational cycle of toxic stress by improving maternal mental health. Yet, much remains to be understood about barriers that may impact feasibility. Objective: This mixed-method pilot randomized controlled trial (RCT) examined barriers and attitudes toward mental health treatment, feasibility, and acceptability of an adapted 8-week DBT Skills Training group for mothers-to-be (DBTMTB) compared to waitlist control (WLC) for African American pregnant women with a history of expanded ACEs and current depression or PTSD symptoms ( n = 30; n = 15 for DBTMTB, n = 15 for WLC). Methods: The study was delivered in a prenatal clinic of an urban public hospital or virtually. Pre-treatment quantitative and qualitative measures of treatment barriers and attitudes toward mental health treatment were obtained. Feasibility was measured through treatment and study retention rates. Acceptability was measured through qualitative responses on intervention acceptability. Results: We found a high level of barriers identified by women; stigma and time constraints were endorsed most often. Approximately half of women were receiving professional help and many reported stigma about asking others for help. Feasibility (treatment retention) was poor; only 26.7% ( n = 4) of participants randomized to DBTMTB completed the intervention ( 6 sessions). Acceptability among treatment completers was high. Conclusions: Poor completion rates suggest challenges to feasibility and acceptability of DBTMTB in this population that must be addressed. African American pregnant women endorsed a high level of barriers to mental health care engagement.Stigma and time constraints were the most endorsed barriers to mental health engagement in this sample.Feasibility of Dialectical Behavior Therapy skills training for moms-to-be (DBTMTB) among African American mothers was poor.Acceptability of DBTMTB was high among treatment completers, although sample size was small.Adaptations to address stigma and other barriers to engagement are needed. Antecedentes: El estr s t xico contribuye a las disparidades socioecon micas y raciales en la salud que persisten a lo largo de las generaciones. Se justifica el desarrollo e implementaci n de intervenciones prenatales que reduzcan el estr s t xico y las comorbilidades asociadas. Las intervenciones grupales de Entrenamiento en Habilidades de Terapia Dial ctica Conductual (TDC) han demostrado su eficacia para la depresi n y el trastorno de estr s postraum tico (TEPT) y son escalables en diversos entornos. Implementar intervenciones grupales de TDC para mujeres embarazadas afroamericanas con experiencias infantiles adversas (ACEs en su sigla en ingl s) y s ntomas actuales de depresi n o TEPT es novedoso y tiene el potencial de interrumpir el ciclo intergeneracional de estr s t xico al mejorar la salud mental materna. Sin embargo, a n queda mucho por comprender sobre las barreras que pueden afectar su factibilidad. Objetivo: Este ensayo piloto aleatorizado y controlado (ECA) de m todos mixtos examin las barreras y actitudes hacia el tratamiento de salud mental, la factibilidad y la aceptabilidad de un grupo de entrenamiento de habilidades de terapia dial ctica conductual adaptado a 8 semanas para futuras madres (DBTMTB en su sigla en ingl s), en comparaci n con un grupo de control en lista de espera (WLC en su sigla en ingl s) para mujeres embarazadas afroamericanas con antecedentes de ACEs expandidas y s ntomas actuales de depresi n o TEPT ( N = 30; n = 15 para DBTMTB, n = 15 para WLC). M todo: El estudio se realiz en una cl nica prenatal de un hospital p blico urbano o de forma virtual. Se obtuvieron medidas cuantitativas y cualitativas previas al tratamiento sobre las barreras y actitudes hacia el tratamiento de salud mental. La factibilidad se midi mediante las tasas de retenci n en el tratamiento y el estudio. La aceptabilidad se midi mediante respuestas cualitativas sobre la aceptabilidad de la intervenci n. Resultados: Se encontr un alto nivel de barreras identificadas por las mujeres; el estigma y las limitaciones de tiempo fueron los m s frecuentes. Aproximadamente la mitad de las mujeres recib an ayuda profesional y muchas reportaron estigma al solicitar ayuda. La factibilidad (retenci n del tratamiento) fue baja; solo el 26,7% ( n = 4) de las participantes asignadas aleatoriamente a DBTMTB complet la intervenci n ( 6 sesiones). La aceptabilidad entre quienes completaron el tratamiento fue alta. Conclusiones: Las bajas tasas de finalizaci n sugieren desaf os para la factibilidad y la aceptabilidad de DBTMTB en esta poblaci n que deben abordarse.