Treatment of Maternal Depression in Home Visitation: Mother and Child Impacts
Condition: Depressive Disorder in Mothers
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      The purpose of this study is to determine the efficacy of In-Home Cognitive Behavioral
      Therapy (IH-CBT) in comparison to Present-Centered Therapy (PCT), a supportive therapeutic
      approach. IH-CBT is adapted form of CBT that is provided to depressed mothers participating
      in ongoing home visitation services. IH-CBT has been adapted to fit the setting, population,
      and context associated with home visiting. Mothers are recruited at 4 months postpartum. A
      comprehensive assessment battery is administered at pre-treatment, post-treatment, and 6, 12,
      and 18 months after the end of treatment. It is hypothesized that IH-CBT will be superior to
      PCT in decreasing depression, improving overall functioning, enhancing parenting
      effectiveness, and preventing relapse.
    

Detailed description: 
      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.
    

Intervention name(s): In-Home Cognitive Behavioral Therapy; Present-Centered Therapy
Intervention type(s): Behavioral; 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 two monthly booster sessions provided after the 15th session.; Present-Centered Therapy is a supportive psychotherapy.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: depression; psychological treatments; Cognitive Behavioral Therapy; child development; parenting; home visitation