Treatment of depressed mothers in home visiting: Impact on psychological distress and social functioning

Abstract

Objectives Depression is prevalent in mothers receiving home visiting. Little is known about the impact of treatment on associated features of maternal depression in this population. The purpose of this study was to examine the impact of a novel, adapted treatment for depressed mothers in home visiting on psychological distress and social functioning. Methods In-Home Cognitive Behavioral Therapy (IH-CBT) was developed to treat depressed mothers in home visiting. A randomized clinical trial design was used in which subjects were 93 new mothers in a home visiting program. Mothers with major depressive disorder identified at 3 months postpartum were randomized into IH-CBT and ongoing home visiting (n = 47) or standard home visiting (SHV; n = 46) in which they received home visitation alone and could obtain treatment in the community. Measures of psychological distress, social support, and social network were measured at pre-treatment, post-treatment, and three-month follow-up. Clinical features of depression and home visiting parameters were examined as potential moderators. Results Subjects receiving IH-CBT reported decreased psychological distress at post-treatment (ES = 0.77) and follow-up (ES = 0.73). Examination of types of psychological distress indicated broad improvements at both time points. Those receiving IH-CBT reported increased social support over time relative to those in the SHV condition. Effect sizes were modest at post-treatment (ES = 0.38) but increased at follow-up (ES = 0.65). Improvements were seen in affiliative and belonginess aspects of social support, in contrast to tangible support which was statistically non-significant. Findings were not moderated by clinical features of depression or home visiting parameters. No group differences were found in size of and involvement with social networks. Conclusions IH-CBT is effective in reducing psychological distress and improving perceived social support in depressed mothers receiving home visiting. To the extent that mothers are better adjusted and feel socially supported, they are more available to their children and more amenable to home visiting services. IH-CBT is a feasible, readily adopted treatment that is compatible with multiple home visiting models. As a result it is a promising approach to help depressed mothers in home visiting. Additional interventions may be needed to support depressed mothers in building sizable and stable social networks.

Evidence‐Based Interventions for Depressed Mothers and Their Young Children

“…In addition, they reported increased social support, improved functioning in daily activities, and decreased psychological distress (Ammerman, Putnam, Altaye, Teeters, et al, 2013); these findings were maintained through to the 3-month follow-up (Ammerman et al, 2015). Because IH-CBT and HVP alone did not differ significantly regarding infants’ social and emotional functioning and observed parenting, Ammerman and colleagues (2015) combined data across groups and found that as mothers’ depression improved, there were parallel improvements in their parenting (e.g., more nurturing and stimulating).…”

Early Childhood Home Visiting

“…16,40 Maternal health is improved by more frequent prenatal care, better birth outcomes, and early detection and treatment of depression. 41 Outcome studies have established the effectiveness of home visiting by nurses or community health workers in reducing child maltreatment, 42 improving birth outcomes, 43 and increasing school readiness. 44 A close examination of the evidence of effectiveness published in 2015 by the HomVEE review provides additional insights about the potential benefits and limitations of current models of home visiting.…”

Development and implementation of a screen-and-refer approach to addressing maternal depression, substance use, and intimate partner violence in home visiting clients

“…The most well-researched efforts to date have involved the delivery of cognitive behavioral interventions for depression by trained mental health professionals during home visits (Ammerman et al, 2005) or as an adjunct to home visiting (Tandon, Leis, Mendelson, Perry, & Kemp, 2014). Accumulating results from these initiatives are highly promising, suggesting that enhancing HV with research-supported mental health interventions can be effective in reducing client symptoms of depression (Ammerman et al, 2013; McFarlane, Burrell, Duggan, & Tandon, 2016; Segre, Brock, & O'Hara, 2015; Tandon et al, 2014). However, approaches that integrate psychotherapy into HV require highly trained therapists to provide the intervention, a resource that may be beyond the reach of some state HV systems and local programs.…”