Treatment of Depression in Mothers in Home Visitation
Condition: Depressive Disorder in Mothers
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      This study develops and contrasts In-Home Cognitive Behavioral Therapy (IH-CBT), an adapted
      evidence-based treatment for depressed mothers participating in home visitation, with typical
      home visitation in which treatment may be obtained in the community. Mothers will be
      identified using a two step process consisting of administration of a screen and subsequent
      diagnosis of Major Depressive Disorder. The will then be randomized into the treatment and
      control conditions. A comprehensive assessment of depression and related areas of functioning
      will be administered at pre-treatment, post-treatment, and 3 month follow-up. It is
      hypothesized that IH-CBT will lead to broad and durable gains in mood and social support
      relative to those in typical home visitation.
    

Detailed description: 
      This study involves the development and preliminarily testing of In-Home Cognitive Behavioral
      Therapy (IH-CBT), a psychological treatment grounded in the cognitive model but adapted for
      administration in conjunction with home visitation. IH-CBT is designed to (1) use the
      techniques and approaches of CBT which have received strong empirical support, (2) be
      implemented in the home setting, (3) meet the needs of young postpartum mothers in their
      first year of home visitation, and (4) be seamlessly integrated with home visitation to
      maximize the likelihood of recovery from depression, prevent relapse, and increase of the
      benefits of home visitation. IH-CBT will be delivered by trained therapist who will provide
      15 treatment sessions followed by a 1 month booster session. A small-scale randomized
      clinical trial will be conducted contrasting IH-CBT delivered in conjunction with home
      visitation and home visitation alone ("typical home visitation"-THV). Mothers in the THV
      condition will be able to obtain treatment in the community if they choose.

      Mothers will be identified based on obtaining a score of ≥12 on the Edinburgh Perinatal
      Depression Screen administered by home visitors at 3 months postpartum. Final eligibility
      will be determined based on subsequently obtaining a diagnosis of Major Depressive Disorder
      (MDD) using the SCID. A comprehensive assessment of depression, other psychiatric symptoms,
      social support and network, and parenting and child adjustment will be administered at
      pre-treatment, post-treatment, and 3 month follow-up. Ratings of MDD at post-treatment and
      follow-up will be conducted by clinicians blind to condition.

      The following hypotheses will be tested:

      Hypothesis 1. Mothers in IH-CBT will report greater reductions in self-reported and
      clinician-rated depression at post-treatment and follow up relative to THV.

      Hypothesis 2. Mothers in IH-CBT will report improvements in overall functioning, social
      support, social network, and general psychiatric symptomatology at post-treatment and follow
      up relative to IH-CBT.

      Hypothesis 3. Mothers who recover from depression at post-treatment will report improvements
      in parenting and child adjustment relative to those who do not recover.
    

Intervention name(s): In-Home Cognitive Behavioral Psychology
Intervention type(s): Behavioral
Intervention description(s): Adapted form of CBT that is delivered in the home setting, uniquely designed for young, low income new mothers, and is explicitly integrated with home visitation. IH-CBT is delivered by a masters level therapist. It consists of 15 weekly sessions and 1 booster session provided 1 month after the 15th session.
Other intervention name(s): IH-CBT
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: depression; psychological treatments; Cognitive Behavioral Therapy; child social/emotional functioning; parenting; home visitation