title: Outcomes of a Randomized Trial of a Cognitive Behavioral Enhancement to Address Maternal Distress in Home Visited Mothers.
abstract: Objectives To assess the effectiveness of a 6-week, cognitive behavioral therapy (CBT) 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. Methods We conducted a randomized controlled trial with 95 low-income mothers of young children to assess the effectiveness of a 6-week, cognitive behavioral group-based enhancement to Healthy Families America and Parents as Teachers 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 3 and 6 months. Participants completed measures of coping, stress and depression at three points: baseline prior to randomization, post-intervention, and 6 months post-intervention. Parent child interaction was also measured at 6 months. Results Intent-to-treat analyses found improved coping and reduced stress and depression post-intervention. While impacts on these outcomes were attenuated at 6 months, positive impacts were observed for selected aspects of mothers' interactions with their children. 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. Conclusions CBT group-based enhancement to home visiting improved maternal coping, reduced stress and depression immediately post intervention but not at 6 months, suggesting more work is needed to sustain positive gains in low-income mothers of young children.
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. ecmcfarl@JHU.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McFarlane
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Burrell
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Duggan
authors.affiliation: Northwestern University Fienberg School of Medicine, Chicago, IL, USA.
authors.forename: Darius
authors.initials: D
authors.lastname: Tandon
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000592:standards*; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D006792:House Calls; D006801:Humans; D007223:Infant; D009035:Mothers / Q000523:psychology*; D010287:Parent-Child Relations; D011181:Postnatal Care / Q000379:methods; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods
keywords: CBT; Depression; Home visiting; Maternal stress; Parent child interaction; Prevention