Outcomes of a Randomized Trial of a Cognitive Behavioral Enhancement to Address Maternal Distress in Home Visited Mothers

Elizabeth Mcfarlane,Darius Tandon,Lori Burrell,Anne Duggan

doi:10.1007/s10995-016-2125-7

Elizabeth Mcfarlane, Darius Tandon + Show 2 more

Open Access

https://doi.org/10.1007/s10995-016-2125-7

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Abstract

Objectives To assess the effectiveness of a 6-week, cognitive behavioral therapy (CBT) group-based enhancement to home visiting to address stress and prevent depression as compared with home visiting as usual in low income mothers of young children. Methods We conducted a randomized controlled trial with 95 low-income mothers of young children to assess the effectiveness of a 6-week, cognitive behavioral group-based enhancement to Healthy Families America and Parents as Teachers home visiting (HV/CBT = 49) to address stress and prevent depression as compared with home visiting as usual (HV = 46). Booster sessions for the HV/CBT group were offered at 3 and 6 months. Participants completed measures of coping, stress and depression at three points: baseline prior to randomization, post-intervention, and 6 months post-intervention. Parent child interaction was also measured at 6 months. Results Intent-to-treat analyses found improved coping and reduced stress and depression post-intervention. While impacts on these outcomes were attenuated at 6 months, positive impacts were observed for selected aspects of mothers’ interactions with their children. Maternal characteristics at baseline were associated with participation in the intervention and with post-intervention and 6-month outcomes. Mothers with lower levels of stress and those with fewer children were more likely to attend intervention sessions. Mothers with lower levels of stress had more favorable post intervention outcomes. Conclusions CBT group-based enhancement to home visiting improved maternal coping, reduced stress and depression immediately post intervention but not at 6 months, suggesting more work is needed to sustain positive gains in low-income mothers of young children.

Highlights

Prenatal and early life experiences affect early development and set the trajectory for health and well-being across the life span (National Research Council and Institute of Medicine 2000)
This study extends the knowledge on cognitive behavioral therapy (CBT) effectiveness in addressing depression in low-income home visited mothers and provides support for its impact on parenting behavior
This study suggests that mothers will participate in preventive group-based interventions to address maternal stress and depression offered as part of home visiting

Summary

Introduction

Prenatal and early life experiences affect early development and set the trajectory for health and well-being across the life span (National Research Council and Institute of Medicine 2000). Many children are born into isolated, vulnerable families whose multiple stressors give rise to an inhospitable environment for the critical first years of development (Felitti et al 1998; National Research Council and Institute of Medicine 2000, 2009). Prevalence of depressive symptoms of 17.1–23.1 % have been reported in new mothers (Cox et al. Matern Child Health J (2017) 21:475–484. Prevalence of depressive symptoms in at-risk women is nearly twice that of their low risk counterparts (Mayberry et al 2007); underscoring the need for prevention, in populations with elevated risk for distress (Ammerman et al 2010; Pawlby et al 2008)

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