Motivating Our Mothers 2
Condition: Depression; Maternal Care Patterns
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      Mothers with symptoms suggesting clinical depression can be identified and potentially
      motivated to seek further care during pediatric visits for their young children. The best
      ways for pediatric providers to encourage mothers to seek further evaluation and treatment
      for their depressive symptoms are not known. The investigators plan to provisionally optimize
      a pediatric office-based intervention that the investigators developed to motivate mothers
      who may be depressed to seek further care and, thereby to improve the well-being of women
      from diverse backgrounds and their children.
    

Detailed description: 
      Depression in mothers parenting young children is common and undertreated. Depression is
      debilitating for mothers, negatively affects their parenting, and is associated with mental,
      behavioral, and physical health problems in their children. Identifying and treating mothers
      with depression improves both the mothers' well-being and their children's mental and overall
      health. Pediatric visits offer a potential significant opportunity to intervene. Mothers may
      see their child's pediatric provider more often than their own, and these providers could
      motivate mothers to seek effective, underutilized, formal depression care, by communicating
      how recovery from depression is linked to child well-being.

      Therefore, in recent pilot work, the investigators developed a pediatric setting-based
      intervention that includes a validated maternal depression screen, and subsequent depression
      education and care-seeking motivational messages that emphasize the benefits of maternal
      depression care for children. Initial testing demonstrated that depression screen-positive
      mothers receiving the intervention had greater intention and attempts to seek depression care
      compared to mothers receiving usual care. The investigators then professionally translated
      the intervention into Spanish as a first step in increasing the generalizability of the
      intervention through refinement in future studies. As is often the case with interventions
      tested as a package, the investigators lack empirical evidence on which components of the
      pilot intervention deliver the greatest effects. Therefore, the investigators propose to
      adopt a rapid-cycle intervention improvement approach.

      In this trial, the investigators will assess the effects intervention refinements on
      depression screen-positive mothers' depression care-seeking, using a factorial randomized
      design. The resulting intervention will be provisionally optimized by including only those
      refined components found to be most experimentally efficacious. This provisionally optimized
      intervention will have a higher probability of demonstrating reproducible effectiveness,
      potentially speeding the way to implementation. The ultimate optimized intervention will
      improve maternal depression care by being an essential link in future integrated systems
      between pediatric-based maternal depression screening and effective community-based programs
      for maternal mental health care.

      The investigators modified the initial anticipated sample size reported from 312 to 80.
      During the course of recruiting and enrollment investigators found the need to reorient the
      trial to one of feasibility and reduced the sample size accordingly. The investigators' goal
      is to obtain an analytic sample size that will allow for balanced numbers of participants in
      each cell across sites, with a minimum of 5 observations per intervention type. Given
      variable recruiting and retention rates, this could be a recruited sample size between 48 and
      80 individuals. In addition, investigators extended the initial recruiting time frame.
    

Intervention name(s): Maternal Depression Education and Care-Seeking Motivation
Intervention type(s): Behavioral
Intervention description(s): Multicomponent behavioral and educational intervention. The investigators are only testing 3 components: Engagement, Problem-Solving, and Follow-Up Motivation
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: maternal depression; pediatric-based maternal depression screening; maternal health services