• By Laura Whybra
  • Posted on Thursday 03rd July, 2014

Beyond home visiting: A novel treatment for depression in mothers

strong>Half a million mothers are served by home visiting programs in the US alone. Thousands of them – in some studies, nearly two-thirds – have depression. They rarely get treatment. A new study suggests that home visiting could bring treatment to them with a cognitive behavioral therapy approach.A recent study of depressed mothers has found that In-Home Cognitive Behavioral Therapy (IH-CBT), when delivered alongside standard home visiting, reduced mothers’ psychological distress while improving their perception of social support. Home visiting is a widely used strategy on both sides of the Atlantic. Programs such as Nurse-Family Partnership and Healthy Families America target mothers who are often young, socially isolated, impoverished, and undereducated. They aim to improve mothers’ skills in parenting and other areas in order to give babies a better start in life.Home visitors already do a lot of work with mothers on how to manage their stress, improve their health, and engage with education. Maternal depression can have a large detrimental impact on these areas, which can, in turn, harm the healthy development of their child. Home visitors have reported that up to 61% of the mothers they serve have clinically elevated levels of depression. But they also say they lack the knowledge and skills to help these mothers. Home visiting alone can do little, if anything, to reduce depression, and mothers suffering from depression often go undiagnosed and untreated. In response to this unmet need, a team led by Robert Ammerman, from the University of Cincinnati College of Medicine, adapted cognitive behavioral therapy for depressed mothers receiving home visiting. Bringing therapy homeIn-Home Cognitive Behavioral Therapy (IH-CBT) is delivered in the home by trained therapists who collaborate with home visitors. It consists of 15 weekly 60-minute sessions, with a booster session delivered one month post-treatment. It combines the core components of traditional CBT with strategies to improve engagement, making the therapy relevant to the home context and to those mothers receiving the program. The program addresses the main concerns of young, low income, new mothers who are socially isolated. Issues such as the transition to adult roles, stress management, parenting challenges, and family relationships are all addressed alongside the content of standard home visits. For particularly young parents, this also includes issues such as school attendance and living with their own parents. Home visitors and therapists work closely together in order to reduce the mother’s depressive symptoms and promote the child’s healthy development. In this US-based study, a randomized clinical trial involving 93 new mothers diagnosed with major depressive disorder (MDD) was used to assess the effectiveness of IH-CBT. Mothers were unmarried, lived in a low-income household, were under 18 years old, or had inadequate prenatal care. Mothers in Ohio and Kentucky received either the Healthy Families America or the Nurse-Family Partnership home visiting program. Half of them were randomly assigned to receive IH-CBT. Participants were asked about psychological distress and quality of social support at pre-treatment, post-treatment and at a three-month follow-up. Those mothers receiving IH-CBT had less psychological distress on average than the control group, both immediately after treatment and three months later. Furthermore, mothers receiving IH-CBT reported greater social support than the control group after the home visits. Mothers receiving IH-CBT said their social support continued to improve between the end of the program and the three-month follow-up. By contrast, mothers in the control group said their social support was about the same at post-treatment and at follow-up. The authors suggest that as mothers’ psychological distress improved with treatment, they might have been more likely to reach out to friends and family. IH-CBT is one of the first treatments designed specifically for new mothers receiving home visiting. Although previous research has demonstrated CBT’s positive impact on reducing depressive symptoms, this study suggests wider benefits. Reducing mothers’ psychological distress and improving their feelings of social support can also improve their parenting ability. Furthermore, improvements in the wellbeing of mothers receiving home visiting can increase their engagement with other support services, increasing the chance of positive outcomes for both themselves and their child. ************Reference:Ammerman, R. T., Putnam, F. W., Altaye, M., Teeters, A. R., Stevens, J., & Van Ginkel, J. B. (2013). Treatment of depressed mothers in home visiting: Impact on psychological distress and social functioning. Child Abuse & Neglect, 37, 544-554.

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