Limiting Home Visiting Effects: Maternal Depression as a Moderator of Child Maltreatment

Abstract

OBJECTIVE: To test, with a sample of adolescent mothers (16–20 at childbirth) and their first-born infants/toddlers (average age 1 year), whether the impact of a home visiting (HV) child maltreatment prevention program was moderated by maternal depression. METHODS: The study design was a randomized controlled trial of Healthy Families Massachusetts, a statewide child maltreatment prevention program. A total of 707 first-time mothers were randomly assigned to the HV or control group. The HV group received visits from paraprofessional home visitors. Mothers in the control group were referred to other service providers. The outcome variable consisted of state Child Protective Services reports of child abuse and neglect (mother or other person as perpetrator). Maternal depression was assessed by maternal report (Center for Epidemiologic Studies-Depression questionnaire). RESULTS: A considerable proportion of families had child maltreatment reports (30% of sample) and maternal depression (38% had clinically significant symptoms). Most maltreatment was neglect. Among control group mothers, reports of maltreatment did not vary according to depressive symptoms. For HV mothers, probability of reports varied with levels of depressive symptoms. Nonsymptomatic HV mothers were less likely to have a child who was reported for maltreatment compared with HV mothers who endorsed clinical levels of depressive symptoms. CONCLUSIONS: The prevalence of maternal depressive symptoms in this sample, and the link between depression and child maltreatment prevention program effectiveness, suggest that home visitors be alert to maternal depression. Programs also should be aware of possible surveillance effects related to maternal depression.

The moderating effect of relationships on intergenerational risk for infant neglect by young mothers

“…We used a dummy variable to indicate whether each participant was randomly assigned to the program group or to the control group. See Easterbrooks et al (2013) for a discussion of home visiting effects on child maltreatment. In the current analysis, we include program participation as a control variable only, as program effects were not a focus of the current study.…”

Paraprofessional-Delivered Home-Visiting Intervention for American Indian Teen Mothers and Children: 3-Year Outcomes From a Randomized Controlled Trial

“…First, current home-visiting programs have not been evaluated in low-resource special populations in the United States, including American Indian, new immigrant, and military families (2, 3)-populations that can be difficult to recruit and retain (3). Second, no home-visiting program currently endorsed by the Maternal, Infant, and Early Childhood Home Visiting Program (3,4) has been designed to target or shown reductions in both maternal drug use and mental health problems known to negatively affect children's early development (5)(6)(7)(8) and disproportionately affect mothers in at-risk settings. Third, current home-visiting interventions have not systematically measured intervention impact on children's emotional and behavior outcomes across early childhood (0 to 3 years) that are known to predict better developmental trajectories across the life course (9,10).…”

Depression improvement and parenting in low-income mothers in home visiting

“…For mothers in home visiting, improvement in depression is accompanied by changes in parenting stress and nurturing caregiving, both of which are key foci of home visiting programs. Treatments that are effective in reducing depression in this population, such as IH-CBT (Ammerman et al 2013a), can facilitate improvement and hold promise to prevent the negative consequences of depression that have been documented in home visiting (Duggan et al 2009; Easterbrooks et al 2013; McFarlane et al 2013). Mothers in home visiting exhibit most of the demographic and clinical factors that are associated with depression.…”

“…In addition, depression mitigates the positive effects of program participation (McFarlane et al 2013). Easterbrooks et al (2013) found that depressed mothers failed to receive the benefits of lowered rates of abuse and neglect relative to their non-depressed counterparts. An effective intervention for perinatal depression in this population holds potential to enhance the lives of low income mothers and children, improve developmental outcomes, and protect the sizable investment made in home visiting programs.…”