Treatment of Maternal Depression in Home Visitation: Mother and Child Impacts

Home visitation is a prevention program for sociodemographically high risk, first-time
mothers and their children that is designed to optimize maternal life course and child
trajectories. Research indicates that maternal depression (1) is a significant problem in
home visitation with up to 45% of mothers experiencing clinically elevated symptoms while
only 14% receive treatment, and (2) can significantly interfere with the efficacy of home
visitation. Moreover, maternal depression negatively impacts mother-child interactions and
child functioning thus potentially precluding the dyad from fully benefiting from home
visitation. To address the high rate of maternal depression in existing home visitation
programs, In-Home Cognitive Behavior Therapy (IH-CBT) was developed through an R34 grant as
a treatment for mothers in home visitation experiencing depression postpartum. IH-CBT
consists of the core features of CBT that have been adapted to address the unique needs and
challenges of mothers receiving home visitation. Findings from the R34 indicate that IH-CBT
is highly effective at reducing depression, with 66.7% of depressed mothers no longer
obtaining a diagnosis of MDD at the end of treatment in contrast to a rate of 24.3% in
mothers receiving home visitation alone. In addition, mothers receiving IH-CBT reported
increased social support and reduction in other psychiatric symptoms, much of which was
maintained at 3 month follow-up. This study seeks to replicate IH-CBT with a larger sample,
compare the treatment to a more rigorous control condition (Present-Centered Therapy—PCT),
and extend follow-up to 18 months in order to determine relapse rate. There is mixed
evidence regarding the long-term effectiveness of home visitation on depressed mothers and
their children—critical outcomes that, if adequately demonstrated, would significantly
enhance the public health implications of home visitation. Accordingly, the study also seeks
to examine the impact of IH-CBT and recovery from depression on parenting and children.
Specifically, 220 mothers who are enrolled in home visitation will be recruited through
initial screening and subsequent diagnosis of MDD. Subjects will be randomly assigned to
IH-CBT + home visitation or PCT + home visitation. Both IH-CBT and PCT will be implemented
in 15 sessions with two booster sessions provided 1 and 2 months after treatment. Measures
of depression, psychiatric comorbidity, adaptive functioning, social support, parenting, and
child functioning will be administered at pre-treatment, post-treatment, and at 6, 12 and 18
month follow-ups after post-treatment. It is hypothesized that IH-CBT will be superior to
PCT in (1) recovery from depression, (2) risk of relapse and recurrence, and (3) increasing
social support and reducing overall psychiatric symptomatology. In addition, mothers who
recover from depression will show improvements in parenting and the mother-child
relationship, and their children will achieve improved cognitive, social, emotional, and
biologic outcomes, relative to non-recovered mothers and their offspring.

Inclusion Criteria:

- first-time mother participating in home visitation program

- enrolled in home visitation program for at least 2 months

- 16 years of age or older

- score of 11 or higher on Edinburgh Perinatal Depression Screen at 3 months postpartum

- diagnosis of Major Depressive Disorder using SCID

- English speaking

Exclusion Criteria:

- lifetime history of bipolar disorder, schizophrenia, mental retardation, organic
brain syndrome, antisocial personality disorder

- history of psychosis

- current substance dependence

- current antidepressant use or other mood altering medications and/or current
involvement in psychotherapy