This application is in response to PA-09-175 Women's Mental Health in Pregnancy and the Postpartum Period. The goal of this exploratory/development (R21) project is to further develop, pilot test, and refine a novel dual-focused mother-infant intervention to prevent/decrease maternal postpartum depression (PPD) and improve aspects of mother-infant relationships and child development outcomes. Approximately 10-15% of women experience PPD after the birth of a baby, with serious negative consequences for maternal well-being, the mother-infant relationship, and subsequent child development. Most current PPD treatments focus exclusively on maternal outcomes, neglect the mother-infant relationship, and thus do not result in improvements in relationship or child outcomes. No study has yet addressed the dual problems of maternal depression and mother-infant relationship dysfunction in an integrated way. The proposed project innovatively addresses this critical research gap by targeting PPD and the associated mother-infant relationship dysfunction concurrently in a theoretically and clinically based early dyadic intervention that consists of: (a) an insight- oriented and supportive relationship-based mother-infant psychotherapeutic component utilizing the infant as an integral part of the therapy, and (b) a developmentally-based infant-oriented component designed to enhance maternal sensitive responsiveness and promote positive mother-infant interactions. Our specific aims are to: (1) Develop the intervention protocol and refine it as appropriate after testing its feasibility with 5 mother-infant dyads;(2) Assess the efficacy of the intervention on the primary outcomes of prevention or reduction of PPD and enhancing the quality of mother-infant interaction at post-intervention, 6 months, and 1 year postpartum follow-ups;and (3) Explore the effects of the intervention on secondary outcomes of maternal anxiety, parenting stress, maternal self-esteem, maternal attachment to the infant, child attachment security, and child cognitive development at post-intervention and follow-up time points. After developing the intervention and refining it based on expert consultation and findings from the initial feasibility testing, we will test its efficacy using a sample of 60 women determined to be at-risk for PPD due to elevated depression scores at 1 week postpartum and their infants. Dyads will be randomly assigned to the intervention or control group. The home-based intervention will consist of 8 mother-infant sessions delivered by specially trained nurses over the first 3 months postpartum. Control group will receive a short educational intervention followed by usual care plus maternal depression monitoring by phone on a schedule comparable to the intervention visits. Maternal and mother-infant outcomes will be measured at baseline, post-intervention, and at two follow- up points. Infant outcomes will be assessed at 1 year of age. Repeated measures analysis of variance will be used to determine intervention effects. If successful, findings from this study will inform the development of a future R01 proposal to conduct a larger randomized trial of the intervention. PUBLIC HEALTH RELEVANCE: Postpartum depression (PPD) is a major public health concern that affects approx 10-15% of mothers with serious negative consequences for not only the mothers, but also the mother-infant relationship and child development. The goal of the proposed project is to develop and assess the feasibility and efficacy of a novel dual-focused mother-infant intervention by specially trained nurses to prevent/decrease maternal postpartum depression and associated mother-infant relationship dysfunction. If shown to be effective, this intervention would provide a new early-stage treatment option for PPD that would hold great benefit for mothers and infants and could be easily adapted for widespread public use for at-risk mother-infant dyads.