title: Nurse home visits improve maternal/infant interaction and decrease severity of postpartum depression.
abstract: OBJECTIVE
  To test the efficacy of the relationship-focused behavioral coaching intervention Communicating and Relating Effectively (CARE) in increasing maternal/infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum.
  
  
  METHODS
  Randomized clinical trial (RCT) with three phases.
  
  
  METHODS
  In this three-phase study, women were screened for postpartum depression (PPD) in Phase I at 6 weeks postpartum. In Phase II, women were randomly assigned to treatment or control conditions and maternal/infant interaction was video recorded at four intervals postpartum: 6 weeks, 3 months, 6 months, and 9 months. Phase III involved focus group and individual interviews with study participants.
  
  
  METHODS
  Phase I mothers were recruited from obstetric units of two major medical centers. Phase II involved the RCT, a series of nurse-led home visits beginning at 6 weeks and ending at 9 months postpartum. Phase III focus groups were conducted at the university and personal interviews were conducted by telephone or in participants' homes.
  
  
  METHODS
  Postpartum mother/infant dyads (134) representative of southeastern New England, United States participated in the RCT. One hundred and twenty-five mother/infant dyads were fully retained in the 9-month protocol.
  
  
  RESULTS
  Treatment and control groups had significant increases in quality of mother/infant interaction and decreases in depression severity. Qualitative findings indicated presence of the nurse, empathic listening, focused attention and self-reflection during data collection, directions for video-recorded interaction, and assistance with referrals likely contributed to improvements for both groups.
  
  
  CONCLUSIONS
  Efficacy of the CARE intervention was only partially supported. Nurse attention given to the control group and the data collection process likely confounded results and constituted an unintentional treatment. Results suggest that nurse-led home visits had a positive effect on outcomes for all participants.
authors.affiliation: Boston College, W. F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA. june.horowitz@bc.edu
authors.forename: June Andrews
authors.initials: JA
authors.lastname: Horowitz
authors.forename: Christine A
authors.initials: CA
authors.lastname: Murphy
authors.forename: Katherine
authors.initials: K
authors.lastname: Gregory
authors.forename: Joanne
authors.initials: J
authors.lastname: Wojcik
authors.forename: Joyce
authors.initials: J
authors.lastname: Pulcini
authors.forename: Lori
authors.initials: L
authors.lastname: Solon
mesh_terms: D000328:Adult; D003152:Community Health Nursing / Q000379:methods*; D019052:Depression, Postpartum / Q000451:nursing* / Q000517:prevention & control*; D005260:Female; D017144:Focus Groups; D064650:Home Health Nursing / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D009034:Mother-Child Relations; D024802:Nurse's Role; D017063:Outcome Assessment, Health Care; D011181:Postnatal Care / Q000379:methods*; D049590:Postpartum Period; D015397:Program Evaluation; D012720:Severity of Illness Index; D055815:Young Adult