Nurse Home Visiting and Maternal Mental Health: 3-Year Follow-Up of a Randomized Trial

Goldfeld, Sharon; Bryson, Hannah; Mensah, Fiona; Gold, Lisa; Orsini, Francesca; Perlen, Susan; Price, Anna; Grobler, Anneke; Dakin, Penelope; Bruce, Tracey; Harris, Diana; Kemp, Lynn

doi:10.1542/peds.2020-025361

Cited by 18 publications

(20 citation statements)

References 39 publications

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“…Groupbased interventions to reduce neonatal mortality in Nepal (Tripathy et al, 2010), home visiting in Cape Town focusing on HIV, maternal and child health (Rotheram-Borus, Tomlinson, Roux, & Stein, 2015), and studies targeting HIV testing of young children and improving early child development outcomes in Zimbabwe (Mebrahtu et al, 2019) have all shown benefits for maternal mental health. Further, where maternal mental health has been the subject of longitudinal follow-up, some studies have shown long-term positive impacts at 3 years after a maternal depression-focused intervention (Goldfeld et al, 2021), and at 2 years post a non-maternal depression-focused intervention (Hiscock, Bayer, Hampton, Ukoumunne, & Wake, 2008). One of the hypotheses to explain improvements in mental health attributes them to the mothers' improving social support networks and problem-solving skills (Tripathy et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

First 1,000 days: enough for mothers but not for children? Long‐term outcomes of an early intervention on maternal depressed mood and child cognitive development: follow‐up of a randomised controlled trial

Tomlinson

Skeen

Melendez‐Torres

et al. 2021

Child Psychology Psychiatry

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Background: Child cognitive development is often compromised in contexts of poverty and adversity, and these deficits tend to endure and affect the child across the life course. In the conditions of poverty and violence that characterise many low-and middle-income countries (LMIC), the capacity of parents to provide the kind of care that promotes good child development may be severely compromised, especially where caregivers suffer from depression. One avenue of early intervention focuses on the quality of the early mother-infant relationship. The aim of this study was to examine the long-term impact of an early intervention to improve the mother-infant relationship quality on child cognitive outcomes at 13 years of age. We also estimated the current costs to replicate the intervention. Method: We re-recruited 333 children from an early childhood maternal-infant attachment intervention, 'Thula Sana', when the children were 13 years old, to assess whether there were impacts of the intervention on child cognitive outcomes, and maternal mood. We used the Kaufman Assessment Battery to assess the child cognitive development and the Patient Health Questionnaire (PHQ-9) and the Self-Reporting Questionnaire (SRQ-20) to assess maternal mental health. Results: Effect estimates indicated a pattern of null findings for the impact of the intervention on child cognitive development. However, the intervention had an effect on caregiver psychological distress (PHQ-9, ES = À0.17 [CI: À1.95, 0.05] and SRQ-20, ES = À0.30 [CI: À2.41, À0.19]), but not anxiety. The annual cost per mother-child pair to replicate the Thula Sana intervention in 2019 was estimated at ZAR13,365 ($780). Conclusion: In a socio-economically deprived peri-urban settlement in South Africa, a home visiting intervention, delivered by community workers to mothers in pregnancy and the first six postpartum months, had no overall effect on child cognitive development at 13 years of age. However, those caregivers who were part of the original intervention showed lasting improvements in depressed mood. Despite the fact that there was no intervention effect on long-term child outcomes, the improvements in maternal mood are important.

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Section: Discussionmentioning

confidence: 99%

First 1,000 days: enough for mothers but not for children? Long‐term outcomes of an early intervention on maternal depressed mood and child cognitive development: follow‐up of a randomised controlled trial

Tomlinson

Skeen

Melendez‐Torres

et al. 2021

Child Psychology Psychiatry

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“…Interventions consisting of group-based antenatal meetings and continuity of carer proved most promising (Pedersen et al, 2021). Similar positive outcomes have been reported elsewhere (Kemp et al, 2011), including a 3-year follow up on an RCT study of a sustained home visiting program designed to support mothers experiencing adversities, which found positive effects on maternal mental health (Goldfeld et al, 2021) as well as the home environment and parenting practices (Goldfeld et al, 2019).…”

Section: Early Interventions and Needs-based Maternity Care Servicessupporting

confidence: 52%

Meeting the need of the family: An ethnographic study on the care experiences of parents in vulnerable positions during pregnancy and the postnatal period

Frederiksen¹

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“…At the program’s end, the trial demonstrated intervention benefits across the three primary outcome domains of parent care, responsivity and the home learning environment [ 17 ]. Evidence of benefits for maternal mental health and wellbeing also emerged at the 3-year-old follow-up, one year after the program ended [ 18 ]. Given the limited longer-term data on NHV effectiveness for countries with universal healthcare, we extended the right@home trial follow-up to child ages 4 and 5 years (2017–19) with the intention to directly assess children’s language and learning outcomes up to the year before school-entry.…”

Section: Introductionmentioning

confidence: 99%

Nurse home visiting to improve child and maternal outcomes: 5-year follow-up of an Australian randomised controlled trial

et al. 2022

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Objectives Nurse home visiting (NHV) is widely implemented to address inequities in child and maternal health. However, few studies have examined longer-term effectiveness or delivery within universal healthcare systems. We evaluated the benefits of an Australian NHV program (“right@home”) in promoting children’s language and learning, general and mental health, maternal mental health and wellbeing, parenting and family relationships, at child ages 4 and 5 years. Setting and participants Randomised controlled trial of NHV delivered via universal, child and family health services (the comparator). Pregnant women experiencing adversity (≥2 of 10 risk factors) were recruited from 10 antenatal clinics across 2 states (Victoria, Tasmania) in Australia. Intervention Mothers in the intervention arm were offered 25 nurse home visits (mean 23·2 home visits [SD 7·4, range 1–43] received) of 60–90 minutes, commencing antenatally and continuing until children’s second birthdays. Primary and secondary outcomes measured At 4 and 5 years, outcomes were assessed via parent interview and direct assessment of children’s language and learning (receptive and expressive language, phonological awareness, attention, and executive function). Outcomes were compared between intervention and usual care arms (intention to treat) using adjusted regression with robust estimation to account for nurse/site. Missing data were addressed using multiple imputation and inverse probability weighting. Results Of 722 women enrolled in the trial, 225 of 363 (62%) intervention and 201 of 359 (56%) usual care women provided data at 5 years. Estimated group differences showed an overall pattern favouring the intervention. Statistical evidence of benefits was found across child and maternal mental health and wellbeing, parenting and family relationships with effect sizes ranging 0·01–0·27. Conclusion An Australian NHV program promoted longer-term family functioning and wellbeing for women experiencing adversity. NHV can offer an important component of a proportionate universal system that delivers support and intervention relative to need. Trial registration 2013–2016, registration ISRCTN89962120

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Nurse Home Visiting and Maternal Mental Health: 3-Year Follow-Up of a Randomized Trial

Cited by 18 publications

References 39 publications

First 1,000 days: enough for mothers but not for children? Long‐term outcomes of an early intervention on maternal depressed mood and child cognitive development: follow‐up of a randomised controlled trial

First 1,000 days: enough for mothers but not for children? Long‐term outcomes of an early intervention on maternal depressed mood and child cognitive development: follow‐up of a randomised controlled trial

Meeting the need of the family: An ethnographic study on the care experiences of parents in vulnerable positions during pregnancy and the postnatal period

Nurse home visiting to improve child and maternal outcomes: 5-year follow-up of an Australian randomised controlled trial

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