Parenting Enhancement, Interpersonal Psychotherapy to Reduce Depression in Low-Income Mothers of Infants and Toddlers

Abstract

Background Depressive symptoms and clinical depression are highly prevalent in low-income mothers and negatively affect their infants and toddlers. Objectives To test interpersonal psychotherapy combined with parenting enhancement on depressive symptoms and parenting behavior, compared with usual care. Method Mothers (n = 226) of Early Head Start infants and toddlers from the southeastern and northeastern United States were randomized to the intervention delivered in-home by psychiatric mental health advanced practice nurses or usual care delivered by generalist nurses. Rigorous clinical depressive symptom and depression assessments and videotaped, coded mother-child interactions were used as baseline and 14-, 22-, and 26-week postintervention measures. Results Both the intervention and control groups had significantly reduced Hamilton Rating Scale for Depression scores at each subsequent time point compared to baseline (p < .0001). However, only mothers receiving the intervention showed a significant increase in positive involvement with their child, as measured by closeness, positive affect, affection, and warm touch at T4 (t = 2.22, df = 156, p < .03). Discussion Both intervention and control conditions resulted in symptom reduction, but only the intervention mothers showed significant interaction changes with their child, an essential step in reducing the negative child outcomes associated with maternal depressive symptoms. Results suggest that a combination of generalist and specialist nurses could be used to treat depressive symptoms in these mothers. Further study with longer postintervention observation is needed to see if, over time, the intervention led to longer-lasting symptom reduction.

Maternal Depression and Early Intervention

“…In the acute postpartum period, there exists a substantial literature for evidence-based psychological interventions for treating PPD, such as interpersonal psychotherapy (Stuart S & O'Hara, 1995; Grote et al, 2009; Zlotnick, Miller, Pearlstein, Howard, & Sweeney, 2006; Beeber et al, 2010; Brandon et al, 2012; Beeber et al, 2013), cognitive behavioral therapy (Cooper, Murray, Wilson & Romaniuk, 2013) and group psychoeducation (Honey, Bennett & Morgan, 2002; Morgan, Matthey, Barnett & Richardson, 1997). Mothers with moderate to severe depressive symptoms should be treated with pharmacotherapy as an appropriate first line and efficacious intervention (Yonkers et al, 2011; Einarson, 2010).…”

“…(Forman et. al, 2007; Murray, Cooper, Wilson, Romaniuk, 2003; Appleby, 1997; O’Hara, 2000; Cooper, 2003; Grote, 2009; Roman, 2009; Ammerman, 2005 & 2009; Beeber, 2013) Thus, although reduction of maternal symptoms is necessary, this in itself is not sufficient to prevent negative child outcomes (Forman, O'Hara, Stuart, Gorman, Larsen, & Coy KC., 2007). …”

A Call for Comprehensive Perinatal Psychotherapy Training

“…Por ejemplo, las intervenciones de psicoterapia que abordan la relación bebé-madre parecen reducir el impacto del PPD sobre el desarrollo cognitivo y emocional de los niños, mejorando la sensibilidad materna, la receptividad, la afectividad, la capacidad de reflexión y la seguridad de apego. 29,[31][32][33][34][35][36][37][38] Del mismo modo, las intervenciones de psicoterapia diseñadas para incluir a las parejas en el tratamiento pueden afectar de forma positiva el estado de ánimo de la madre, mejorar la calidad de las relaciones de cocrianza y promover resultados positivos en los niños.…”

A pilot, exploratory report on dyadic interpersonal psychotherapy for perinatal depression

“…While these interventions effectively treat depressive symptoms, they do not address the mother-infant relationship, a critical foundation for healthy infant social and emotional development. Evidence suggests that depression treatment that focuses solely on maternal depressive symptoms is necessary but not sufficient to enhance infant cognitive and emotional development (Beeber et al 2013; Forman et al 2007; Murray et al 2003). …”

“…However, these interventions typically do not address or reduce maternal depression (Nylen et al 2006). Recently, interventions have been developed to improve maternal depressive symptoms as well as the mother- infant relationship: Clark and colleagues’ multicomponent group intervention (Clark et al 2008); van Doesum and colleagues’ (2008) home-visiting intervention; and Beeber and colleagues’ (2013) in-home IPT and parenting enhancement intervention for postpartum mothers enrolled in Early Head Start. To our knowledge, none of these types of interventions have been initiated during pregnancy, and it is not known what effect these interventions might have on infant's social and emotional development.…”