Outcomes of a Randomized Trial to Address Maternal Distress in Home Visited Mothers

Objectives: 1) To assess the effectiveness of a six-week, cognitive behavioral group-based enhancement to home visiting to address stress and prevent depression as compared with home visiting as usual in low income mothers of young children; 2) to explore the relationship between intervention dose and outcomes in the treatment group; and 3) to explore assess if maternal characteristics at baseline were associated with intervention participation and outcomes.  

Methods: We conducted a randomized controlled trial with 95 low-income mothers of young children to assess the effectiveness of a six-week, cognitive behavioral group-based enhancement to home visiting (HV/CBT = 49) to address stress and prevent depression as compared with home visiting as usual (HV = 46).  Booster sessions for the HV/CBT group were offered at three and six months.  Participants completed measures of coping, stress and depression at three points: baseline prior to randomization, post-intervention, and six months post-intervention.  Parent child interaction was also measured at six months. 

Results: Intent-to-treat analyses found improved coping (Ways of Coping p<.01) and reduced stress (Perceived Stress Scale p<.06) and depression post-intervention (Beck Depression Inventory p<.05). While impacts on these outcomes were attenuated at six months, positive impacts were observed for selected aspects of mothers’ interactions with their children (Sensitivity of Responses p<.04 and Involvement in Child’s Activities p<.07).  Higher level of intervention participation was associated with better outcomes. Maternal characteristics at baseline were associated with participation in the intervention and with post-intervention and 6-month outcomes. Mothers with lower levels of stress and those with fewer children were more likely to attend intervention sessions.  Mothers with lower levels of stress had more favorable post intervention outcomes.  

Conclusion: CBT group-based enhancement to home visiting improved maternal coping, reduced stress and depression immediately post intervention but not at six months, suggesting more work is needed to sustain positive gains in low-income mothers of young children.

Significance: Low-income mothers are at elevated risk for poor mental health.  The negative effects of poor maternal mental health on child development are well documented.  This study extends the knowledge on CBT effectiveness in addressing depression in low-income, home visited mothers and provides support for its impact on parenting behavior.