title: 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.
authors.affiliation: Eliot-Pearson Department of Child Development, Tufts University, Medford, MA 02155. ann.easterbrooks@tufts.edu.
authors.forename: M Ann
authors.initials: MA
authors.lastname: Easterbrooks
authors.forename: Jessica Dym
authors.initials: JD
authors.lastname: Bartlett
authors.forename: Maryna
authors.initials: M
authors.lastname: Raskin
authors.forename: Jessica
authors.initials: J
authors.lastname: Goldberg
authors.forename: Mariah M
authors.initials: MM
authors.lastname: Contreras
authors.forename: Chie
authors.initials: C
authors.lastname: Kotake
authors.forename: Jana H
authors.initials: JH
authors.lastname: Chaudhuri
authors.forename: Francine H
authors.initials: FH
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D002649:Child Abuse / Q000517:prevention & control* / Q000523:psychology*; D019052:Depression, Postpartum / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006792:House Calls; D006801:Humans; D007223:Infant; D008297:Male; D008429:Maternal Welfare / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult
keywords: child maltreatment; home visiting; maternal depression